COVID-19 and Gastrointestinal Symptoms-A Case Report.

COVID-19, a new illness secondary to a novel Coronavirus emerged in December 2019 in China. Our early understanding of the clinical features of COVID-19 has been based on case series emerging from the first outbreak in Wuhan. These features included fever, a dry cough, myalgia and dyspnea. Gastrointestinal symptoms were rarely reported as a key feature. We present a case report of a 74-year-old male who presented with symptoms of gastroenteritis and subsequently tested positive for COVID-19. This article aims to highlight an uncommon presentation of COVID-19 and that a high index of suspicion is required for COVID-19 in older people given their greater likelihood of presenting atypically

Funded hospital discharges to care homes: a cohort study

© 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC), https://creativecommons.org/licenses/by-nc/4.0/Background Optimising timely discharge from hospitals is an international priority. In 2020, the Coronavirus disease 2019 (COVID-19) pandemic resulted in the United Kingdom Government implementing the Discharge to Assess (D2A) model across England. This funded temporary care home placement to allow further recovery and assessment of care needs outside of the hospital. Objectives Determine if older adults discharged from hospital to care homes after implementation of D2A differ in their characteristics or outcomes. Design and methods Two cohorts of older adults discharged from hospital to care homes pre- and post-implementation of the D2A model (n = 244), with 6 months of follow-up. Data were extracted from routinely collected healthcare records. Results The mean duration of the hospital admission was reduced (29 vs. 23 days (P = 0.02)) but discharges to care homes did not increase with implementation of D2A (n = 161 in both cohorts prior to exclusions). In July–December 2020 (post-implementation), 28% of people were living in a private residence 6 months post-discharge, compared with 18% in the same period in 2019 (P = 0.09). When those who died were excluded, this changed to 40 vs. 28% (P = 0.19). There was no change in 6-month mortality (26 vs. 35% (P = 0.17)), and no increase in readmission rate (0.48 vs. 0.63 (P = 0.21) readmissions-per-patient over 6 months). No differences in key characteristics were found. However, patients were placed in care homes further from admission addresses (17.3 vs. 9.8 km (P = 0.00001)). Conclusions Implementation of D2A did not result in poorer outcomes but was associated with a reduced length of hospital stay.Peer reviewe

Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study.

AIM: Frail individuals may be at higher risk of death from a given acute illness severity (AIS), but this relationship has not been studied in an English National Health Service (NHS) acute hospital setting. METHODS: This was a retrospective observational study in a large university NHS hospital in England. We analyzed all first non-elective inpatient episodes of people aged ≥75years (all specialties) between October 2014 and October 2015. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, and AIS in the Emergency Department was measured with a Modified Early Warning Score (ED-MEWS<4 was considered as low acuity, and ED-MEWS≥4 as high acuity). A survival analysis compared times to 30-day inpatient death between CFS categories (1-4: very fit to vulnerable, 5: mildly frail, 6: moderately frail, and 7-8: severely or very severely frail). RESULTS: There were 12,282 non-elective patient episodes (8202 first episodes, of which complete data was available for 5505). In a Cox proportional hazards model controlling for age, gender, Charlson Comorbidity Index, history of dementia, current cognitive concern, and discharging specialty (medical versus surgical), ED-MEWS≥4 (HR=2.87, 95% CI: 2.27-3.62, p<0.001), and CFS 7-8 (compared to CFS 1-4, HR=2.10, 95% CI: 1.52-2.92, p<0.001) were independent predictors of survival time. CONCLUSIONS: We found frailty and AIS independently associated with inpatient mortality after adjustment for confounders. Hospitals may find it informative to undertake large scale assessment of frailty (vulnerability), as well as AIS (stressor), in older patients admitted to hospital as emergencies.This is the final version of the article. It first appeared from Elsevier via https://doi.org/ 10.1016/j.ejim.2016.08.03

Frailty Assessment in Clinical Practice: Opportunity in the Midst of a Pandemic.

Emerging evidence from studies of older adults hospitalised with COVID-19 suggests that there is a high prevalence of frailty in this patient group. We reflect on the measurement of frailty in older patients hospitalized as an emergency and the translation of frailty from a research to a clinical concept. We consider whether, despite the contemporary challenges in the care of older adults as a result of COVID-19, there are opportunities for care quality improvement during a pandemic.This editorial received no specific funding. Christopher N. Osuafor is supported by the Cambridge British Heart Foundation Centre of Research Excellence (CRE, Centre Code: RE/18/1/34212). Victoria L. Keevil is funded by an MRC/NIHR Clinical Academic Research Partnership Grant (CARP; grant code: MR/T023902/1).The views expressed are those of the authors onl

Lower Mental Health Related Quality of Life Precedes Dementia Diagnosis : findings from the EPIC-Norfolk prospective population-based study.

Acknowledgements The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1, MC-UU_12015/1 and MC_UU_00006/1) and Cancer Research UK (C864/A14136). We are grateful to all the participants and participating GP practices who have been part of the project, and to the many members of the study team at the University of Cambridge who have enabled this researchPeer reviewe

Television viewing, walking speed, and grip strength in a prospective cohort study.

PURPOSE: Television (TV) watching is the most prevalent sedentary leisure time activity in the United Kingdom. We examined associations between TV viewing time, measured over 10 yr, and two objective measures of physical capability, usual walking speed (UWS) and grip strength. METHODS: Community-based participants (n = 8623; 48-92 yr old) enrolled in the European Prospective Investigation of Cancer-Norfolk study attended a third health examination (3HC, 2006-2011) for measurement of maximum grip strength (Smedley dynamometer) and UWS. TV viewing time was estimated using a validated questionnaire (n = 6086) administered during two periods (3HC, 2006-2007; 2HC, 1998-2000). Associations between physical capability and TV viewing time category (<2, 2 < 3, 3 < 4, and ≥4 h·d) at the 3HC, 2HC, and using an average of the two measures were explored. Sex-stratified analyses were adjusted for age, physical activity, anthropometry, wealth, comorbidity, smoking, and alcohol intake and combined if no sex-TV viewing time interactions were identified. RESULTS: Men and women who watched the least TV at the 2HC or 3HC walked at a faster usual pace than those who watched the most TV. There was no evidence of effect modification by sex (Pinteraction = 0.09), and in combined analyses, participants who watched for <2 h·d on average walked 4.29 cm·s (95% confidence interval, 2.56-6.03) faster than those who watched for ≥4 h·d, with evidence of a dose-response association (Ptrend < 0.001). However, no strong associations with grip strength were found. CONCLUSIONS: TV viewing time predicted UWS in older adults. More research is needed to inform public health policy and prospective associations between other measures of sedentariness, such as total sitting time or objectively measured sedentary time, and physical capability should be explored.VLK declares a Wellcome Trust clinical training fellowship [092077/Z/10/Z] and KW a British Heart Foundation intermediate basic science research fellowship [FS/12/58/29709]. For the remaining authors no conflicts of interest were declared. The EPIC-Norfolk study was supported by programme grants from the Medical Research Council [G9502233; G0401527] and Cancer Research UK [C864/A8257]. A grant from Research into Ageing [262] funded the 3HC clinic.This is the final published version. It first appeared at http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=2015&issue=04000&article=00008&type=abstract

Self-reported physical functional health predicts future bone mineral density in EPIC-Norfolk cohort.

Using a large population sample from the UK, we found that self-reported physical functional health may be used to predict future bone mineral density especially in women. It may be a useful and inexpensive way to identify individuals before further decline in bone mineral density and the risk of fracture. PURPOSE: Self-reported physical functional health may predict bone mineral density (BMD) and thus provide a method to identify people at risk of low BMD. In this study, the association between the 36-item short-form questionnaire (SF-36) physical component summary (PCS) score and future BMD in participants aged 40-79 years enrolled in the European Prospective Investigation of Cancer-Norfolk study was investigated. METHODS: Associations between a participant's SF-36 PCS score, measured 18 months after baseline health check, and broadband ultrasound attenuation (BUA-a measure of BMD), measured 2-5 years after baseline, were examined using sex-specific linear and logistic regression analyses adjusting for age, BMI, medical co-morbidities, lifestyle and socioeconomic factors. RESULTS: Data from 10,203 participants, mean (standard deviation (SD)) age 61.5 (8.9) years (57.4% women), were analysed from 1993 to 2000. For every five points lower PCS score in men and women, there was approximately a 0.5 dB/MHz lower mean BUA. In women, a PCS score of less than one standard deviation (1SD) below the sex-specific mean was associated with having a low BUA (< 1SD below sex-specific mean) and very low BUA (< 2.5SD below the sex specific mean); odds ratio (OR) (95% confidence interval) 1.53 (1.24, 1.88) and 8.28 (2.67, 25.69), respectively. The relationship was lesser so in men; corresponding OR (95% CI) were 1.34 (0.91, 1.98) and 2.57 (0.72, 9.20), respectively. CONCLUSIONS: Self-reported physical functioning predicts BMD in an apparently healthy population, particularly in women. This could potentially provide an inexpensive, simple screening tool to identify individuals at risk of osteoporosis

Antihypertensive prescribing pattern and blood pressure control among hypertensive patients over a ten year period in a primary care setting in Malaysia

Suboptimal control blood pressure (BP) leads to multiple complications. This study aims to examine BP control and the change in prescribing pattern of antihypertensive agents over a 10-year period. Data was obtained from the 10-year retrospective cohort of randomly selected adult patients registered with the Department of Primary Care Medicine Clinic at the University of Malaya Medical Centre. Demographic data, BP and anti-hypertensive drug use in 1998, 2002 and 2007 were captured from patient records. Target BP control was defined as BP <140/90mmHg for those with hypertension alone and <130/80mmHg for those hypertensives with concomitant diabetes mellitus or chronic kidney disease. A total of 886 hypertensives patients were recruited. The mean age was 57.2 years (SD±9.6); 63.1% were female. The mean BP at baseline and at the end of 10-year were 146 / 87 (18/10) mmHg and 136/80 (16/9) mmHg respectively. In 1998, 74.3%, 22.5% and 1.6% were on monotherapy, 2 agents and ≥3 agents respectively. In 2007 after 10 years, 24.9%, 46.5% and 26.9% were on monotherapy, 2 agents and ≥3 agents respectively. At the end of 10 years there was improvement in overall blood pressure control, increasing from 15.6% in 1998 to 43.7% in 2007. However, the control rate of BP is still far from optimal in spite of an increase in the number of agents per patients used over a10 year follow-up. Based on our study the majority of patients with hypertension will need 2 or more agents to achieve target BP

Allocating patients to geriatric medicine wards in a tertiary university hospital in England: A service evaluation of the Specialist Advice for the Frail Elderly (SAFE) team.

The number of older patients admitted to acute hospitals has increased; however, their needs are heterogeneous and there is no gold-standard method of triaging them towards practicing comprehensive geriatric assessment (CGA). In our hospital, the SAFE (Specialist Advice for the Frail Elderly) team provide an initial geriatric assessment of all emergency admissions of patients aged ≥75 years (with some assessments also occurring in those aged 65 to 74 years) and recommend as to whether CGA in a dedicated Department of Medicine for the Elderly (DME) ward may be required. SAFE assessments include routine screening for geriatric syndromes using validated tools. Our aim was to compare the characteristics (age, gender, acute illness severity on admission as per modified early warning score (MEWS), Charlson Comorbidity Index, Clinical Frailty Scale (CFS), presence of dementia and delirium) and outcomes (length of stay, delayed discharge, inpatient mortality, discharge to usual place of residence, and new institutionalization) of patients listed to a DME ward, to those not listed. We analyzed all SAFE team assessments of patients admitted nonelectively between February 2015 and November 2016. Of 6192 admissions, 16% were listed for a DME ward. Those were older, had higher MEWS and CFS score, were more often affected by cognitive impairment, had longer hospital stay, higher inpatient mortality, and more often required new institutionalization. Higher CFS and presence of dementia and delirium were the strongest predictors of DME ward recommendation. Routine measurement of markers of geriatric complexity may help maximize access to finite inpatient CGA resources

Using Accelerometers to Measure Physical Activity in Older Patients Admitted to Hospital.

BACKGROUND: Low levels of physical activity in older patients during hospitalization have been linked to loss of functional ability. Practical methods of measuring physical activity are needed to better understand this association and to measure the efficacy of interventions. The aims of this study were to evaluate the feasibility of using accelerometers to discriminate between lying, sitting, standing, and standing and moving and to determine the acceptability of the method from the patients' perspective. METHODS: A convenience sample of 24 inpatients was recruited. Participants wore accelerometers on their thigh and on their lower leg (just above the ankle) for 48 hours during their hospitalization. Postural changes and movement during the 48 hours were differentiated using derived pitch angles of the lower leg and thigh, and nongravity vector magnitude of the lower leg, respectively. RESULTS: On average, patients were lying for 61.2% of the recording time, sitting for 35.6%, standing but not moving 2.1%, and standing and moving 1.1%. All participants found the accelerometers acceptable to wear. CONCLUSIONS: The methodology described in this study can be used to differentiate between lying, sitting, standing, and moving and is acceptable from a hospitalized older person's perspective.This feasibility study was part of PH’s Addenbrooke’s Charitable Trust/NIHR Cambridge Biomedical Research Centre (BRC) Internal Research Fellowship and completed as part of his Dunhill Medical Trust Research Training Fellowship [grant number: RTF115/0117]. The work of KW and SB was supported by the Medical Research Council [MC_UU_12015/3] and the NIHR Biomedical Research Centre Cambridge [IS-BRC-1215-20014]. TW was supported by a PhD studentship from MedImmune Ltd.Peer Reviewe