Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study

Caterina Trevisan, Susanna Del Signore, Stefano Fumagalli, Pietro Gareri, Alba Malara, Enrico Mossello, Stefano Volpato, Fabio Monzani, Alessandra Coin, Giuseppe Bellelli, Gianluca Zia, Anette Hylen Ranhoff, Raffaele Antonelli Incalzi, GeroCovid Working Group, Caterina Trevisan, Susanna Del Signore, Stefano Fumagalli, Pietro Gareri, Alba Malara, Enrico Mossello, Stefano Volpato, Fabio Monzani, Alessandra Coin, Giuseppe Bellelli, Gianluca Zia, Anette Hylen Ranhoff, Raffaele Antonelli Incalzi, GeroCovid Working Group

Abstract

Background: Despite the growing evidence on COVID-19, there are still many gaps in the understanding of this disease, especially in individuals in advanced age. We describe the study protocol of GeroCovid Observational, a multi-purpose, multi-setting and multicenter initiative that aims at investigating: risk factors, clinical presentation and outcomes of individuals affected by COVID-19 in acute and residential care settings; best strategies to prevent infection in long-term care facilities; and, impact of the pandemic on neuropsychologic, functional and physical health, and on medical management in outpatients and home care patients at risk of COVID-19, with a special focus on individuals with dementia.

Methods: GeroCovid involves individuals aged ≥60 years, at risk of or affected by COVID-19, prospectively or retrospectively observed since March 1st, 2020. Data are collected in multiple investigational sites across Italy, Spain and Norway, and recorded in a de-identified clinical e-Registry. A common framework was adapted to different care settings: acute wards, long-term care facilities, geriatric outpatient and home care, and outpatient memory clinics.

Results: At September 16th, 2020, 66 investigational sites obtained their Ethical Committee approval and 1618 cases (mean age 80.6 [SD=9.0] years; 45% men) have been recorded in the e-Registry. The average inclusion rate since the study start on April 25th, 2020, is 11.2 patients/day. New cases enrollment will ended on December 31st , 2020, and the clinical follow-up will end on June 30th, 2021.

Conclusion: GeroCovid will explore relevant aspects of COVID-19 in adults aged ≥60 years with high-quality and comprehensive data, which will help to optimize COVID-19 prevention and management, with practical implications for ongoing and possible future pandemics.

Trial registration: NCT04379440 (clinicaltrial.gov).

Keywords: COVID-19; Health Services for the Aged; Inpatients; Nursing Homes; Observational Study; Outpatients.

Conflict of interest statement

None.

Copyright © 2021. Published by Elsevier B.V.

Figures

Figure 1
Figure 1
Age distribution of the 734 men and the 883 women enrolled in the GeroCovid initiative (data updated to the September 16th, 2020; n=1 participant had missing information on sex)
Figure 2
Figure 2
Frequency of GeroCovid cases by setting of care (data updated to the September 16th, 2020)

References

    1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA - J Am Med Assoc. 2020;323:2052–2059. doi: 10.1001/jama.2020.6775.
    1. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020 doi: 10.1001/jama.2020.4683.
    1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 doi: 10.1001/jama.2020.1585.
    1. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-net, 14 states. Morb Mortal Wkly Rep. 2020;69:458–464. doi: 10.15585/MMWR.MM6915E3. 2020.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156.
    1. Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R. Frailty and Multimorbidity: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2019;74:659–666. doi: 10.1093/gerona/gly110.
    1. Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Heal. 2020:e444–e451. doi: 10.1016/S2468-2667(20)30146-8.
    1. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 doi: 10.1002/dmrr.3319.
    1. Zhao X, Zhang B, Li P, Ma C, Gu J, Hou P, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis Running title: Predictors of clinical prognosis of COVID-19. MedrxivOrg 2020:2020.03.17.20037572. .
    1. Mueller AL, Mcnamara MS, Sinclair DA. Why does COVID-19 disproportionately affect the elderly? Preprints 2020:1–32. .
    1. Franceschi C, Campisi J. Chronic Inflammation (Inflammaging) and Its Potential Contribution to Age-Associated Diseases. Journals Gerontol Ser A Biol Sci Med Sci. 2014;69:S4–S9. doi: 10.1093/gerona/glu057.
    1. Meftahi GH, Jangravi Z, Sahraei H, Bahari Z. The possible pathophysiology mechanism of cytokine storm in elderly adults with COVID-19 infection: the contribution of “inflame-aging. Inflamm Res. 2020;1:3. doi: 10.1007/s00011-020-01372-8.
    1. Guo T, Shen Q, Guo W, He W, Li J, Zhang Y. Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study. Gerontology. 2020:1–9. doi: 10.1159/000508734.
    1. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG. Epidemiology of COVID-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382:2005–2011. doi: 10.1056/NEJMoa2005412.
    1. Kemenesi G, Kornya L, Tóth GE, Kurucz K, Zeghbib S, Somogyi BA, et al. Nursing homes and the elderly regarding the COVID-19 pandemic: situation report from Hungary. GeroScience 2020:1. .
    1. Rada AG. COVID-19: The precarious position of Spain’s nursing homes. BMJ. 2020;369 doi: 10.1136/bmj.m1554.
    1. Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. 2020;180:817–818. doi: 10.1001/jamainternmed.2020.1562.
    1. Cuffaro L, Di Lorenzo F, Bonavita S, Tedeschi G, Leocani L, Lavorgna L. Dementia care and COVID-19 pandemic: a necessary digital revolution. Neurol Sci. 2020;41:1977–1979. doi: 10.1007/s10072-020-04512-4.
    1. De Filippo O, D’Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A. Reduced Rate of Hospital Admissions for ACS during COVID-19 Outbreak in Northern Italy. N Engl J Med. 2020 doi: 10.1056/nejmc2009166.
    1. Vindegaard N, Eriksen Benros M. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020 doi: 10.1016/j.bbi.2020.05.048.
    1. Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on September 7 th, 2020. n.d.
    1. WHO R&D Blueprint. novel Coronavirus COVID-19 - Therapeutic Trial Synopsis. Geneva, Switzerland: 2020.
    1. Pedone C, Costanzo L, Cesari M, Bandinelli S, Ferrucci L, Antonelli Incalzi R. Are Performance Measures Necessary to Predict Loss of Independence in Elderly People? - PubMed. J Gerontol A Biol Sci Med Sci. 2016;71:84–89. doi: 10.1093/gerona/glv096.
    1. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020.
    1. Constitution n.d. (accessed June 10, 2020).
    1. Grabowski DC, Joynt Maddox KE. Postacute Care Preparedness for COVID-19: Thinking Ahead. JAMA - J Am Med Assoc. 2020;323:2007–2008. doi: 10.1001/jama.2020.4686.
    1. Volpato S, Landi F, Incalzi RA. A Frail Health Care System for an Old Population: Lesson form the COVID-19 Outbreak in Italy. J Gerontol A Biol Sci Med Sci. 2020;XX:1–2. doi: 10.1093/gerona/glaa087.
    1. Cagnin A, Di Lorenzo R, Marra C, Bonanni L, Cupidi C, Laganà V. Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Front Psychiatry. 2020;11:1–15. doi: 10.3389/fpsyt.2020.578015.
    1. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's. Dement. 2011;7:263–269. doi: 10.1016/j.jalz.2011.03.005.
    1. Katz S. Assessing Self-maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living. J Am Geriatr Soc. 1983;31:721–727. doi: 10.1111/j.1532-5415.1983.tb03391.x.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186.
    1. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16:622–626.
    1. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93:580–586. doi: 10.1378/chest.93.3.580.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49.
    1. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–935.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (Sf-36): I. conceptual framework and item selection. Med Care. 1992;30:473–483. doi: 10.1097/00005650-199206000-00002.
    1. Spielberger C. State-Trait Anxiety Inventory for Adults - Manual, Instrument and Scoring Guide. 1983 Consult Psychol Press Inc Mind Gard Inc 2010:0–78. .
    1. Group TE. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy (New York) 1990;16:199–208. .
    1. Depression and Other Common Mental Disorders n.d. (accessed July 31, 2020).
    1. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17 doi: 10.3390/ijerph17051729.
    1. Tsai AC, Mini Lai M-Y. Nutritional Assessment and short-form Mini Nutritional Assessment can predict the future risk of falling in older adults – Results of a national cohort study. Clin Nutr. 2014;33:844–849. doi: 10.1016/j.clnu.2013.10.010.
    1. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res Aging. 2004;26:655–672. doi: 10.1177/0164027504268574.
    1. Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English longitudinal study of ageing. Psychosom Med. 2013;75:161–170. doi: 10.1097/PSY.0b013e31827f09cd.
    1. Carver CS. You want to measure coping but your protocol's too long: Consider the brief COPE. Int J Behav Med. 1997;4:92–100. doi: 10.1207/s15327558ijbm0401_6.
    1. Bottesi G, Ghisi M, Altoè G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015;60:170–181. doi: 10.1016/j.comppsych.2015.04.005.
    1. Caserta MS, Lund DA, Wright SD. Exploring the caregiver burden inventory (CBI): Further evidence for a multidimensional view of burden. Int J Aging Hum Dev. 1996;43:21–34. doi: 10.2190/2DKF-292P-A53W-W0A8.
    1. Cohen S. Perceived Stress Scale. 1994.
    1. Nucci M, Mapelli D, Mondini S. Cognitive Reserve Index questionnaire (CRIq): a new instrument for measuring cognitive reserve. Aging Clin Exp Res. 2012;24:218–226. doi: 10.3275/7800.
    1. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology. 1994;44 doi: 10.1212/WNL.44.12.2308. 2308–2308.
    1. Bellelli G, Morandi A, Davis DHJ, Mazzola P, Turco R, Gentile S. Validation of the 4AT, a new instrument for rapid delirium screening: A study in 234 hospitalised older people. Age Ageing. 2014;43:496–502. doi: 10.1093/ageing/afu021.
    1. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23:271–284. doi: 10.1016/0006-3223(88)90038-8.

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