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During the first COVID-19 pandemic wave in Spain, 50% of deaths occurred in nursing homes, making it necessary for some hospitals to support these facilities with the care of infected patients. This study compares origin, characteristics, and mortality of patients admitted with COVID-19 during six pandemic waves in the Hospital Central de la Cruz Roja in Madrid. It is a retrospective observational study of patients ≥80 years old, admitted with an acute SARS-CoV-2 infection, with a total of 546 patients included, whose final outcome was death or discharge. During the first wave, those from nursing homes had a higher risk of death than those from home; during the two successive waves, the risk was higher for those from home; and in the last two waves, the risk equalized and decreased exponentially in both groups. Men had 72% higher risk of death than women. For each year of age, the risk increased by 4% (p = 0.036). For each Charlson index point, the risk increased by 14% (p = 0.019). Individuals in nursing homes, despite being older with higher comorbidity, did not show a higher overall lethality. The mortality decreased progressively in each successive wave due to high vaccination rates and COVID-19 control measures in this population.

Objective To establish the prevalence of potentially inappropriate prescription (PIP) in older people with advanced dementia, monitored by a Geriatric Home Care Unit (GHC), as well as the associated risk factors and costs. Methods Community-dwelling patients ≥65 years with an advanced dementia diagnosis (GDS-FAST ≥ 7a) and poor 1-year vital prognosis (Frail-VIG ≥ 0.6) were included. Pharmacotherapy history was reviewed retrospectively, collecting functional and cognitive status, on the first GHC visit, of patients assessed January 2016–January 2019. Potentially inappropriate medication was defined following STOPP-Frail criteria. Results 100 patients included (76% women, 89.15 ± 5.8 years). Total medications prescribed 760 (7.63 ± 3.4 drugs per patient). 85% patients were given at least one drug considered to be PIP. 26% (196) of the total drugs registered were PIPs. Patients who were prescribed an inappropriate drug showed a higher number of total prescribed drugs (7.92 ± 3.42 vs 6.00 ± 2.24; p 0.04) and a higher frequency of polypharmacy (84.7% vs 60%; p 0.025). Risk of receiving inappropriate medication increased by 24% for each additional drug prescribed (OR 1.24; 95% CI 1.01–1.52; p 0.04). The costs associated with PIP were 113.99 euros per 100 patients/day; 41,606.35 euros per 100 patients/year. Conclusions Prescription of PIP to community-dwelling patients with severe dementia and poor vital prognosis is common and is associated with high economic impact in this population group.

Key summary points Aim The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Findings Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Message Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19., Purpose To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Design Single-center observational study. Setting and participants Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19. Methods Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Results Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was

Resumen Introduccion y objetivos El pronostico de la estenosis aortica (EAo) grave asintomatica en la poblacion anciana, que a menudo asocia fragilidad y comorbilidades no ha sido estudiado. Se propuso analizar que factores podrian influir en la mortalidad precoz esta poblacion. Metodos Estudio ambispectivo de cohortes en 104 pacientes con edad ≥ 70 anos y EAo grave asintomatica. Se recogieron variables epidemiologicas, geriatricas, clinicas y ecocardiograficas y se compararon entre pacientes fragiles y no fragiles. Durante el seguimiento se recogio el tiempo desde el diagnostico hasta la mortalidad. Resultados El 59,6% de los pacientes eran fragiles. El 69,4% de los pacientes fragiles fallecieron, con una mediana de supervivencia de 2,52 anos (IC95%, 1,36-3,69). La tasa de supervivencia global al ano en estos sujetos fue del 76%. En el analisis multivariante la edad (HR = 2,47; IC95%, 1,00-6,12), el indice de Charlson ≥ 5 (HR = 3,75; IC95%, 1,47-9,52) y la fragilidad (HR = 6,67; IC95%, 1,43-9,52) se asociaron independientemente a la mortalidad. Un 8,7% de los pacientes presentaron un indice de Charlson ≥ 5 y tuvieron una mediana de supervivencia de 1,01 anos (IC95%, 0,36-1,67). El area bajo la curva receiver operating characteristic del indice de Charlson fue 0,739 (IC95%, 0,646-0,832). Los valores ≥ 5 mostraron una elevada especificidad (100%) pero baja sensibilidad. Conclusiones Existe una elevada prevalencia de fragilidad en pacientes ancianos con EAo grave asintomaticos. La edad, un indice de Charlson ≥ 5 y la fragilidad son marcadores independientes de mortalidad, asociando un pronostico desfavorable a corto plazo.

Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. Results: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L, interquartile range (IQR) 2.40–7.17) than in the no PE group (1.39 mg/L, IQR 1.01–2.75) (p &lt, 0.001). The area under the curve (AUC) for DD was 0.789 (0.652–0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. Conclusions: The cutoff point DD &gt, 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.

Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients >= 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden's index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels., This work was partially supported by grants (to M.Q.-F., J.G.-P.) from the "New announcement for extraordinary initiative fund UAX-Santander COVID-19," Alfonso X el Sabio University.

Analyse which factors could influence in earlier hospitalizations for congestive heart failure in geriatric patients with degenerative aortic stenosis. The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86). In our study, there was an increased risk of congestive heart failure admission in frail patients with moderate-severe degenerative aortic stenosis. Degenerative aortic stenosis has become a new valvular epidemic in the last few decades due to its high prevalence in the geriatric population. We sought to analyse factors that could influence earlier hospitalization for congestive heart failure in geriatric patients with moderate–severe degenerative aortic stenosis. This investigation was an ambispective cohort study of 104 patients aged 70 years or older with moderate–severe aortic stenosis. Epidemiological, geriatric, clinical, echocardiographic and electrocardiographic variables were collected. During the follow-up, the number of admissions for congestive heart failure and the time elapsed from diagnosis to first admission were recorded. A total of 45.2% of the patients were admitted for congestive heart failure, with a median time to first admission of 3 years (95% CI 1.88–4.25). For patients aged 85 years or older, this median was 8.07 months (95% CI 0.05–1.99). The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41), atrial fibrillation (HR 2.19, 95% CI: 1.01–4.73), a high EuroSCORE (HR 1.03, 95% CI: 1.00–1.05), the affected valvular area (HR 0.11, 95% CI: 0.02–0.47), age (HR 1.11, 95% CI: 1.04–1.18) and renal failure (HR 4.13, 95% CI: 1.46–11.63). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86). In geriatric patients with moderate–severe degenerative aortic stenosis, frailty is an independent marker of early congestive heart failure admission with a powerful and important association.

Introduction and objectives The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. Methods This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. Results Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. Conclusions A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis.