COVID-19 and the ageing immune system in an elderly patient : a case report

Background The severity of COVID-19 infection has an increasing trend in the elderly, which contributes to the high morbidity and mortality rates in this population. Aging itself is a prominent risk factor for severe disease and death from COVID-19. Case Description This case report a 71-year-old woman who complained of shortness of breath for 3 days before being admitted to the hospital. Bilateral consolidation and increased bronchovascular pattern were found on chest radiograph, and a positive SARS-COV2 nasopharyngeal swab PCR test result was noted. This patient was diagnosed with confirmed severe manifestation of COVID-19, community-acquired pneumonia and type 1 respiratory failure, as well as type II diabetes mellitus and suspicion of acute gastritis. The results of the geriatric status assessment were moderate functional status, risk of malnutrition, and moderate risk of deep vein thrombosis (DVT). This patient underwent treatment in accordance with the COVID-19 protocol along with management for geriatric status improvement. The patient was given permission to return home after 14 days of treatment, during which time her health had improved and her functional status had changed to moderate dependency. During follow-up, the patient continued to receive therapy. She is still being observed and future evaluations will be conducted. Conclusion The increased susceptibility of the elderly to COVID-19 infection is caused by various factors. A burden of death and long-term disability brought on by this pandemic may be lessened by new or modified therapies that target aging-associated mechanisms. Therefore, COVID-19 case management in this population should be done with a comprehensive approach

High Myostatin Serum Related with High Prevalence of Sarcopenia Among Elderly Population in Pedawa Village, Bali, Indonesia

BACKGROUND: Sarcopenia is defined as a decrease in muscle mass accompanied by a decrease in muscle strength and performance. Sarcopenia arises from the disruption of the complex balance between anabolic and catabolic factors. Myostatin strongly influences muscle growth inhibition. Deletion and function loss of myostatin causes hyperplasia and skeletal muscle hypertrophy.METHODS: This study was an analytical cross-sectional study. Seventy respondents aged ≥60 years in Pedawa Village, Bali, Indonesia were selected by using the stratified random sampling technique. Sarcopenia status was assessed according to Asian Working Group for Sarcopenia (AWGS) criteria, including muscle mass, grip strength, and walking speed. While the myostatin serum levels was measured by enzyme-linked immunosorbent assay (ELISA).RESULTS: The incidence of sarcopenia in the elderly was 45 people (64.3%). Based on the analysis, there was a significant difference between myostatin levels in sarcopenia subjects (47.59 ng/mL) and non-sarcopenia subjects (39.7 ng/mL). Based on the statistical calculations, it was determined that the cut-off range of myostatin levels was 48.91 ng/mL. The prevalence ratio of sarcopenia incidence based on the myostatin levels in the elderly was 3.84, while based on the combination of age risk and myostatin levels was 9.75.CONCLUSION: Based of the data, there are significant differences of myostatin level between elderly people with and without sarcopenia. The prevalence of high myostatin levels in elderly is almost 4 times higher than low myostatin levels in the elderly.KEYWORDS: myostatin, sarcopenia, elderl

Decreased Follistatin Levels as a Risk of Acute Sarcopenia Marker in Elderly

Background: Acute sarcopenia is an acute muscle loss that has been associated to the frailty and vulnerability of the elderly. Follistatin has been known as a significant marker for sarcopenia, however, studies of follistatin in humans have shown varying results and there have been no studies to date regarding the relationship between follistatin and acute sarcopenia. The aim of this study was to determine changes in follistatin levels as a risk of acute sarcopenia in elderly.Materials and methods: This study was a prospective observational study involving hospitalized elderly. The follistatin level was examined with enzyme-linked immunosorbent assay (ELISA). Meanwhile the determination of acute sarcopenia was done through the measurement of changes in hand grip strength and calf circumference parameters. The data obtained was descriptively analyzed, followed by bivariate and multivariate analysis. A p<0.05 was considered significant.Results: There were 66 subjects in this study. A total of 10 subjects (15.2%) had acute sarcopenia on the 7th day of hospitalization. The cut-off point of decreased follistatin levels was 4.870 with a sensitivity of 82.1% and a specificity of 60%. There was an association between decreased follistatin levels and acute sarcopenia (p=0.01; RR: 6.90; 95% CI: 1.638-29.069). Multivariate analysis results showed that decreased follistatin levels was a significant factor that might influence the occurrence of acute sarcopenia.Conclusion: Since this study showed that decreased follistatin levels might be a risk of acute sarcopenia in the elderly, thus it could be used as a marker of acute sarcopenia, which should be further investigated.Keywords: decreased follistatin levels, acute sarcopenia, elderl

Molecular Mechanism of ­Acute Sarcopenia in Elderly Patient with COVID - 19

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Case fatality rate has been on the rise among older adults. Muscle loss is a consequence of several chronic diseases (chronic sarcopenia) and recent theory also suggested that acute sarcopenia may caused by acute significant stressor such as an acute illness, surgery, infections, trauma or burns including COVID-19 infection leading to further muscle loss in elderly. Cytokine storm, the hallmark of COVID-19 pathogenesis will induce various pro-inflammatory cytokine such as IL-1 and IL-6 causing acute sarcopenia by activating negative regulators like NF-κB, atrogin-1, MURF-1. Long standing chronic inflammation also known as inflammaging along with acute inflammation during COVID-19 in elderly will cause reticulum endoplasmic and mitochondria stress activating caspase and finally increase both cytosolic and nuclear levels of AIF and EndoG to induce acute sarcopenia. Several precipitating factors shared same molecular pathway like physical inactivity and hormonal dysregulation which act through IGF-1-AKT-mTOR pathway. Physical inactivity during COVID-19 infection also induced myostatin and Atrogin-1/ MaFbx/ MuRF pathway. This review provides recent research advances dealing with molecular pathway modulating muscle mass in acute sarcopenia during COVID-19 infection

HUBUNGAN ANTARA SIKAP SLEEP HYGIENE DENGAN DERAJAT INSOMNIA PADA LANSIA DI POLIKLINIK GERIATRI RSUP SANGLAH, DENPASAR

Insomnia merupakan gangguan tidur yang paling sering dialami oleh lansia. Insomnia berpengaruh langsung terhadap penurunan kualitas hidup dan memiliki kecenderungan terhadap peningkatan angka morbiditas dan mortalitas pada lansia. Selama ini berbagai terapi pengobatan telah dikembangkan untuk membantu mengatasi keluhan, namun belum ditemukan suatu terapi pengobatan yang ideal bagi lansia penderita insomnia. Melihat fenomena di atas, maka diperlukan metode dalam penatalaksanaan insomnia pada lansia melalui pendekatan terapi nonfarmakologis dan hanya menggunakan obat-obatan pada saat yang mendesak. Terapi nonfarmakologis yang paling efektif adalah terapi perilaku, yaitu sleep hygiene. Sleep hygiene merupakan identifikasi dan modifikasi perilaku dan lingkungan yang mempengaruhi tidur. Sehubungan hal diatas, penulis tertarik untuk mengetahui hubungan antara sikap sleep hygiene dengan derajat insomnia pada lansia di Poliklinik Geriatri RSUP Sanglah. Penelitian ini merupakan studi analitik cross-sectional dengan sampel sebanyak 43 lansia yang berkunjung ke Poliklinik Geriatri RSUP Sanglah pada bulan Februari 2014. Data diperoleh dengan wawancara melalui kuisioner yang terstruktur meliputi identitas, sikap sleep hygiene, dan derajat insomnia menggunakan kuesioner Insomnia Severity Index. Penelitian ini memperoleh rerata jenis kelamin, pendidikan, dan pekerjaan pada masing-masing derajat insomnia adalah homogen. Berdasarkan uji korelasi diperoleh bahwa terdapat hubungan antara sikap sleep hygiene dengan derajat insomnia pada lansia di Poliklinik Geriatri RSUP Sanglah pada dua komponen, yaitu faktor diet (p=0,006) dan olahraga (p=0,010), sedangkan tidak terdapat hubungan antara sikap sleep hygiene dengan derajat insomnia pada lansia di Poliklinik Geriatri RSUP Sanglah pada dua komponen lainnya, yaitu faktor perilaku (p=0,374) dan lingkungan (p=0,222). </p

Sedentary Lifestyle of Older Adults and Its Associated Factors: A Multicentre Cross-Sectional Study During COVID-19 Pandemic in Indonesia

Background: COVID-19 is here to stay, and humans ought to decide how to adapt. We aimed to describe lifestyle changes during COVID-19 pandemic, and to determine the prevalence and factors associated with sedentary lifestyle among older adults.Methods: We obtained data from community-dwelling older adults aged ≥60 years. We presented the data descriptively and used multivariate analysis to assess the association between Physical Activity Scale for the Elderly (PASE) -based sedentary lifestyle and other variables in several tertiary geriatric centres.Results: Among 601 participants, 21.1% had sedentary lifestyle. Ethnic groups with the highest prevalence of sedentary lifestyle were Minang, Balinese, and Sundanese. Changes related to food intake, body weight, and physical activity were seen in a small proportion of older adults. Sun exposure habit was described. Sedentary lifestyle was associated with less consumption of food (OR 2.59, 95% CI 1.07-6.30), weight loss (OR 3.00, 95% CI 1.64-5.48), and higher intensity of snacking (OR 0.45, 95% CI 0.20-0.99).Conclusion: During COVID-19 pandemic, one out of five older adults had sedentary lifestyle, which was positively associated with less consumption of food and weight loss, and negatively associated with higher intensity of snacking. The prevalence of sedentary lifestyle varied across ethnic groups. Adequate and appropriate food intake may be crucial to keep older adults active, preventing them from entering vicious cycle of malnutrition, sarcopenia, and frailty