Publications by authors named "Roman Romero-Ortuno"

97 Publications

Associations between Cardiovascular Signal Entropy and Cognitive Performance over Eight Years.

Entropy (Basel) 2021 Oct 14;23(10). Epub 2021 Oct 14.

The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland.

In this study, the relationship between non-invasively measured cardiovascular signal entropy and global cognitive performance was explored in a sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA), both cross-sectionally at baseline ( = 4525; mean (SD) age: 61.9 (8.4) years; 54.1% female) and longitudinally. We hypothesised that signal disorder in the cardiovascular system, as quantified by short-length signal entropy during rest, could provide a marker for cognitive function. Global cognitive function was assessed via Mini Mental State Examination (MMSE) across five longitudinal waves (8 year period; = 4316; mean (SD) age: 61.9 (8.4) years; 54.4% female) and the Montreal Cognitive Assessment (MOCA) across two longitudinal waves (4 year period; = 3600; mean (SD) age: 61.7 (8.2) years; 54.1% female). Blood pressure (BP) was continuously monitored during supine rest at baseline, and sample entropy values were calculated for one-minute and five-minute sections of this data, both for time-series data interpolated at 5 Hz and beat-to-beat data. Results revealed significant associations between BP signal entropy and cognitive performance, both cross-sectionally and longitudinally. Results also suggested that as regards associations with cognitive performance, the entropy analysis approach used herein potentially outperformed more traditional cardiovascular measures such as resting heart rate and heart rate variability. The quantification of entropy in short-length BP signals could provide a clinically useful marker of the cardiovascular dysregulations that potentially underlie cognitive decline.
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http://dx.doi.org/10.3390/e23101337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534418PMC
October 2021

How can urban environments support dementia risk reduction? A qualitative study.

Int J Geriatr Psychiatry 2021 Sep 27. Epub 2021 Sep 27.

Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany.

Objective: Interventions to reduce the risk of cognitive decline and dementia largely focus on individual-level strategies. To maximize risk reduction, it is also necessary to consider the environment. With the majority of older people living in cities, we explored how urban environments could support risk reduction.

Materials And Methods: In our qualitative study, we conducted semi-structured interviews with community members aged ≥65 years and stakeholders, all living in Leipzig, Germany. Interview guides were informed by the framework on modifiable risk factors for dementia of the Lancet Commission on Dementia Prevention, Intervention, and Care. Interviews were audio-recorded, verbatim-transcribed, and thematically analysed.

Results: Community members (n = 10) were M = 73.7 (SD = 6.0) years old and 50% were women. Stakeholders (n = 10) were aged 39-72 years, and 70% were women. Stakeholders' fields included architecture, cultural/arts education, environmental sciences, geriatrics, health policy, information and technology, philosophy, psychology, public health, and urban sociology. Across interviews with both older individuals and stakeholders, three main themes were identified: (i) social participation and inclusion (emphasizing social contacts, social housing, intergenerationality, neighbourhood assistance, information and orientation, digital and technological literacy, lifelong learning, co-creation/co-design), (ii) proximity and accessibility (emphasizing proximity and reachability, mobility, affordability, access to health care, access to cultural events, public toilets), (iii) local recreation and wellbeing (emphasizing safety in traffic, security, cleanliness and environmental protection, urban greenery, climate change and heat waves, outdoor physical activity).

Discussion: The design of urban environments holds large potential to create favourable conditions for community-dwelling individuals to practice lifestyles that promote brain health. Public policy should involve community members in co-creating such environments.
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http://dx.doi.org/10.1002/gps.5626DOI Listing
September 2021

SART and Individual Trial Mistake Thresholds: Predictive Model for Mobility Decline.

Geriatrics (Basel) 2021 Aug 31;6(3). Epub 2021 Aug 31.

The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590 Dublin, Ireland.

The Sustained Attention to Response Task (SART) has been used to measure neurocognitive functions in older adults. However, simplified average features of this complex dataset may result in loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we describe a new method to visualise individual trial (raw) information obtained from the SART test, vis-à-vis age, and groups based on mobility status in a large population-based study of ageing in Ireland. A thresholding method, based on the individual trial number of mistakes, was employed to better visualise poorer SART performances, and was statistically validated with binary logistic regression models to predict mobility and cognitive decline after 4 years. Raw SART data were available for 4864 participants aged 50 years and over at baseline. The novel visualisation-derived feature , indicating the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline expressed by the transition from Timed Up-and-Go (TUG) < 12 to TUG ≥ 12 s (OR = 1.29; 95% CI 1.14-1.46; < 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03-1.21; = 0.011), in models adjusted for multiple covariates. However, no SART-related variables resulted significant for the risk of cognitive decline, expressed by a decrease of ≥2 points in the Mini-Mental State Examination (MMSE) score. This novel multimodal visualisation could help clinicians easily develop clinical hypotheses. A threshold approach to the evaluation of SART performance in older adults may better identify subjects at higher risk of future mobility decline.
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http://dx.doi.org/10.3390/geriatrics6030085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482118PMC
August 2021

The Importance of Age in the Prediction of Mortality by a Frailty Index: A Machine Learning Approach in the Irish Longitudinal Study on Ageing.

Geriatrics (Basel) 2021 Aug 27;6(3). Epub 2021 Aug 27.

The Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40 Dublin, Ireland.

The quantification of biological age in humans is an important scientific endeavor in the face of ageing populations. The frailty index (FI) methodology is based on the accumulation of health deficits and captures variations in health status within individuals of the same age. The aims of this study were to assess whether the addition of age to an FI improves its mortality prediction and whether the associations of the individual FI items differ in strength. We utilized data from The Irish Longitudinal Study on Ageing to conduct, by sex, machine learning analyses of the ability of a 32-item FI to predict 8-year mortality in 8174 wave 1 participants aged 50 or more years. By wave 5, 559 men and 492 women had died. In the absence of age, the FI was an acceptable predictor of mortality with AUCs of 0.7. When age was included, AUCs improved to 0.8 in men and 0.9 in women. After age, deficits related to physical function and self-rated health tended to have higher importance scores. Not all FI variables seemed equally relevant to predict mortality, and age was by far the most relevant feature. Chronological age should remain an important consideration when interpreting the prognostic significance of an FI.
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http://dx.doi.org/10.3390/geriatrics6030084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482125PMC
August 2021

Using accelerometers in the assessment of sarcopenia in older adults attending a day hospital service in Ireland.

J Frailty Sarcopenia Falls 2021 Sep 1;6(3):98-110. Epub 2021 Sep 1.

Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, School of Physiotherapy, Ireland.

Objectives: The aim of this study was to describe the associations between sarcopenia and variables derived from wrist accelerometry in community-dwelling older adults attending a day hospital service in Ireland.

Methods: An observational cross-sectional study was carried out using a consecutive series of older adults attending a day hospital service. Sarcopenia was diagnosed using the latest European Working Group of Sarcopenia in Older People guidelines. Accelerometers were worn by each participant for a 7-day period on their non-dominant wrist.

Results: Thirty-eight out of forty-one participants (93%) met the accelerometer wear time criterion and were included in statistical analyses. Included participants had a mean age of 81.1 years (standard deviation 6.2). Both sarcopenia (Grip) and sarcopenia (Lower limb) were associated with increased time spent in low physical activity and reduced average of Kcals per hour. Only sarcopenia (Lower limb) was associated with increased time in sedentary behaviour as well as reduced number of steps taken in a week.

Conclusions: Accelerometer data can be used in an older day hospital population to track physical activity levels and sedentary behaviours. The assessment tool used to assess muscle strength and the cut-off criteria for physical activity behaviour influences the association with sarcopenia.
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http://dx.doi.org/10.22540/JFSF-06-098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419851PMC
September 2021

Frailty index transitions over eight years were frequent in The Irish Longitudinal Study on Ageing.

HRB Open Res 2021 9;4:63. Epub 2021 Jun 9.

The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.

: The frailty index (FI) is based on accumulation of health deficits. FI cut-offs define non-frail, prefrail and frail states. We described transitions of FI states in The Irish Longitudinal Study on Ageing (TILDA). : Participants aged ≥50 years with information for a 31-deficit FI at wave 1 (2010) were followed-up over four waves (2012, 2014, 2016, 2018). Transitions were visualized with alluvial plots and probabilities estimated with multi-state Markov models, investigating the effects of age, sex and education. : 8174 wave 1 participants were included (3744 men and 4430 women; mean age 63.8 years). Probabilities from non-frail to prefrail, and non-frail to frail were 18% and 2%, respectively. Prefrail had a 19% probability of reversal to non-frail, and a 15% risk of progression to frail. Frail had a 21% probability of reversal to prefrail and 14% risk of death. Being older and female increased the risk of adverse FI state transitions, but being female reduced the risk of transition from frail to death. Higher level of education was associated with improvement from prefrail to non-frail. : FI states are characterized by dynamic longitudinal transitions and frequent improvement. Opportunities exist for reducing the probability of adverse transitions.
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http://dx.doi.org/10.12688/hrbopenres.13286.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406448PMC
June 2021

Involving older people in co-designing an intervention to reverse frailty and build resilience.

Fam Pract 2021 Jul 16. Epub 2021 Jul 16.

School of Medicine, University College Dublin, Dublin, Ireland.

Background: An essential consideration in health research is to conduct research with members of the public rather than for them. Public and patient involvement (PPI) of older people in research can improve enrolment, relevance and impact. However, few studies with PPI in frailty research have been identified. PPI has fallen during the Covid-19 pandemic.

Objective: We aimed to involve older people in co-designing a randomised control trial (RCT) intervention to reverse frailty and build resilience. We also wished to encourage wider use of PPI with older people by outlining our approach.

Methods: Involvement of older people was undertaken in three stages. Eighteen over 65-year-olds helped co-design an exercise intervention in two group discussions using the Socratic education method. Ninety-four contributed intervention feedback in one-on-one telephone interviews over nine months. Ten contributors helped optimise the intervention in three online workshops. Multidisciplinary team input and systematic review supported co-design.

Results: Eleven home-based resistance exercises were co-designed by group discussion contributors (mean age 75, 61% female). Frailty intervention format, gender balance and GP follow-up were shaped in telephone interviews (mean age 77, 63% female). Dietary guidance and patient communication were co-designed in workshops (mean age 71, 60% females). Technology proved no barrier to PPI. The co-designed frailty intervention is being evaluated in a definitive RCT.

Conclusions: We enabled meaningful the involvement of 112 older people in the co-design of an intervention to reverse frailty and build resilience in diverse ways. Inclusive involvement can be achieved during a pandemic. Feedback enhanced intervention feasibility for real-world primary-care.
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http://dx.doi.org/10.1093/fampra/cmab084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414058PMC
July 2021

Informing patterns of health and social care utilisation in Irish older people according to the Clinical Frailty Scale.

HRB Open Res 2021 18;4:54. Epub 2021 May 18.

TILDA, Trinity College Dublin, Dublin, Ireland.

There is increasing policy interest in the consideration of frailty measures (rather than chronological age alone) to inform more equitable allocation of health and social care resources. In this study the Clinical Frailty Scale (CFS) classification tree was applied to data from The Irish Longitudinal Study on Ageing (TILDA) and correlated with health and social care utilisation. CFS transitions over time were also explored. Applying the CFS classification tree algorithm, secondary analyses of TILDA data were performed to examine distributions of health and social care by CFS categories using descriptive statistics weighted to the population of Ireland aged ≥65 years at Wave 5 (n=3,441; mean age 74.5 (SD ±7.0) years, 54.7% female). CFS transitions over 8 years and (Waves 1-5) were investigated using multi-state Markov models and alluvial charts. : The prevalence of CFS categories at Wave 5 were: 6% 'very fit', 36% 'fit', 31% 'managing well', 16% 'vulnerable', 6% 'mildly frail', 4% 'moderately frail' and 1% 'severely frail'. No participants were 'very severely frail' or 'terminally ill'. Increasing CFS categories were associated with increasing hospital and community health services use and increasing hours of formal and informal social care provision. The transitions analyses suggested CFS transitions are dynamic, with 2-year probability of transitioning from 'fit' (CFS1-3) to 'vulnerable' (CFS4), and 'fit' to 'frail' (CFS5+) at 34% and 6%, respectively. 'Vulnerable' and 'frail' had a 22% and 17% probability of reversal to 'fit' and 'vulnerable', respectively. Our results suggest that the CFS classification tree stratified the TILDA population aged ≥65 years into subgroups with increasing health and social care needs. The CFS could be used to aid the allocation of health and social care resources in older people in Ireland. We recommend that CFS status in individuals is reviewed at least every 2 years.
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http://dx.doi.org/10.12688/hrbopenres.13301.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220351PMC
May 2021

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses.

Eur Geriatr Med 2021 Jun 16. Epub 2021 Jun 16.

School of Medicine, Trinity College Dublin, Dublin, Ireland.

Introduction: COVID-19 has caused unprecedented challenges in nursing homes. In this scoping review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges.

Methods: The MeSH terms "Nursing homes" and "COVID-19" were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes.

Results: The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents' well-being, and technological innovations.

Conclusion: COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.
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http://dx.doi.org/10.1007/s41999-021-00531-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208072PMC
June 2021

Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years.

Geriatrics (Basel) 2021 May 11;6(2). Epub 2021 May 11.

The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 R590 Dublin, Ireland.

Previous research cross-sectionally characterised eight morphological systolic blood pressure (SBP) active stand (AS) patterns using a clinical clustering approach at Wave 1 (W1) of the Irish Longitudinal Study on Ageing. We explored the longitudinal stability and clinical associations of these groupings at Wave 3 (W3), four years later. Eight AS groups had their clinical characteristics and AS patterns at W3 compared to W1. We explored longitudinal associations (new cognitive decline, falls, syncope, disability, and mortality) using multivariate logistic regression models. In total, 2938 participants (60% of Wave 1 sample) had adequate AS data from both W1 and 3 for analysis. We found no longitudinal stability of the eight AS groups or their morphological patterns between the waves. A pattern of impaired stabilisation and late deficit seemed more preserved and was seen in association with new cognitive decline (OR 1.63, 95% CI: 1.12-2.36, = 0.011). An increase in antihypertensive usage seemed associated with reduced immediate SBP drops, improved AS patterns, and reduced orthostatic intolerance (OI). In pure longitudinal groups, AS patterns were not preserved after 4 years. AS patterns are longitudinally dynamic, and improvements after 4 years are possible even in the presence of higher antihypertensive burden.
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http://dx.doi.org/10.3390/geriatrics6020050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162355PMC
May 2021

Supine Hypertension Is Associated With an Impaired Cerebral Oxygenation Response to Orthostasis: Finding From The Irish Longitudinal Study on Ageing.

Hypertension 2021 07 1;78(1):210-219. Epub 2021 Jun 1.

The Irish Longitudinal Study on Ageing (L.N., J.D.O., R.R.-O., R.A.K.), Trinity College Dublin, Ireland.

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17111DOI Listing
July 2021

The Syncope-Falls Index (SYFI): A tool for predicting risk of syncope and complex falls in the older adult based on cumulative health deficits.

QJM 2021 May 20. Epub 2021 May 20.

MedEL Directorate, St. James's Hospital, James St, Dublin 8, Ireland.

Background: Syncope is aetiologically diverse and associated with adverse outcomes; in older people, there is clinical overlap with complex falls presentations (i.e. recurrent, unexplained, and/or injurious).

Aim: To formulate an index to predict future risk of syncope and falls in the Irish Longitudinal Study on Ageing (TILDA).

Design/methods: Using the frailty index methodology, we selected, from TILDA Wave 1 (2010), 40 deficits that might increase risk of syncope and falls. This syncope-falls index (SYFI) was applied to TILDA Wave 1 participants aged 65 and over, who were divided into three risk groups (low, intermediate, high) based on SYFI tertiles. Multivariate logistic regression models were used to investigate, controlling for age and sex, how SYFI groups predicted incident syncope, complex falls and simple falls occurring up to Wave 4 of the study (2016).

Results: At Wave 1, there were 3499 participants (mean age 73, 53% women). By Wave 4, of the remaining 2907 participants, 185 (6.4%) had reported new syncope, 1077 (37.0%) complex falls, and 218 (7.5%) simple falls. The risk of both syncope and complex falls increased along the SYFI groups (high risk group: OR 1.88 [1.26-2.80], P = 0.002 for syncope; 2.22 [1.82-2.72], P < 0.001 for complex falls). No significant relationship was identified between SYFI and simple falls.

Conclusion: The 6-year incidences of falls and syncope were high in this cohort. SYFI could help identify older adults at risk of syncope and complex falls, and thus facilitate early referral to specialist clinics to improve outcomes.
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http://dx.doi.org/10.1093/qjmed/hcab141DOI Listing
May 2021

Association between gait speed and the SHARE Frailty Instrument in a Falls and Syncope Clinic.

Eur Geriatr Med 2021 10 15;12(5):1101-1105. Epub 2021 May 15.

Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.

Purpose: Identifying physical frailty is useful in the context of falls and syncope assessment. The phenotype-based SHARE Frailty Instrument for Primary Care (SHARE-FI) does not measure gait speed. We evaluated the association between SHARE-FI and gait speed in a Falls' and Syncope Unit (FASU).

Methods: We recruited a pilot sample of patients aged 50 and over attending FASU between November 2019 and March 2020. The association between gait speed and SHARE-FI was assessed with the Spearman's co-efficient (r). Logistic regression was conducted to investigate the association controlling for age, sex, body mass index, comorbidities and polypharmacy.

Results: 104 participants were included (34 frail) median (IQR) age 74 (68-79) years. 68 were female. There was a significant negative correlation between frailty and gait speed (r - 0.54, P < 0.001). In the multivariable model, gait speed remained independently associated with frailty (OR 0.09, 95% CI 0.02-0.52, P = 0.007).

Conclusions: SHARE-FI significantly captured gait speed in this clinical sample, adding to its validity.
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http://dx.doi.org/10.1007/s41999-021-00509-0DOI Listing
October 2021

Protocol for a randomised controlled trial of a primary care intervention to Reverse Frailty and Enhance Resilience through Exercise and dietary protein Education (REFEREE) in community-dwelling adults aged 65 and over.

HRB Open Res 2020 21;3:91. Epub 2021 Apr 21.

School of Medicine, University College Dublin, Dublin, Ireland.

Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to 'intervention' or 'usual care'. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.
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http://dx.doi.org/10.12688/hrbopenres.13188.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080984PMC
April 2021

The relationship between the severity and mortality of SARS-CoV-2 infection and 25-hydroxyvitamin D concentration - a metaanalysis.

Adv Respir Med 2021 ;89(2):145-157

Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.

Introduction: There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality.

Objective: To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality.

Material And Methods: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for studies published between December 2019 and December 2020. Effect statistics were pooled using random effects models. The quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Targeted outcomes: mortality and severity proportions in COVID-19 patients with 25(OH)D deficiency, defined as serum 25(OH)D < 50 nmol/L.

Results: In the 23 studies included (n = 2692), the mean age was 60.8 (SD ± 15.9) years and 53.8% were men. Results suggested that vitamin 25(OH)D deficiency was associated with increased risk of severe SARS-CoV-2 disease (RR 2.00; 95% CI 1.47-2.71, 17 studies) and mortality (RR 2.45; 95% CI 1.24-4.84, 13 studies). Only 7/23 studies reported C-reactive protein values, all of which were > 10 mg/L. Conclusions 25(OH)D deficiency seems associated with increased SARS-CoV-2 infection severity and mortality. However, findings do not imply causality, and randomized controlled trials are required, and new studies should be designed to determine if decreased 25(OH)D is an epiphenomenon or consequence of the inflammatory process associated with severe forms of SARS-CoV-2. Meanwhile, the concentration of 25(OH)D could be considered as a negative acute phase reactant and a poor prognosis in COVID-19 infection.
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http://dx.doi.org/10.5603/ARM.a2021.0037DOI Listing
May 2021

Transitions in frailty phenotype states and components over 8 years: Evidence from The Irish Longitudinal Study on Ageing.

Arch Gerontol Geriatr 2021 Jul-Aug;95:104401. Epub 2021 Mar 26.

The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland.

Aim: Fried's frailty phenotype (FP) is defined by exhaustion (EX), unexplained weight loss (WL), weakness (WK), slowness (SL) and low physical activity (LA). Three or more components define the frail state, and one or two the prefrail. We described longitudinal transitions of FP states and components in The Irish Longitudinal Study on Ageing (TILDA).

Methods: We included participants aged ≥50 years with FP information at TILDA wave 1 (2010), who were followed-up over four longitudinal waves (2012, 2014, 2016, 2018). Next-wave transition probabilities were estimated with multi-state Markov models.

Results: 5683 wave 1 participants were included (2612 men and 3071 women; mean age 63.1 years). Probabilities from non-frail to prefrail, and non-frail to frail were 27% and 2%, respectively. Prefrail had a 32% probability of reversal to non-frail, and a 10% risk of progression to frail. Frail had an 18% probability of reversal to prefrail and 31% risk of death. Probabilities of transitioning from not having to having a component were: 17% for LA, 11% for SL, 9% for EX, 7% for WL and 6% for WK. Probabilities of having a FP component and dying were: 17% for WL, 15% for WK, 14% for SL, 13% for EX, and 10% for LA. Probabilities of having a component and recovering at the next wave were: 59% for WL, 58% for EX, 40% for WK, 35% for LA and 23% for SL.

Conclusions: FP states and components are characterized by dynamic longitudinal transitions. Opportunities exist for reducing the probability of adverse transitions.
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http://dx.doi.org/10.1016/j.archger.2021.104401DOI Listing
June 2021

Vasovagal Syncope.

JAMA Intern Med 2021 Jun;181(6):880

Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.

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http://dx.doi.org/10.1001/jamainternmed.2020.9151DOI Listing
June 2021

Prevalence of sarcopenia and associated factors in older adults attending a day hospital service in Ireland.

Eur Geriatr Med 2021 08 13;12(4):851-862. Epub 2021 Feb 13.

School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland.

Purpose: Sarcopenia is a muscle disease that is linked to the effects of ageing, chronic diseases, physical inactivity, and poor nutrition. In Ireland, there is a lack of readily available information on sarcopenia in older adults. The aim of this study was to describe the prevalence and associated factors of sarcopenia in community-dwelling older adults attending a day hospital service in Ireland, using the European Working Group of Sarcopenia in Older People (EWGSOP) guidelines.

Methods: An observational cross-sectional study was conducted, where a consecutive series of older adults attending a day hospital service were invited to participate. The measure of primary interest was the diagnosis of sarcopenia using the EWGSOP 2019 guidelines. We also collected other Comprehensive Geriatric Assessment measures including cognition, nutrition, frailty and physical activity.

Results: A total of 134 participants took part in the study. The mean age was 81.7 (SD ± 7.1). Sixty-one percent (N = 82) were female. The prevalence of sarcopenia ranged from 27 to 37% depending on the assessment tool used to assess muscle strength. Sarcopenia was associated with older age, frailty, reduced nutritional state, poor physical performance and reduced anthropometric measures, irrespective of how muscle strength was measured. Independently associated factors differed depending on muscle strength test, except for older age.

Conclusion: The prevalence of sarcopenia in the day hospital ranged from 27 to 37%. The assessment tool used to assess muscle strength influenced both the prevalence and associated factors of sarcopenia, suggesting scope for further research.
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http://dx.doi.org/10.1007/s41999-021-00463-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882055PMC
August 2021

Choice reaction time and subsequent mobility decline: Prospective observational findings from The Irish Longitudinal Study on Ageing (TILDA).

EClinicalMedicine 2021 Jan 5;31:100676. Epub 2020 Dec 5.

Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland.

Background: Cognitive and motor function in ageing are intertwined, but whether slower motor response time (MRT) to a cognitive stimulus could herald accelerated mobility decline is unknown. Using data from The Irish Longitudinal Study on Ageing (TILDA), we examined whether slower MRT may predict a greater than expected increase in Time Up and Go (TUG) after 4 years.

Methods: Participants aged 50 years or older were divided into two groups based on their mean MRT (< 250 ms versus ≥ 250 ms). A repeated measures ANOVA compared TUG trajectories between groups, controlling for baseline age, sex, height, education level, mini mental-state examination (MMSE) score, self-reported vision and hearing, medical conditions (cardiovascular, cerebrovascular disease, diabetes), and number of medications.

Findings: At Wave 1, 1982 (58.7%) had a mean MRT of < 250 ms, with a mean TUG of 8.1 s (SD 1.6); and 1397 (41.3%) had an MRT of ≥ 250 ms, with a TUG of 9.0 s (SD 2.2). At Wave 3, TUG increased to 8.8 s (SD 2.0) and 10.2 s (SD 3.9), respectively. The results of the adjusted repeated measures ANOVA suggested that there was a statistically significant interaction between MRT group and Wave ( = 0.023, η  = 0.002).

Interpretation: TILDA participants in the slower MRT group seemed to have faster mobility decline, but this effect was statistically and clinically small.

Funding: TILDA is funded by Atlantic Philanthropies, the Irish Department of Health and Irish Life. Roman Romero-Ortuno is funded by Science Foundation Ireland (grant number 18/FRL/6188).
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http://dx.doi.org/10.1016/j.eclinm.2020.100676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846709PMC
January 2021

Physical and Mental Health of Older People while Cocooning during the COVID-19 Pandemic.

QJM 2021 Jan 20. Epub 2021 Jan 20.

Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.

Background: Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health.

Aim: To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years.

Design: Survey of 150 patients (55% female, mean age 80 years, mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital.

Methods: The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data was presented descriptively.

Results: Almost 40% (59/150) reported that their mental health was 'worse' or 'much worse' while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all.Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely 'very often'. Half of participants (75/150) reported a decline in their quality of life (QOL).Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term 'cocooning'.

Conclusions: Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness, continue physical activity and access timely medical care and rehabilitation services should be a priority.
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http://dx.doi.org/10.1093/qjmed/hcab015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928635PMC
January 2021

Associations between Neurocardiovascular Signal Entropy and Physical Frailty.

Entropy (Basel) 2020 Dec 22;23(1). Epub 2020 Dec 22.

The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland.

In this cross-sectional study, the relationship between noninvasively measured neurocardiovascular signal entropy and physical frailty was explored in a sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA). The hypothesis under investigation was that dysfunction in the neurovascular and cardiovascular systems, as quantified by short-length signal complexity during a lying-to-stand test (active stand), could provide a marker for frailty. Frailty status (i.e., "non-frail", "pre-frail", and "frail") was based on Fried's criteria (i.e., exhaustion, unexplained weight loss, weakness, slowness, and low physical activity). Approximate entropy (ApEn) and sample entropy (SampEn) were calculated during resting (lying down), active standing, and recovery phases. There was continuously measured blood pressure/heart rate data from 2645 individuals (53.0% female) and frontal lobe tissue oxygenation data from 2225 participants (52.3% female); both samples had a mean (SD) age of 64.3 (7.7) years. Results revealed statistically significant associations between neurocardiovascular signal entropy and frailty status. Entropy differences between non-frail and pre-frail/frail were greater during resting state compared with standing and recovery phases. Compared with ApEn, SampEn seemed to have better discriminating power between non-frail and pre-frail/frail individuals. The quantification of entropy in short length neurocardiovascular signals could provide a clinically useful marker of the multiple physiological dysregulations that underlie physical frailty.
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http://dx.doi.org/10.3390/e23010004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822043PMC
December 2020

One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index.

J Gerontol A Biol Sci Med Sci 2021 04;76(5):885-892

The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Ireland.

Background: Orthostasis is a potent physiological stressor which adapts with age. The age-related accumulation of health deficits in multiple physiological systems may impair the physiological response to orthostasis and lead to negative health outcomes such as falls, depression, and cognitive decline. Research to date has focused on changes with orthostasis at prespecified intervals of time, without consideration for whole signal approaches.

Methods: One-dimensional statistical parametric mapping identified regions in time of significant association between variables of interest using a general linear model. Frailty index operationalized accumulated health and social deficits using 32-items from a computer-assisted interview. This study examined the association of frailty index on blood pressure, heart rate, and cerebral oxygenation during an orthostatic test in a sample of 2742 adults aged 50 or older from The Irish Longitudinal Study on Ageing.

Results: Frailty index was seen to be negatively associated with cerebral oxygenation changes from baseline over a period of 7 seconds (p = .036). Heart rate and systolic blood pressure were positively and negatively associated with frailty index over periods of 17 seconds (p = .001) and 10 seconds (p = .015), respectively.

Conclusions: Statistical parametric mapping demonstrated these significant regions of cerebral oxygenation during orthostasis provide indirect evidence of impaired autoregulation associated with frailty. Statistical parametric mapping also replicated prior relationships in heart rate and systolic blood pressure associated with a higher frailty index. These findings highlight the utility of 1-dimensional statistical parametric modeling in identifying significant regions of interest in physiological recordings.
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http://dx.doi.org/10.1093/gerona/glaa315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087271PMC
April 2021

Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department.

Eur J Intern Med 2021 Mar 24;85:50-55. Epub 2020 Nov 24.

Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland.

Background: Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017.

Aim: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes.

Design: Retrospective observational study.

Methods: We included all first patients seen by Home FIRsT between 7 May and 19 October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital.

Results: In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models.

Conclusions: Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.
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http://dx.doi.org/10.1016/j.ejim.2020.11.015DOI Listing
March 2021

Frequency of Long QT in Patients with SARS-CoV-2 Infection Treated with Hydroxychloroquine: A Meta-analysis.

Int J Antimicrob Agents 2020 Dec 24;56(6):106212. Epub 2020 Oct 24.

Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland.

Introduction Hydroxychloroquine (HCQ) has been proposed as a SARS-CoV-2 treatment but the frequency of long QT (LQT) during use is unknown. Objective To conduct a meta-analysis of the frequency of LQT in patients with SARS-CoV-2 infection treated with HCQ. Data Sources PubMed, EMBASE, Google Scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv, Research Square) were searched for studies published between December 2019 and June 30, 2020. Methods Effect statistics were pooled using random effects. The quality of observational studies and randomized controlled trials was appraised with STROBE and the Cochrane Risk of Bias Assessment tools, respectively. Outcomes Critical LQT was defined as: (1) maximum QT corrected (QTc)≥500 ms (if QRS<120 ms) or QTc≥550 ms (if QRS≥120 ms), and (2) QTc increase ≥60 ms. Results In the 28 studies included (n=9124), the frequency of LQT during HCQ treatment was 6.7% (95% confidence interval [CI]: 3.7-10.2). In 20 studies (n=7825), patients were also taking other QT-prolonging drugs. The frequency of LQT in the other 8 studies (n=1299) was 1.7% (95% CI: 0.3-3.9). Twenty studies (n=6869) reported HCQ discontinuation due to LQT, with a frequency of 3.7% (95% CI: 1.5-6.6). The frequency of ventricular arrhythmias during HCQ treatment was 1.68% (127/7539) and that of arrhythmogenic death was 0.69% (39/5648). Torsades de Pointes occurred in 0.06% (3/5066). Patients aged >60 years were at highest risk of HCQ-associated LQT (P<0.001). Conclusions HCQ-associated cardiotoxicity in SARS-CoV-2 patients is uncommon but requires ECG monitoring, particularly in those aged >60 years and/or taking other QT-prolonging drugs.
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http://dx.doi.org/10.1016/j.ijantimicag.2020.106212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584880PMC
December 2020

Changes in muscle strength and physical function in older patients during and after hospitalisation: a prospective repeated-measures cohort study.

Age Ageing 2021 01;50(1):153-160

Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Aim: to investigate changes in knee-extension strength and physical function in older adults during and after acute hospital admission, and the contributions of illness severity, frailty and sedentary activity to changes in knee-extension strength.

Methods: prospective repeated-measures cohort study on a sample of participants aged ≥75 recruited within 24 hours of acute hospital admission. Knee-extension, grip strength and functional mobility (de Morton Mobility Index, DEMMI) were measured at recruitment, day 7 (or discharge if earlier), and at follow-up 4-6 weeks later. During the first 7 days, continuous measurement of physical activity and daily measurements of muscle strength were taken. Participants recalled the functional ability they had 2-weeks before admission and self-reported it at follow-up (Barthel Index, BI).

Results: sixty-five of 70 participants (median age 84 years) had at least one repeated measure of muscle strength in hospital. Knee-extension strength declined during hospitalisation by 11% (P < 0.001), but did not change post-hospitalisation (P = 0.458). Grip strength did not change during hospitalisation (P = 0.665) or from discharge to follow-up (P = 0.508). General functional ability (BI) deteriorated between 2 weeks before admission and follow-up (P < 0.001). Functional mobility (DEMMI) improved during hospitalisation (P < 0.001), but did not change post-hospitalisation (P = 0.508). A repeated-measures mixed model showed that greater loss in knee-extension strength during hospitalisation was associated with increased sedentary time, frailty and baseline strength and lower baseline inflammatory levels.

Conclusions: our observations add to a growing body of evidence on potential risk factors for hospital-associated deconditioning.
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http://dx.doi.org/10.1093/ageing/afaa103DOI Listing
January 2021

Clinical clustering of eight orthostatic haemodynamic patterns in The Irish Longitudinal Study on Ageing (TILDA).

Age Ageing 2021 05;50(3):854-860

The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.

Background: Orthostatic hypotension (OH) can be assessed with non-invasive continuous beat-to-beat haemodynamic monitoring during active stand (AS) testing; this yields large volumes of data outside the scope of the traditional OH definition. We explored clinical associations of different AS patterns in participants from Wave 1 of the Irish Longitudinal Study on Ageing.

Methods: AS patterns were generated based on three sequential binary systolic blood pressure features: drop ≥40 mmHg within 10 sec post-stand ("immediate deficit"), failure to return to within 20 mmHg of supine level at 40 sec after standing ("stabilisation deficit") and drop ≥20 mmHg between >40 and 120 sec post-stand ("late deficit"). Eight AS groups resulted from combining the presence/absence of these three features. The groups were cross-sectionally characterised, and their ability to independently predict orthostatic intolerance (OI) during AS, and falls or syncope in the past year, was evaluated using multivariate logistic regression models.

Results: A total of 4,899 participants were included (mean age 61), of which 3,312 (68%) had no deficits. Older age was associated with stabilisation deficit and late deficits were seen in groups with higher proportions of beta blockers and psychotropic medications. Regression models identified independent associations between OI and three immediate-deficit groups; associations seemed stronger as more deficits were present. There was a significant association between falls history and the three-deficit group (odds ratio 1.54, 95% confidence interval: 1.15-2.07, P = 0.004).

Conclusions: More deficits seemed associated with the higher risk of OI and falls history. Observations are not causal but the recognition of these patterns may help clinicians focus on careful prescribing.
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http://dx.doi.org/10.1093/ageing/afaa174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098799PMC
May 2021

Functional Analysis of Continuous, High-Resolution Measures in Aging Research: A Demonstration Using Cerebral Oxygenation Data From the Irish Longitudinal Study on Aging.

Front Hum Neurosci 2020 3;14:261. Epub 2020 Jul 3.

The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland.

: A shift towards the dynamic measurement of physiologic resilience and improved technology incorporated into experimental paradigms in aging research is producing high-resolution data. Identifying the most appropriate analysis method for this type of data is a challenge. In this work, the functional principal component analysis (fPCA) was employed to demonstrate a data-driven approach to the analysis of high-resolution data in aging research. : Cerebral oxygenation during standing was measured in a large cohort [The Irish Longitudinal Study on Aging (TILDA)]. FPCA was performed on tissue saturation index (TSI) data. A regression analysis was then conducted with the functional principal component (fPC) scores as the explanatory variables and transition time as the response. : The mean ± SD age of the analysis sample was 64 ± 8 years. Females made up 54% of the sample and overall, 43% had tertiary education. The first PC explained 96% of the variance in cerebral oxygenation upon standing and was related to a baseline shift. Subsequent components described the recovery to before-stand levels (fPC2), drop magnitude and initial recovery (fPC3 and fPC4) as well as a temporal shift in the location of the minimum TSI value (fPC5). Transition time was associated with components describing the magnitude and timing of the nadir. : Application of fPCA showed utility in reducing a large amount of data to a small number of parameters which summarize the inter-participant variation in TSI upon standing. A demonstration of principal component regression was provided to allow for continued use and development of data-driven approaches to high-resolution data analysis in aging research.
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http://dx.doi.org/10.3389/fnhum.2020.00261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379867PMC
July 2020

Clustering of Behavioral Changes and Their Associations With Cognitive Decline in Older Adults.

J Am Med Dir Assoc 2020 11 25;21(11):1689-1695.e1. Epub 2020 Jul 25.

Department of Psychology, Maynooth University, Maynooth, Ireland.

Objectives: To examine (1) the clustering of reduced falls-efficacy, social withdrawal, and physical activity withdrawal in Irish adults aged 50 years and older, and (2) the concurrent and prospective associations of these clustered behaviors with cognitive decline.

Design: Longitudinal cohort study.

Setting And Participants: Data were from 4571 participants (mean age 64.5 ± 8.6, 54.9% women) in The Irish Longitudinal Study on Ageing, a population-based study.

Methods: Changes in social and physical activity and falls-efficacy from 2012/2013 to 2014/2015 were used to define the behaviors of social withdrawal, physical activity withdrawal, and reduced falls-efficacy. Patterns of behaviors were associated with concurrent (2012/2013-2014/2015) and prospective (2014/2015-2016/2017) changes in immediate recall, delayed recall, and verbal fluency using random effects mixed models.

Results: Eighty-six percent of participants had social withdrawal, physical activity withdrawal, or reduced falls-efficacy, and 15% had all 3 behaviors. Participants with all 3 behaviors showed the greatest declines in immediate recall (concurrent: B = -0.51, confidence interval [CI] = -0.77 to -0.25; prospective: B = -0.51, CI = -0.78 to -0.25), delayed recall (concurrent: B = -0.40, CI = -0.61 to -0.18; prospective: B = -0.47, CI = -0.69 to -0.25) and verbal fluency (concurrent: B = -1.05, CI = -1.58 to -0.52; prospective: B = -1.29, CI = -1.83 to -0.74).

Conclusions And Implications: The clustering of social withdrawal, physical activity withdrawal, and reduced falls-efficacy is common. Presence of multiple behaviors was associated with greater cognitive declines, suggesting a cumulative association of these behaviors with cognitive decline. These findings guide (1) identification of vulnerable groups, (2) intervention design, and (3) care planning for people presenting with 1 or more of these changes in behavior.
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http://dx.doi.org/10.1016/j.jamda.2020.05.063DOI Listing
November 2020

A pharmacological perspective of chloroquine in SARS-CoV-2 infection: An old drug for the fight against a new coronavirus?

Int J Antimicrob Agents 2020 Sep 4;56(3):106078. Epub 2020 Jul 4.

Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is having serious consequences on health and the economy worldwide. All evidence-based treatment strategies need to be considered to combat this new virus. Drugs need to be considered on scientific grounds of efficacy, safety and cost. Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration should be given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events. The safety of CQ and HCQ has been studied for over 50 years, however recently published data raise concerns for cardiac toxicity of CQ/HCQ in patients with COVID-19. This review also re-examines the real information provided by some of the published alarming reports, although concluding that cardiac toxicity should in any case be stringently monitored in patients receiving CQ/HCQ.
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http://dx.doi.org/10.1016/j.ijantimicag.2020.106078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334645PMC
September 2020

Predictors of physical activity in older adults early in an emergency hospital admission: a prospective cohort study.

BMC Geriatr 2020 05 18;20(1):177. Epub 2020 May 18.

Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Background: Reduced mobility may be responsible for functional decline and acute sarcopenia in older hospitalised patients. The drivers of reduced in-hospital mobility are poorly understood, especially during the early phase of acute hospitalisation. We investigated predictors of in-hospital activity during a 24-h period in the first 48 h of hospital admission in older adults.

Methods: This was a secondary analysis of a prospective repeated measures cohort study. Participants aged 75 years or older were recruited within the first 24 h of admission. At recruitment, patients underwent a baseline assessment including measurements of pre-morbid functional mobility, cognition, frailty, falls efficacy, co-morbidity, acute illness severity, knee extension strength and grip strength, and consented to wear accelerometers to measure physical activity during the first 7 days (or until discharge if earlier). In-hospital physical activity was defined as the amount of upright time (standing or walking). To examine the predictors of physical activity, we limited the analysis to the first 24 h of recording to maximise the sample size as due to discharge from hospital there was daily attrition. We used a best subset analysis including all baseline measures. The optimal model was defined by having the lowest Bayesian information criterion in the best-subset analyses. The model specified a maximum of 5 covariates and used an exhaustive search.

Results: Seventy participants were recruited but eight were excluded from the final analysis due to lack of accelerometer data within the first 24 h after recruitment. Patients spent a median of 0.50 h (IQR: 0.21; 1.43) standing or walking. The optimal model selected the following covariates: functional mobility as measured by the de Morton Mobility Index and two measures of illness severity, the National Early Warning Score, and serum C-reactive protein.

Conclusions: Physical activity, particularly in the acute phase of hospitalisation, is very low in older adults. The association between illness severity and physical activity may be explained by symptoms of acute illness being barriers to activity. Interdisciplinary approaches are required to identify early mobilisation opportunities.
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http://dx.doi.org/10.1186/s12877-020-01562-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236296PMC
May 2020
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