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The deficiency of 25OH vitamin D (25[OH]D) is common in the older population. It physiologically triggers secondary hyperparathyroidism resulting in normal circulating calcium levels. Adjusted calcium (CaA) is estimated by the PAYNE method and several studies report a misclassification of calcium status by corrected calcium compared to ionized calcium (CaI) in older patients. Hypocalcemia is common in older COVID-19 patients. Blunted secondary hyperparathyroidism explain this high prevalence of hypocalcemia in COVID-19. However, no studies have focused on patients older than 75 years despite the high mortality rate in this population. In the present study, the association between the different types of calcium (CaI, CaA, and total calcium [CaT]) and 25(OH)D deficiency (below 50 nmol/L) was investigated. The study of the correlation between each type of calcium was performed secondarily. Observational monocentric study focused on the GERIA-COVID database during the second wave of COVID-19 in France from October 2020 to March 2021. COVID-19 was diagnosed with RT-PCR and/or chest CT-scan. A population of 181 older COVID-19 patients (86.4 years ± 5.7) was analyzed. Sixty-three patients (34.8%) were deficient in 25(OH)D. The prevalence of total and ionized hypocalcemia was 44.1% and 39.2%, respectively. A negative association was reported in linear regression between 25(OH)D deficiency and CaA (β =-0.052 [- 0.093; -0.010], p = 0.015) as well as with CaT (β = -0.05 [-0.09; -0.01], p =0.034) in the multivariate model. No association was found between vitamin D deficiency and CaI. In the multivariate models, there was no association between each type of calcium and PTH. CaI was correlated with CaT (r = 0.39, p < 0.001) and with CaA (r = 0.15, p = 0.043). Secondary hyperparathyroidism was not activated in the context of COVID-19 in this study. After reviewing the literature, this appears to be the first study in older patients to expose such results.

The objective of this cohort study was to determine whether hypercalcemia in early COVID-19 was associated with 3-month mortality in frail elderly patients. Circulating calcium and albumin concentrations at hospital admission and 3-month mortality were assessed in geriatric patients hospitalized for COVID-19 with normal-to-high calcium concentrations. Hypercalcemia was defined as corrected calcium >2.5mmol/L. Covariables were age, sex, functional abilities, malignancies, hypertension, cardiomyopathy, number of acute health issues, use antibiotics and respiratory treatments. In total, 94 participants (mean±SD 88.0±5.5years;47.9% women;22.3% hypercalcemia;0% hypocalcemia) were included. Sixty-five participants who survived at 3months exhibited less often hypercalcemia at baseline than the others (13.9% versus 41.4%, P=0.003). Hypercalcemia was associated with 3-month mortality (fully-adjusted HR=3.03, P=0.009) with specificity=0.86 and sensitivity=0.41. Those with hypercalcemia had shorter survival time than those with normocalcemia (log-rank P=0.002). In conclusion, hypercalcemia was associated with poorer survival in hospitalized frail elderly COVID-19 patients. © 2021, Serdi-Editions and Springer-Verlag France.

The COVID-19 pandemic affects older adults particularly severely. Our objective was to identify from the international literature the symptoms most commonly experienced by older adults infected with SARS-CoV-2. This systematic literature review was conducted using MEDLINE between 1 December 2019 and 13 April 2020. The methodological quality analysis used a method dedicated to case series and case reports. Of the 260 articles initially identified, only two studies were ultimately included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. COVID-19 symptoms were as follows: fever, dry cough, dyspnoea, asthenia, anorexia, chest tightness, diarrhoea and, to a lesser extent, myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain, and vomiting. Lymphopenia was noted from complete blood counts. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in very elderly frail people, who are normally considered to constitute the geriatric population. The national survey conducted by the Société Française de Gériatrie et Gérontologie will help bridge this semiological gap.

Background Humoral response against sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after two doses of BNT162b2 (Pfizer-BioNTech) has been proven to be less intense in maintenance dialysis patients as compared with healthy subjects, leading the French authorities to recommend a third injection in this population. Here we investigated the response to the third injection in two cohorts of haemodialysis (HD) patients. Methods Data from two prospective observational cohorts were collected. In the first (‘systematic’) cohort, patients from two HD centres (n = 66) received a third injection of BNT162b2, regardless of the response after two injections. In the second (‘conditional’) cohort, the injection was only prescribed to patients (n = 34) with no or low response to the previous two doses. In both cohorts, the third dose was injected 1–2 months after the second dose. Serology was performed after the second and third doses to assess anti-Spike immunoglobulin G (S IgG) antibody titre. Results In the systematic cohort, anti-S IgG was found in 83.3 and 92.4% of patients after the second and third doses of BNT162b2, respectively. In this cohort, 6/11 (54.5%) and 20/21 (95.2%) patients switched from non-responder to low responder and from low responder to high responder, respectively. In low and high responders to two doses, 50/55 (90.9%) at least doubled their anti-S IgG titre. Similar trends were observed in the conditional cohort. Conclusions In maintenance HD patients, humoral response against SARS-CoV-2 was boosted after a third dose of BNT162b2, allowing seroconversion in more than half of non-responders. These data may support an intensified vaccination protocol with a third dose of BNT162b2 in dialysis patients., Graphical Abstract Graphical Abstract

Nosocomial COVID-19 in older patients has a high mortality rate. We describe an outbreak of COVID-19 in a geriatric acute care unit (GACU) in March/April 2020 and the lessons learnt regarding prevention. Thirty-six patients were diagnosed with COVID-19 during that 2-month period, in France's "first wave" of SARS-CoV-2 infections. Thirty (83.3%) were considered nosocomial. Attributable mortality reached 33.3% in these patients. Healthcare workers (HCW) were not spared, with an overall attack rate of 36.8%, but the rate was especially high among nurse assistants (68.2%). Repeated testing, single rooms, hand hygiene, and good use of personal protective equipment are paramount in GACUs to prevent in-hospital COVID-19 outbreaks.

The COVID-19 pandemic affects older adults particularly severely. Our objective was to identify from the international literature the symptoms most commonly experienced by older adults infected with SARS-CoV-2. This systematic literature review was conducted using MEDLINE between 1 December 2019 and 13 April 2020. The methodological quality analysis used a method dedicated to case series and case reports. Of the 260 articles initially identified, only two studies were ultimately included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. COVID-19 symptoms were as follows: fever, dry cough, dyspnoea, asthenia, anorexia, chest tightness, diarrhoea and, to a lesser extent, myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain, and vomiting. Lymphopenia was noted from complete blood counts. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in very elderly frail people, who are normally considered to constitute the geriatric population. The national survey conducted by the Societe Francaise de Geriatrie et Gerontologie will help bridge this semiological gap.