Update 2021: Corona-Pandemie – Herausforderungen für die Geriatrie

Nach über einem Jahr stellt die Corona-Pandemie auch die Geriatrie weiterhin vor große Herausforderungen. Die Patienten sind zwar nicht mehr größtenteils (Hoch-) Betagte und die Virusmortalität besteht nun weniger bei multimorbiden Menschen, da diese weitgehend geimpft sind. Dennoch sind Hochbetagte immer noch speziell gefährdet, an einer COVID-19-Infektion zu sterben. Zudem beeinflusst die Pandemie die Versorgung betagter Menschen.

Abstract

Nobody supposed that after one year of the pandemia, the SARS-CoV-2 Virus and its emerging mutants dominates the press, our lives and the health system as a whole. As for Geriatric Medicine, many things have also changed: The majority of COVID-19 patients are no more the (oldest) old and mortality is less observed in multimorbid persons, as most of them have been vaccinated. (Oldest) old persons are still especially vulnerable to die due to a COVD-19 infection. In longterm care, a significant higher mortality was seen in the former waves, but now, some longterm care facilities have more places that they can fill. This is a situation that many European countries would never have anticipated.

Ressource allocationin stormy times is now more openly discussed, especially who should be admitted to intensive care units. This has led to more detailed and new guidelines which may help even when the pandemia is over. Here, some thoughts regarding the care of older adults in times of the pandemia are discussed.

Schlüsselwörter

Corona-Pandemie - COVID-19 - Geriatrie - Multimorbidität - Ernährung - Long-COVID

Key words

Coronavirus pandemic - COVID-19 - geriatrics - multimorbidity - diet - Long-Covid

Publication History

Article published online:
13 July 2021

• Literatur

• 1 Fried LP, Tangen CM, Walston J. et al Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
• 2 Sieber CC. Frailty – from concept to clinical practice. Exp Gerontol 2016. doi:S0531-5565(16)30139-5
• 3 Kojima G. Prevalence of frailty in nursing homes: A systematic review and meta-analysis. J Am Med Dir Assoc 2015; 16: 940-945
• 4 Hubbard RE, Maier AB, Hilmer SN. et al. Frailty in the face of COVID-19. Age and Ageing 2020;
• 5 Beard DR, Jotheeswaran AT, Cesari M. et al. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open 2019;
• 6 Sieber C. COVID-19: a geriatric point of view. Dtsch Med Wschr 2020; 145: 1039-1042
• 7 Nestola T, Orlandini L, Beard JR. et al. COVID-19 and intrinsic capacity. J Nutr Health Aging 2020; 24: 692-695
• 8 Juma S, Taabazuing MM, Montero-Odasso M. Clinical frailty scale in an acute medicine unit: a simple tool that predicts length of stay. Can Geriatrics J 2016; 19: 34-39
• 9 Basic D, Shanley C. Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes. J Aging Health 2015; 27: 670-685
• 10 Wallis SJ, Wall J, Biram RW. et al. Assosciation of the clinical frailty scale with hopsital outcomes. QJM 2015; 108: 943-949
• 11 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495
• 12 Deutsche Gesellschaft für Geriatrie (DGG). Clinical frailty scale. Im Internet (Stand: 30.06.2021): https://www.dggeriatrie.de
• 13 World Health Organization. International classification of functioning, disability and health: ICF. Geneva: 2001
• 14 Tinetti ME, Naik AD, Dodson JA. Moving from disease-centered to patient goals-directed care for patients with multiple chronic conditions: patient valued-based care. JAMA Cardiol 2015; 1: 9-10
• 15 Zhang XM, Jiao J, Cao J. et al. Frailty as a predictor of mortality among patients with COVID-19: a systemic review and meta-analysis. BMC Geriatrics 2021; 21: 816
• 16 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062
• 17 Lithander FE, Neumann S, Tenison E. et al. COVID-19 in older people: a rapid clinical review. Age and Ageing 2020;
• 18 Aiello A, Forzaneh F, Candore G. et al. Immunosenescence and its hallmarks: how to oppose aging strategically? A review of potential options for therapeutic intervention. Front Immun 2010;
• 19 COVID-19-Pandemie: Triage von intensivmedizinischen Behandlungen bei Ressourcenknappheit. Aktualisierte Version 3.1 vom 17. Dezember 2020. Im Internet: https://www.samw.ch
• 20 Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a national academies report. Am J Geriatr Psychiatry 2020; 28: 1233-1244
• 21 Pun BT, Badenes R, Heras La Calle G. et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med 2021; 9: 239-250
• 22 Zazzara MA, Penfold RS, Roberts AL. et al. Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age Ageing 2021; 50: 4048
• 23 Inouye SK, van Dyck CH, Alessi CA. et al. Clatifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941-948
• 24 Folstein MF, Folstein SE, MgHugh PR. „Mini mental state“. A practical method for grading the cognitive state of patients fort he clinician. J Psychiatr Res 1975; 12: 189-198
• 25 Hantke NC, Gould CG. Examining older adult cognitive status in the time of COVID-19. J Am Geriatr Soc 2020;
• 26 Pironi L, Sasdelli AS, Ravaioli F. et al. Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease. Clin Nutr 2020;
• 27 Bedock D, Bel Lassen P, Mathian A. et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN 2020; 40: 214-219
• 28 Li T, Zhang Y, Gong C. et al. Prevalence of malnutrition and analysis related factors in elderly patients with COVID-19 in Wuhan. China Eur J Clin Nutr 2020; 74: 871-875
• 29 Drey M, Ferrari U, Schraml M. et al. German version of SARC-F: Translation, adaptation, and validation. J Am Med Dir Assoc 2020; 21: 747-751
• 30 Casas-Herrero A, Anton-Rodrigo I, Zambon-Ferraresi F. et al. Effect of multicomponent exercise programme (VIVIFRAIL) on functional capacity in frail community elders with cognitive decline: study protocol for a randomized multicentre control trial. Trials 2019; 20: 363
• 31 Azzolino D, Saporiti E, Proietti M. et al. Nutritional considerations in frail older patients with COVID-19. J Nutr Health Aging 2020; 24: 696-698
• 32 Martineau AR, Forouhi NG. Vitamin D for COVID-19: a case to answer?. Lancet Diabetes Endocrinol 2020; 8: 735-736
• 33 Illie PC, Stefanescu S, Smith L. The role of vitamin d in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res 2020; 32: 1195-1198
• 34 Cangiamo B, Fatti LM, Danesi L. et al. Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations oft he diagnostic tests. Aging 2020; 12: 34522-24534
• 35 Allegra A, Tonacci A, Pioggia G. et al. Vitamin deficiency as risk factor for SARS-CiV-2 infection: correlation with suceptibility and prgonosis. Eur Rev Med Pharmacol Sci 2020; 24: 9721-9738
• 36 Cereda E, Bogliolo L, de Stefano L. et al. A brief discussion of the benefit and mechanism of vitamin D supplementation on coronavirus disease 2019: Curr Opin. Clin Nutr Metab Care 2020;
• 37 Rhodes JM, Subrmanian S, Laird E. et al. Perspective: vitamin D deficiency and COVID-19 severity – plausibly linked by latitude, ethnicitiy, impacts on cytokines, ACE2 and thrombosis. J Intern Med 2020;
• 38 Chopra V, Flanders SA, O´Malley M. et al. Sixty-day outcomes among patients hospitalized with COVID-19. Ann Intern Med 2020;
• 39 Song WJ, Hui CKM, Hull JH. et al Confronting COVID-19- associated cough and post-COVID syndrome: role of neurotropism, neuroinflammation, and neuroimmune response. Lancet Resp Med 2021; 9: 533-544
• 40 Sudre CH, Murray B, Varsavsky T. et al. Attributes and predictors of Long-Covid: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App.
• 41 Huang C, Huang L, Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232