Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions

Delivery of future healthcare information systems requires systems to support patients with multi-morbidity. Current approaches to computer interoperable guidelines typically consider only a single clinical guideline for a single condition. There is a need to establish a robust protocolized approach to the development of holistic consensus computer interoperable guidelines in the context of multi-morbidity. The presence of mild cognitive impairment (MCI) and dementia adds an additional challenge to the delivery of effective digital health solutions. CAREPATH proposes an ICT-based solution for the optimization of clinical practice in the treatment and management of multi-morbid older adults with mild cognitive impairment or mild dementia. In this manuscript, we present an evidence-based protocol for the development of a single computer interoperable holistic guideline for a collection of multi-morbid conditions. To the best of our knowledge, this is the first published protocol for the production of a consensus interoperable clinical guideline for people with multi-morbidity, with special focus on older adults with MCI or mild dementia. This addresses a still unmet need for such processes which are expected to play a central role for future integrated healthcare information systems

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Factores relacionados con el insomnio en ancianos internados en un centro sociosanitario

Resumen: Objetivos: Describir las características del sueño de los ancianos internados en un centro sociosanitario tanto en relación con la presencia de insomnio como mediante la calidad del sueño. Metodología: Estudio descriptivo y transversal sobre 100 sujetos de 65 años o más, internados en la residencia Núñez de Balboa (Albacete). Variables: características sociodemográficas, comorbilidad, consumo de psicofármacos, diagnóstico de insomnio según el Manual diagnóstico y estadístico de los trastornos mentales V (DSM-V), dolor, Escala de depresión de Yesavage, Minimental State Examination, Índice de Barthel, Índice de calidad del sueño Pittsburgh (ICSP), y Mini Nutritional Assessment. Resultados: La prevalencia de insomnio fue del 15% y de “malos dormidores”, del 77%. Destaca una latencia en la conciliación del sueño superior a 30 minutos en el 35% de los casos, una eficiencia del sueño inferior al 65% en el 42%, y en contraposición, una calidad subjetiva del sueño de muy buena o bastante buena en un 77%. Las puntuaciones más altas del ICSP se asociaron con peor estado funcional (r = -0,22; p < 0,05), mayor riesgo de depresión (r = 0,33; p < 0,001), peor estado nutricional (r = -0,25; p < 0,05), polifarmacia (r = 0,22; p < 0,05) y dolor (p < 0,05). Conclusiones: Nuestra muestra presenta una baja prevalencia de trastorno de insomnio frente a una alta frecuencia de “malos dormidores”, principalmente en sujetos con mayor nivel de dependencia, con mayor riesgo de depresión, con peor estado nutricional, con dolor y polifarmacia

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn.

Background/objectivesTo analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain.DesignEpidemiological study.SettingSix open LTCFs in Albacete (Spain).Participants198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents.MeasurementsBaseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed.ResultsThe pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals.ConclusionThe COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high

Baricitinib reduces 30‐day mortality in older adults with moderate‐to‐severe COVID‐19 pneumonia

Background: Older adults are at the highest risk of severe disease and death due to COVID‐19. Randomized data have shown that baricitinib improves outcomes in these patients, but focused stratified analyses of geriatric cohorts are lacking. Our objective was to analyze the efficacy of baricitinib in older adults with COVID‐19 moderate‐to‐severe pneumonia.Methods: This is a propensity score [PS]‐matched retrospective cohort study. Patients from the COVID‐AGE and Alba‐Score cohorts, hospitalized for moderate‐to‐severe COVID‐19 pneumonia, were categorized in two age brackets of age <70 years old (86 with baricitinib and 86 PS‐matched controls) or ≥70 years old (78 on baricitinib and 78 PS‐matched controls). Thirty‐day mortality rates were analyzed with Kaplan–Meier and Cox proportional hazard models.ResultsMean age was 79.1 for those ≥70 years and 58.9 for those <70. Exactly 29.6% were female. Treatment with baricitinib resulted in a significant reduction in death from any cause by 48% in patients aged 70 or older, an 18.5% reduction in 30‐day absolute mortality risk (n/N: 16/78 [20.5%] baricitinib, 30/78 [38.5%] in PS‐matched controls, p < 0.001) and a lower 30‐day adjusted fatality rate (HR 0.21; 95% CI 0.09–0.47; p < 0.001). Beneficial effects on mortality were also observed in the age group <70 (8.1% reduction in 30‐day absolute mortality risk; HR 0.14; 95% CI 0.03–0.64; p = 0.011).Conclusions: Baricitinib is associated with an absolute mortality risk reduction of 18.5% in adults older than 70 years hospitalized with COVID‐19 pneumonia.</p