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Clinical Features and Outcomes of COVID-19 in Older Adults

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (16 April 2023) | Viewed by 23632

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Dr. Maurizio Gabrielli

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Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: COVID-19; sepsis; biomarkers
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Special Issue Information

Dear Colleagues,

Since the first reported case in December 2019, the SARS-CoV2 pandemic has claimed millions of lives worldwide. Older adults are at high risk of worse outcomes, especially as carriers of various comorbidities. After the first wave, a better understanding of the pathophysiology and clinical course of COVID-19, associated with the growing and widespread knowledge of non-invasive respiratory support techniques and the introduction of effective pharmacological treatments, led to significantly better management of these patients. The availability of effective and safe vaccines has therefore drastically reduced the morbidity and mortality of COVID-19. However, repeated doses are necessary to effectively protect against infection and severe disease. At present, only the most developed countries have achieved the goal of mass vaccination.

This Special Issue aims to provide updates on the clinical aspects and outcomes of COVID-19 in older adults in different countries, especially in light of the introduction of vaccines and new treatments.

I look forward to receiving your contributions.

Dr. Maurizio Gabrielli
Guest Editor

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Keywords

SARS-CoV2
COVID-19
epidemiology
biomarkers
comorbidities
clinical outcomes
treatment
respiratory support
vaccination
prevention

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Published Papers (10 papers)

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Editorial

Jump to: Research, Review, Other

5 pages, 219 KiB

Open AccessEditorial

COVID-19 in Older Adults at the Time of the Omicron Variant

by Maurizio Gabrielli

J. Clin. Med. 2022, 11(18), 5273; https://doi.org/10.3390/jcm11185273 - 7 Sep 2022

Cited by 4 | Viewed by 1780

Abstract

Since its outbreak, COVID-19 has had a significant impact on older adults worldwide [...] Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

Research

Jump to: Editorial, Review, Other

16 pages, 2366 KiB

Open AccessArticle

Vitamin D, Albumin, and D-Dimer as Significant Prognostic Markers in Early Hospitalization in Patients with COVID-19

by Biljana Popovska Jovičić, Ivana Raković, Jagoda Gavrilović, Sofija Sekulić Marković, Sara Petrović, Vladan Marković, Aleksandar Pavković, Predrag Čanović, Ružica Radojević Marjanović, Violeta Irić-Čupić, Lidija Popović Dragonjić and Miloš Z. Milosavljević

J. Clin. Med. 2023, 12(8), 2825; https://doi.org/10.3390/jcm12082825 - 12 Apr 2023

Cited by 9 | Viewed by 2354

Abstract

SARS-CoV-2 continues to pose a major challenge to scientists and clinicians. We examined the significance of the serum concentrations of vitamin D, albumin, and D-dimer for the severity of the clinical picture and mortality in COVID-19. Materials and methods: A total of 288 patients treated for COVID-19 infection participated in the research. The patients were treated in the period from May 2020 to January 2021. All patients were divided based on the need for oxygen therapy (Sat > 94%) into patients with mild or severe clinical pictures. The biochemical and radiographic parameters of the patients were analyzed. Appropriate statistical methods were used in the statistical analysis. Results: In patients with COVID-19 with confirmed severe clinical pictures, lower values of serum albumin (p < 0.0005) and vitamin D (p = 0.004) were recorded, as opposed to elevated values of D-dimer (p < 0.0005). Accordingly, the patients with fatal disease outcomes had lower levels of albumin (p < 0.0005) and vitamin D (p = 0.002), while their D-dimer (p < 0.0005) levels were elevated. An increase in the radiographic score, as a parameter for assessing the severity of the clinical picture, was accompanied by a decrease in serum albumin (p < 0.0005) and a simultaneous increase in D-dimer (p < 0.0005), without a change in the vitamin D concentration (p = 0.261). We also demonstrated the interrelations of the serum levels of vitamin D, albumin, and D-dimer in patients with COVID-19 as well as their significance as predictors of the outcome of the disease. Conclusion: The significance of the predictive parameters in our study indicates the existence of an important combined role of vitamin D, albumin, and D-dimer in the early diagnosis of the most severe patients suffering from COVID-19. Reduced values of vitamin D and albumin, in combination with elevated values of D-dimer, can be timely indicators of the development of a severe clinical picture and death due to COVID-19. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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13 pages, 703 KiB

Open AccessArticle

Inadequate Physical Activity Is Associated with Worse Physical Function in a Sample of COVID-19 Survivors with Post-Acute Symptoms

by Vincenzo Galluzzo, Maria Beatrice Zazzara, Francesca Ciciarello, Matteo Tosato, Anna Maria Martone, Cristina Pais, Giulia Savera, Riccardo Calvani, Anna Picca, Emanuele Marzetti, Francesco Landi and on behalf of Gemelli Against COVID-19 Post-Acute Care Team

J. Clin. Med. 2023, 12(7), 2517; https://doi.org/10.3390/jcm12072517 - 27 Mar 2023

Cited by 4 | Viewed by 1791

Abstract

Background—Patients affected by Long COVID often report shorter times spent doing physical activity (PA) after COVID-19. The aim of the present study was to evaluate potential associations between PA levels and parameters of physical function in a cohort of COVID-19 survivors with post-acute symptoms, with a particular focus on individuals aged 65 and older. Materials and methods—PA levels before and after COVID-19 were assessed in a sample of patients that had recovered from COVID-19 and were admitted to a post-acute outpatient service at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy). Participation in PA was operationalized as the engagement in leisure-time PA for at least 150 min per week in the last 3 months. Self-rated health and measures of physical performance and muscle strength were assessed. Results—Mean age of 1846 participants was 55.2 ± 14.4 years and 47% were women. Before COVID-19, inactivity was detected in 47% of the whole study population; only 28% maintained pre-COVID-19 PA engagement. Inactivity was more frequent in women. The stopping of physical activity was associated with increased BMI and CRP levels, lower vitamin D levels and a higher prevalence of post-COVID-19 fatigue, dyspnea, arthralgia, and myalgia. Active participants had higher handgrip strength and performed better on both the six-minute walking test (6MWT) and at the one-minute sit-to-stand test (1MSTST). In particular, at the 6MWT, participants 65 and older that were still active after COVID-19 walked 32 m more than sedentary peers. Moreover, the distance covered was 28 m more than those who were active only before COVID-19 (p = 0.05). Formerly active subjects performed similarly at the 6MWT to inactive participants. PA was associated with better self-rated health. Conclusions—Our findings reveal that inactivity is frequent in the post-acute COVID-19 phase. Stopping physical activity after COVID-19 results in measures of performance that are comparable to those who were never active. Relevant differences in the distance covered at the 6MWT were found between older active subjects and their sedentary peers. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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11 pages, 1327 KiB

Open AccessArticle

COVID-19 Patients with Early Gastrointestinal Symptoms Show Persistent Deficits in Specific Attention Subdomains

by Juliana Schmidt, Maria Cruz, Julio Tolentino, Aureo Carmo, Maria Paes, Glenda de Lacerda, Ana Gjorup and Sergio Schmidt

J. Clin. Med. 2023, 12(5), 1931; https://doi.org/10.3390/jcm12051931 - 1 Mar 2023

Cited by 4 | Viewed by 1669

Abstract

Previous studies have shown that COVID-19 inpatients exhibited significant attentional deficits on the day of discharge. However, the presence of gastrointestinal symptoms (GIS) has not been evaluated. Here, we aimed to verify: (1) whether COVID-19 patients with GIS exhibited specific attention deficits; (2) which attention subdomain deficits discriminated patients with GIS and without gastrointestinal symptoms (NGIS) from healthy controls. On admission, the presence of GIS was recorded. Seventy-four physically functional COVID-19 inpatients at discharge and sixty-eight controls underwent a Go/No-go computerized visual attentional test (CVAT). A Multivariate Analysis of Covariance (MANCOVA) was performed to examine group differences in attentional performance. To discriminate which attention subdomain deficits discriminated GIS and NGIS COVID-19 patients from healthy controls, a discriminant analysis was applied using the CVAT variables. The MANCOVA showed a significant overall effect of COVID-19 with GIS on attention performance. The discriminant analysis indicated that the GIS group could be differentiated from the controls by variability of reaction time and omissions errors. The NGIS group could be differentiated from controls by reaction time. Late attention deficits in COVID-19 patients with GIS may reflect a primary problem in the sustained and focused attention subsystems, whereas in NGIS patients the attention problems are related to the intrinsic-alertness subsystem. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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12 pages, 1664 KiB

Open AccessArticle

Assessment of Clinical Indicators Registered on Admission to the Hospital Related to Mortality Risk in Cancer Patients with COVID-19

by Alina Szewczyk-Dąbrowska, Mirosław Banasik, Krystyna Dąbrowska, Krzysztof Kujawa, Wojciech Bombala, Agata Sebastian, Agnieszka Matera-Witkiewicz, Magdalena Krupińska, Urszula Grata-Borkowska, Janusz Sokołowski, Katarzyna Kiliś-Pstrusińska, Barbara Adamik, Adrian Doroszko, Krzysztof Kaliszewski, Michał Pomorski, Marcin Protasiewicz, Ewa A. Jankowska and Katarzyna Madziarska

J. Clin. Med. 2023, 12(3), 878; https://doi.org/10.3390/jcm12030878 - 22 Jan 2023

Viewed by 1710

Abstract

Background: Oncology patients are a particularly vulnerable group to the severe course of COVID-19 due to, e.g., the suppression of the immune system. The study aimed to find links between parameters registered on admission to the hospital and the risk of later death in cancer patients with COVID-19. Methods: The study included patients with a reported history of malignant tumor (n = 151) and a control group with no history of cancer (n = 151) hospitalized due to COVID-19 between March 2020 and August 2021. The variables registered on admission were divided into categories for which we calculated the multivariate Cox proportional hazards models. Results: Multivariate Cox proportional hazards models were successfully obtained for the following categories: Patient data, Comorbidities, Signs recorded on admission, Medications used before hospitalization and Laboratory results recorded on admission. With the models developed for oncology patients, we identified the following variables that registered on patients’ admission were linked to significantly increased risk of death. They are: male sex, presence of metastases in neoplastic disease, impaired consciousness (somnolence or confusion), wheezes/rhonchi, the levels of white blood cells and neutrophils. Conclusion: Early identification of the indicators of a poorer prognosis may serve clinicians in better tailoring surveillance or treatment among cancer patients with COVID-19. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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10 pages, 987 KiB

Open AccessArticle

Older People Hospitalized for COVID-19: Prognostic Role of Multidimensional Prognostic Index and Other Prognostic Scores

by Luca Carruba, Maria Armata, Giusy Vassallo, Carlo Saccaro, Carla Di Palermo, Chiara Giannettino, Laura Cilona, Rossella Capitummino, Nicola Veronese, Ligia J. Dominguez and Mario Barbagallo

J. Clin. Med. 2023, 12(2), 594; https://doi.org/10.3390/jcm12020594 - 11 Jan 2023

Viewed by 1752

Abstract

During the SARS-CoV-2 pandemic, frailty and patients’ poor outcomes seem to be closely related. However, there is no clear indication of the significance of this connection and the most adequate risk index in clinical practice. In this study, we compared a short version of MPI (multidimensional prognostic index) and other two prognostic scores for COVID-19 as potential predictors of poor patient outcomes. The patients were consecutively enrolled in the hospital of Palermo for COVID-19. The accuracy of Brief-MPI, 4C score and COVID-GRAM score in points was evaluated using the area under the curve (AUC) with 95% CI, taking mortality or sub-ICU admission as outcome. The study included 112 participants (mean age 77.6, 55.4% males). During a mean of 16 days of hospitalization, Brief-MPI significantly increased by 0.03 ± 0.14 (p = 0.04), whilst COVID-GRAM did not. Brief-MPI, 4C score and COVID-GRAM scores had good accuracy in predicting negative outcomes (AUC > 0.70 for all three scores). Brief-MPI was significantly associated with an increased mortality/ICU admission risk, indicating the importance of multidimensional impairment in clinical decision-making with an accuracy similar to other prognostic scores commonly used in COVID-19 study, providing information regarding domains for which interventions can be proposed. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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11 pages, 5313 KiB

Open AccessArticle

Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study

by Chukwuma Okoye, Valeria Calsolaro, Alessia Maria Calabrese, Sonia Zotti, Massimiliano Fedecostante, Stefano Volpato, Stefano Fumagalli, Antonio Cherubini, Raffaele Antonelli Incalzi and Fabio Monzani

J. Clin. Med. 2022, 11(19), 5578; https://doi.org/10.3390/jcm11195578 - 22 Sep 2022

Cited by 7 | Viewed by 1710

Abstract

Hospitalization for acute SARS-CoV-2 infection confers an almost five-fold higher risk of post-discharge, all-cause mortality compared to controls from the general population. A negative impact on the functional autonomy of older patients, especially in cases of severe disease and prolonged hospitalization, has been recently described. However, little is known about the determinants of cause-specific mortality and loss of independence (LOI) in the activities of daily living (ADL) following COVID-19 hospitalization. Thus, the current prospective, multicenter study is aimed at identifying the determinants of post-discharge cause-specific mortality and the loss of autonomy in at least one ADL function. Older patients hospitalized for a SARS-CoV-2 infection were consecutively enrolled in an e-Registry from 1 March 2020, until 31 December 2020. After at least six months from discharge, patients were extensively re-evaluated according to a common protocol at the outpatient clinic of eight tertiary care Italian hospitals. Of 193 patients [109 (56.4%) men, mean age 79.9 ± 9.1 years], 43 (22.3%) died during follow-up. The most common causes of death were cardiovascular diseases (46.0%), respiratory failure (26.5%), and gastrointestinal and genitourinary diseases (8.8% each). Pre-morbid ADLs qualified as an independent mortality risk factor [adjusted HR 0.77 (95%CI: 0.63–0.95)]. Of 132 patients, 28 (21.2%) lost their independence in at least one ADL. The adjusted risk of LOI declined with a lower frailty degree [aOR 0.03 (95%CI: 0.01–0.32)]. In conclusion, at long-term follow-up after hospitalization for acute SARS-CoV-2 infection, more than 40% of older patients died or experienced a loss of functional independence compared to their pre-morbid condition. Given its high prevalence, the loss of functional independence after hospitalization for COVID-19 could be reasonably included among the features of the “Long COVID-19 syndrome” of older patients. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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Review

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20 pages, 2284 KiB

Open AccessReview

Cognitive Deficits in the Acute Phase of COVID-19: A Review and Meta-Analysis

by Isabele Jacot de Alcântara, Anthony Nuber-Champier, Philippe Voruz, Alexandre Cionca, Frederic Assal and Julie A. Péron

J. Clin. Med. 2023, 12(3), 762; https://doi.org/10.3390/jcm12030762 - 18 Jan 2023

Cited by 7 | Viewed by 3337

Abstract

This meta-analysis was conducted to quantify the risk of patients exhibiting cognitive deficits in the acute phase of COVID-19 at the time of the first variants (i.e., before the vaccine) and quantify the potential vulnerability of older patients and those who experienced more severe respiratory symptoms. To this end, we searched the LitCovid and EMBASE platforms for articles, including preprints, and included all studies (n = 48) that featured a measurement of cognition, which encompassed 2233 cases of COVID-19. Of these, 28 studies reported scores on global cognitive efficiency scales administered in the acute phase of COVID-19 (up to 3 months after infection). We were able to perform a meta-analysis of proportions on 24 articles (N_patients = 943), and a logistic regression on 18 articles (N_patients = 518). The meta-analysis for proportion indicated that 52.31% of patients with COVID-19 exhibited cognitive deficits in the acute phase. This high percentage, however, has to be interpreted taking in consideration the fact that the majority of patients were hospitalized, and some presented neurological complications, such as encephalopathy. A bootstrap procedure with random resampling revealed that an age of 59 was the threshold at which one would be more prone to present cognitive deficits. However, the severity of respiratory symptoms did not influence the scores on a global cognitive efficiency scale. Overall, our results indicated that neuropsychological deficits were a major consequence of the acute phase of the first forms of COVID-19. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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20 pages, 1961 KiB

Open AccessReview

COVID-19: A Comprehensive Review on Cardiovascular Alterations, Immunity, and Therapeutics in Older Adults

by José Rivera-Torres, Natalia Girón and Esther San José

J. Clin. Med. 2023, 12(2), 488; https://doi.org/10.3390/jcm12020488 - 6 Jan 2023

Cited by 8 | Viewed by 3533

Abstract

Here, we present a review focusing on three relevant issues related to COVID-19 and its impact in older adults (60 years and older). SARS-CoV-2 infection starts in the respiratory system, but the development of systemic diseases accompanied by severe clinical manifestations has also been reported, with cardiovascular and immune system dysfunction being the major ones. Additionally, the presence of comorbidities and aging represent major risk factors for the severity and poor prognosis of the disease. Since aging-associated decline has been largely related to immune and cardiovascular alterations, we sought to investigate the consequences and the underlying mechanisms of these pathologies to understand the severity of the illness in this population. Understanding the effects of COVID-19 on both systems should translate into comprehensive and improved medical care for elderly COVID-19 patients, preventing cardiovascular as well as immunological alterations in this population. Approved therapies that contribute to the improvement of symptoms and a reduction in mortality, as well as new therapies in development, constitute an approach to managing these disorders. Among them, we describe antivirals, cytokine antagonists, cytokine signaling pathway inhibitors, and vaccines. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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Other

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15 pages, 615 KiB

Open AccessSystematic Review

A Systematic Review of Lung Autopsy Findings in Elderly Patients after SARS-CoV-2 Infection

by Susa Septimiu-Radu, Tejaswi Gadela, Doros Gabriela, Cristian Oancea, Ovidiu Rosca, Voichita Elena Lazureanu, Roxana Manuela Fericean, Felix Bratosin, Andreea Dumitrescu, Emil Robert Stoicescu, Iulia Bagiu, Mircea Murariu and Adelina Mavrea

J. Clin. Med. 2023, 12(5), 2070; https://doi.org/10.3390/jcm12052070 - 6 Mar 2023

Cited by 12 | Viewed by 2947

Abstract

Although COVID-19 may cause various and multiorgan diseases, few research studies have examined the postmortem pathological findings of SARS-CoV-2-infected individuals who died. Active autopsy results may be crucial for understanding how COVID-19 infection operates and preventing severe effects. In contrast to younger persons, however, the patient’s age, lifestyle, and concomitant comorbidities might alter the morpho-pathological aspects of the damaged lungs. Through a systematic analysis of the available literature until December 2022, we aimed to provide a thorough picture of the histopathological characteristics of the lungs in patients older than 70 years who died of COVID-19. A thorough search was conducted on three electronic databases (PubMed, Scopus, and Web of Science), including 18 studies and a total of 478 autopsies performed. It was observed that the average age of patients was 75.6 years, of which 65.4% were men. COPD was identified in an average of 16.7% of all patients. Autopsy findings indicated significantly heavier lungs, with an average weight of the right lung of 1103 g, while the left lung mass had an average weight of 848 g. Diffuse alveolar damage was a main finding in 67.2% of all autopsies, while pulmonary edema had a prevalence of between 50% and 70%. Thrombosis was also a significant finding, while some studies described focal and extensive pulmonary infarctions in 72.7% of elderly patients. Pneumonia and bronchopneumonia were observed, with a prevalence ranging from 47.6% to 89.5%. Other important findings described in less detail comprise hyaline membranes, the proliferation of pneumocytes and fibroblasts, extensive suppurative bronchopneumonic infiltrates, intra-alveolar edema, thickened alveolar septa, desquamation of pneumocytes, alveolar infiltrates, multinucleated giant cells, and intranuclear inclusion bodies. These findings should be corroborated with children’s and adults’ autopsies. Postmortem examination as a technique for studying the microscopic and macroscopic features of the lungs might lead to a better knowledge of COVID-19 pathogenesis, diagnosis, and treatment, hence enhancing elderly patient care. Full article

(This article belongs to the Special Issue Clinical Features and Outcomes of COVID-19 in Older Adults)

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