Allen Y. Chang, MDCM, Kimberly N. Babb, FRCPC
Faculty of Medicine, Memorial University, St. John’s, NL.DOI: https://doi.org/10.5770/cgj.25.553
ABSTRACT
Background
Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness.
Method
We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric population between December 2019 and April 2021, a total of 748 articles.
Results
The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism.
Conclusion
This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.
Key words: COVID-19, geriatric, bio-psycho-social, coronavirus, biological, psychological, sociological
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has devastated the world over the past year. First notified on December 31st, 2019, the World Health Organization officially declared a global pandemic on March 11th, 2020.(1) Since then, there have been over 150 million confirmed cases and 3 million deaths worldwide.(2) In Canada, there have been 1,219,418 confirmed cases, as well as 24,219 deaths as of April 30th, 2021.(3)
Previous studies have indicated one out of every three deaths of older adults are caused by infectious diseases,(4) and the COVID-19 pandemic is certainly no different; the case fatality rate of COVID-19 has been found to grow exponentially with age.(5,6) Older adults were also particularly vulnerable to increasing fear and loneliness.(7) Interestingly, the systemic expression of the angiotensin-converting enzyme 2 (ACE2) receptor, through which the SARS-CoV-2 virus is dependent on to infect cells, has been show to decrease with age among older adults.(8) However, the ACE2 receptor expression has been found to increase with age in the lungs,(6) likely contributing to the severity and mortality in the geriatric population. Building upon the concept of frailty as being defined as accumulation of deficits and comorbidities,(9) it is understandable that older adults are therefore more predisposed to mortality due to strong associations with pre-existing, age-related diseases.(6)
The Bio-Psycho-Social model was proposed by George L. Engel in 1977. Prior to this, there was a dominance of the biomedical model, which excluded the sociological and psychological impacts on health. The Bio-Psycho-Social model, in contrast, utilizes a more holistic approach which illustrates the overlapping domains within health and their interactions.(10) When adapted for use in the health of older adults, they include, but are not limited to, the following aspects: a) Biological—age, comorbidities, immunosenescence, b) Psychological—anxiety, loss of loved ones, cognitive decline, and c) Sociological—isolation, negative stereotypes, ageism.
In preparing this literature review, 749 studies were reviewed on electronic databases and preprint servers (PubMed, Google Scholar, bioRxiv, SSRN), of which 113 English articles were found to be relevant and up-to-date pertaining to the older adult population. Databases were searched for the key words of “geriatrics,” “older adults,” “older individuals,” “aged,” or “aging” to encompass the older adult population. Key words of “COVID-19,” “COVID,” “coronavirus,” and “SARS-CoV-2” were used to search for articles about the COVID-19 pandemic. Articles not addressing both COVID-19 and older adults were excluded, as were articles writing in languages other than English and without dedicated translations. The majority of articles defined the older adult population as age 65 or older, though some studies investigated a smaller subset of age ranges within this population. When articles had opposing views, both the majority consensus and dissenting views were included. Articles included and cited are original research, unless interpretations from secondary sources are deemed relevant. Search dates range from December 31st, 2019 to April 30th, 2021. Given that the Bio-Psycho-Social model describes the three domains as being integrated parts of the whole, the following review will separate findings by the domain in which the primary research goal is characterized.
Aging is associated with increasing risk factors of disease. In young individuals, aging plays a non-significant role, and disease risk is largely determined by the overlap of genetic and environmental predispositions. As an individual ages, the role of aging increases, overlapping with the genetic and environmental predispositions. At extreme ages, age-related predispositions become the predominant risk factor for disease risk.(11)
The concept of inflammaging vs. immunosenescence in older adults is not new. Inflammaging is defined as the imbalance between pro-inflammatory and anti-inflammatory pathways. Decreased macrophage and T cell activation leads to stunted pro-inflammatory response. On the other hand, decreased anti-inflammatory pathways lead to a low-grade sterile inflammation.(11) Both the innate and adaptive responses within lymphoid and non-lymphoid tissues become impaired.(12) Furthermore, decreased naïve T cells with an associated accumulation of memory T and B cells in circulation are observed,(13) with more cells entering senescence overall.(14) The accumulated and exhausted T cells also preferentially secrete pro-inflammatory INF and TNF factors.(15) In combination, older adults are more predisposed to latent or novel infections, resulting in increased morbidity and mortality.(12)
Isolation and loneliness have led to several detrimental outcomes in older adults, and both have been associated with poor sleep quality and physical inactivity.(16) Physical inactivity, in turn, leads to sarcopenia and frailty, and lack of sunlight may translate to lower vitamin D levels, which has been associated with impaired immunity.(17) Worsening age-associated conditions, along with frailty and falls, have also been observed.(18) In particular, older adults living in isolation in nursing homes experienced more falls.(19) Loneliness and social isolation have also previously been associated with hypertension, cardiac disease, and cardiac-associated deaths.(20–22) In all, the following recommendations have been made for older adults during this time: exercising while taking caution with masks, small amounts of sugar prior to exercising (found to be anti-inflammatory), and caution against binging of foods.(23)
After being infected with COVID-19, older adults often have atypical presentations and higher mortality as a result of immunosenescence and multiple age-related comorbid conditions.(24) This is particularly true for those living in nursing homes, making those living in these institutions particularly vulnerable.(19,23,25) Multiple age-related comorbidities have been associated with poorer outcomes such as heart and lung disease, diabetes, dementia, and polypharmacy.(24) Specifically, poor prognosis is linked to male gender, diabetes mellitus,(26–28) hypertension, malignancy,(29) renal disease, obesity,(30) as well as presenting with increased O2 requirements, bilateral chest infiltrates on imaging, and crackles on exam.(31) Severity of infection has been found to be associated with a variety of factors: albumin, D-dimer, onset to hospitalization time,(32) ADL impairment, fever, and increased C-reactive protein.(33) Higher mortality rates were associated with increasing age, frailty, inflammation, renal disease, cardiovascular disease, and cancers; age and frailty were independently associated with higher mortality.(34) Nutritional deficiency was also associated with significantly longer length of stay, higher hospital expenses, poor appetite, heavier disease severity, and more weight change.(35) Linear associations have also been found between clinical frailty score, functional status, and mortality.(36–40) Older adults also have a high risk for developing cardiac injuries due to yet-unknown etiologies;(41) heart failure as a result of cardiac injuries may mimic the symptoms of COVID pneumonia-related dyspnea, but can be differentiated by point-of-care ultrasound (POCUS).(42)
Based on the prognostic factors identified above, several assessment tools have been found to be appropriate for assessing in-hospital mortality in older adults, including ISARIC-4C, COVID-GRAM, qSOFA, lung ultrasound score (LUS), and possibly qCSI and NEWS.(43–45) Furthermore, it has been hypothesized that accurate prognostication of older adults including the three following components are more accurate than the individual components themselves(46): a) current risk classification systems such as Pneumonia Severity Index (PSI) and CURB-65, b) nutritional status such as utilizing the Geriatric Nutritional Risk Index,(47) and c) functional status with Eastern Cooperative Oncology Group (ECOG) score, Barthel index, or handgrip strength.
While disease-modifying medications of COVID-19 have not been specifically studied in the older adult population, certain medications have been demonstrated to impact prognosis. Alterations of gut microbiota have been observed post-infection, likely due to antibiotic use. Targeting the microbiota has been speculated to help treatment and reduce pro-inflammatory states.(48) The COVIT-TRIAL has demonstrated vitamin D3 supplementation improves survival rates and also decreases severity of illness.(49,50) Older adults who were on vitamin K antagonists have been associated with increased mortality.(51) Diabetic patients on metformin should be monitored for increased disease progression,(52) though studies done in nursing homes without age restriction have found it to reduce 30-day mortality.(53) Patients on angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) prior to infection have better outcomes, and their use should be continued throughout hospitalization.(54) There was also dose-dependent immunosuppressant usage associated with mortality in observational studies.(55)
Once older adults have overcome COVID-19 infections, rehabilitation becomes the cornerstone for moving towards their new baseline. Six-week respiratory therapy has been associated with improvements in both respiration and quality of life.(56) Physiotherapy should not only take into account the patient’s respiratory symptoms, but also their functional status prior to hospitalization.(57) Malnutrition was a common (57%) consequence, likely driven by multiple processes.(58) Therefore, nutritional status should be targeted for therapy, especially for older adults with diabetes mellitus, low calf circumference, and low albumin.(58) Age, frailty, delirium, dementia, and mental health diagnoses are also associated with higher care needs post-discharge.(34)
Vaccines are seen as the way to bring the pandemic to an end, but many uncertainties are associated with their efficacy in older adults. Immunosenescence was thought to impair the response of the vaccine among this population, similar to what has been observed in other vaccines.(59) Natural immunity developed post-infection was also found to be comparatively less in older adults.(60) To date, there have been limited studies regarding the exact impacts of aging on human immune responses, largely inferring from animal model data.(61) However, unanticipated effectiveness has been observed, especially in the new generation of mRNA vaccines, which does not appear to be limited by the aging biology.(62) In contrast to annual influenza vaccines which do not confer long-term memory and poorly stimulate T cell response, COVID-19 vaccines based on mRNA technology appear to be potent stimulators of CD4 and CD8 T cells.(63,64)
As our understanding of the immune response to COVID-19 increases, it has become clear that humoral response and cellular response play different roles. Humoral responses alone may not be sufficient to prevent severe disease, but potent responses may in fact worsen the outcomes.(65,66) Mutations in the COVID-19 variants have also been speculated to lead to changes in epitopes that may dampen the highly specific B-cell mediated humoral response.(67) Prior studies of the immune response against coronavirus have suggested CD8 T cells may confer cross-reactivity and immunity against other strains, as well as COVID-19.(68) Previous SARS-infected patients were found to continue having T cell responses 17 years after the initial outbreak.(65,69) Thus, it has been suggested that T cell recruitment is essential in the long-term protection against COVID-19, and should be engaged via vaccines.(70)
A variety of vaccines have been developed against COVID-19, some of which have been studied more than others. In pre-print data studying the efficacy of single dose BNT162b2 and ChAdOx1 vaccines, both vaccines were found to have comparable B cell responses and titres (93% and 87%, respectively). However, the ChAdOx1 vaccine elicited a superior T cell response (30.7% to 12.3%). This difference remains unclear, but may be attributed to the adenovirus vectors.(71) These high single-dose humoral response findings were found to “support” the decision by Canadian and UK governments to delay second doses of the vaccine, allowing for inoculation of more individuals at a time when vaccine supplies were limited. It has also been noted that the second dose of BNT162b2 vaccine induces strong humoral and cellular responses, including responses against variants.(72,73) Interestingly, studies have also found the Bacillus Calmette-Guérin (BCG) vaccine may also train the innate immune response of older adults to reduce the severity of COVID-19 infections.(74)
Psychological changes have been associated with both predisposition towards and resulting sequalae of COVID-19 infections. Here, we focus on the following three categories of psychological symptoms of older adults, and associated treatments: delirium, dementia, and mood disorders.
Delirium has been identified as a common presentation of older adults with COVID-19 in the emergency department.(75) There are case reports where delirium was the sole symptom.(76) In both hospital and community dwelling older adults, delirium was also more prevalent in those who were frail.(77) While some studies dispute the association with higher mortality,(34) most studies agree that delirium is associated with poorer outcomes and death.(78–80) The most common types of delirium were hypoactive, followed by hyperactive and mixed.(80) Therefore, screening for delirium as a symptom of COVID-19 is suggested.(75) Unfortunately, as part of the treatment of cytokine storm and immune-mediated severe encephalopathy associated with COVID-19 infection, corticosteroids are the medication of choice, which may cause or worsen delirium. Regrettably, no interventional trials have yet to investigate this in the older adult population, and due to this lack of evidence, it is presently recommended that the risks and benefits are evaluated and balanced for each patient.(81) Furthermore, the multidimensional prognostic index (MPI), an assessment tool that encompasses multiple health domains, has been found to be predictive of delirium and death, and has been recommended to be incorporated as part of the comprehensive geriatric assessment (CGA).(82)
The COVID-19 pandemic has had a negative impact on patients with cognitive impairments and dementia. Their needs were often neglected, and caregiver stress increased in the context of little external support. It has since been recommended that regular contact be made with these families, as well as the distribution of self-help guides to help the patients during times of social distancing.(83) It is expected that long-term impacts may include less stringent follow-up and less frequent medication adjustments in an already vulnerable population.(17) Case reports have also highlighted the progression of mild cognitive impairment and associated mood symptoms as a result of pandemic distancing.(84) In combination with depression, loneliness has resulted in worsening cognition,(85) increasing the incidence of dementia.(86) The cardiorespiratory fitness decline during isolation has also been associated with decline in cognitive functioning.(17) Hence, it is recommended to utilize remote access digital platforms to assess or provide therapy to patients with dementia.(81) One group of patients who are particularly vulnerable are those with dementia living in care homes, which has been associated with mortality, specifically more so in Alzheimer’s dementia compared to frontotemporal dementia.(87) This is particularly interesting because frontotemporal dementia patients were less likely to follow COVID-19 preventative measures as a symptom of the disease nature.(88) Moreover, for unknown reasons, both Alzheimer’s dementia and Parkinson’s disease are associated with increased risk of being infected by COVID-19.(89)
Long-term isolation during the pandemic has also been found to result in mood disorders. Thirty-seven per cent (37%) of older adults during the pandemic experienced anxiety and depression,(16,90) and survivors of COVID-19 significantly suffered more.(91) In particular, those with Alzheimer’s dementia were also more at risk for developing anxiety and depression.(92) The sudden loss of a loved one may also result in prolonged grief disorder, a new diagnosis recently included in ICD-11 and under consideration for DSM-5, where adaptations to loss are stalled or halted.(93) Previous studies have found that loneliness and isolation are not only associated with suicide attempts and completed suicides in older adults,(94) but also reduced resiliency factors such as self-worth, sense of purpose, and feeling valued.(95) The pandemic has led to a combination of risk factors which increase the risk of suicide, and should be mitigated.(96) Moving forward, resiliency is identified as having an essential role in healthy aging within the post-COVID era.(97)
Fortunately, many treatment methods have been studied for mood disorders associated with COVID-19. Yoga has been suggested as a form of exercise to prevent or alleviate mental health symptoms.(98,99) Exergames, defined as physically active video games, have been found to be beneficial for anxiety.(100) For anxiety post-COVID infection, six-week respiratory therapy has been found to improve anxiety, but not depression.(56) As shown for anxiety symptoms, patients who exercised experienced less depression-like symptoms.(101) More specifically, vigorous and moderate-vigorous physical activity was associated with better resilience, positive affect, and fewer depressive symptoms.(102) In patients who experience severe debilitating depression, electroconvulsive therapy should be utilized once the patients swab negative.(103,104) Zoom small groups also significantly improved loneliness, and marginally improved depression. However, the authors recognized that cost will be a major limiting factor.(105) Older adults also have other obstacles in accessing telemedicine including social disparity (which will be discussed further in the sociological section below); frailty and multimorbidity due to physical limitations such as sensory and dexterity impairments, and cognitive deficits are also limiting factors.(106,107) Regardless of the treatment modality, ongoing screening, intervention, and follow up should continue through telemedicine.(108–110)
While there is little doubt about the long-term sequelae that patients previously infected by COVID-19 may suffer, it remains to be seen how it may impact the practice of geriatricians. An eye-opening study recently published found one in three patients developed neurocognitive or psychiatric outcomes at six months post-infection. Furthermore, 1 in 50 inpatients and 1 in 500 outpatients infected with COVID-19 also developed dementia,(111) an observation also confirmed by other research groups,(112,113) Similar results have been observed by the same research group at three months post-infection, which also identified bidirectional associations between COVID-19 and dementia,(114) and more severe outcomes.(115) This certainly poses the question whether geriatricians will encounter more post-COVID–infection patients suffering from diseases previously associated with the geriatric population. While longer term studies and observations are required to elucidate this question, early data have suggested that the Montreal Cognitive Assessment (MoCA) is validated for detecting mild cognitive impairment in COVID patients.(112,113,116)
Soon after the World Health Organization declared COVID-19 a pandemic, the United Nations Department of Economic and Social Affairs posted an issue brief regarding the impacts of COVID-19 on older persons. Of note, the issues that were highlighted were largely centred on the social implications of the care and well-being of older adults.(117) As the world was struggling with the fallout of COVID-19, the basic needs and rights of older adults were often neglected or overlooked.
Ageism, a term coined by gerontologist Dr Robert Butler in 1969, describes the stereotyping and discrimination based upon the age of individuals or groups.(118) That same stereotyping has characterized older adults as “vulnerable,” “at risk,” and “needy” during the COVID era.(119) These concepts were commonplace online, where one out of every four tweets about COVID-19 analyzed were identified as being ageist or offensive towards older adults.(120) However, these worrisome trends were also introduced into the policies of governments and institutions. In response to overflowing intensive care units during the early months of COVID-19, Italy utilized policies that worked against older adults, including but not limited to setting age limits for ICU admissions, or further evaluating the comorbidities of older adults prior to ICU admission,(121) and we in Canada are certainly not exempt from utilizing similar policies.(122) The American Geriatric Society has also since then recommended against similar ageist policies,(123) and the United Nations has also called upon governments to include older adults in consultation for policy-making.(117) Colenda et al.(124) have recommended the following four goals to prevent ageist policies: a) make clinical research more inclusive of all ages, such as emergent use of experimental therapies and diagnostic tools; b) engage geriatricians and gerontologists in institutional decisions regarding care, including rationing; c) inform policy and funding with cognizance of the needs of vulnerable populations; and d) emphasize the importance of personalized approaches to older adults that enact respect for autonomy, justice, and beneficence.
Older adults are also more vulnerable to disparities in everyday life, which the pandemic has unfortunately magnified. Older adults and those socioeconomically vulnerable have been identified as being disproportionately affected, and once infected, there were also inequalities noted with regard to their medical and social care, as well as their long-term consequences.(125) In Canada, early waves of COVID-19 ravaged older adults living in long-term facilities, demonstrating the dire need for reform;(122,126,127) data from Ontario’s Long-Term Care COVID-19 Commission shows that little has been done to mitigate this one year into the pandemic.(128) While internet and digital technologies have connected the world in the current times of social distancing, older adults have also been disproportionately limited in their use,(129,130) leaving them with worse outcomes associated with isolation.
End-of-life care is quintessential in the care of older adults with COVID-19, given the higher mortality associated with age. Kunz and Minder(131) have made the following recommendations for palliation when the situation arises: a) consideration of palliation at home or in nursing homes, or allowing for visits of families during visitation ban; b) optimizing of comfort care medications; and c) open discussion regarding advance care planning. Due to social distancing and visitation bans, many patients in early days of COVID-19 were dying alone without the company of their loved ones. It is recommended that exceptions are made for the family members of dying patients by utilizing rapid testing of the caregivers and family where available.(132) It is also important to take into account the end-of-life experience specific to COVID-19 which have shorter dying phases, for which comfort care medication should be targeted accordingly.(133) Palliative care teams should be involved in the care of these patients and the discussions of advance care planning, as well as any communications with family members who are unable to be at the side of the patients.(132)
As the COVID-19 pandemic progresses, our understanding of its impacts evolves daily. This literature review serves as a summary of the research that has been published to date, and highlights many questions that are still yet unanswered. It is quite unfortunate, however, that older adults are under-represented in randomized controlled trials,(134) and that there is a lack of research investigating the role of comprehensive geriatric assessment.(135) There are still many unknowns due to the lack of high-quality research amongst older adults,(134) such as what the long-term sequelae are, or whether more patients will require care going forward due to developing geriatric syndromes. Nevertheless, there is no doubt that the consequences of COVID-19 will be observed within the geriatric population in years to come, and physicians must be ready with the knowledge to provide care.
We would like to thank our Department of Geriatrics colleagues at Memorial University, as well as the reviewers who have kindly taken their time to assist us in refining this manuscript.
We have read and understood the Canadian Geriatrics Journal’s policy on conflicts of interest disclosure and declare there are no conflicts of interest.
This research did not receive external funding.
1 Listings of WHO’s response to COVID-19: WHO; 2020 [cited 2021 May 1, 2021]. Available from: https://www.who.int/news/item/29-06-2020-covidtimeline
2 Center for Systems Science and Engineering (CSSE). COVID-19 dashboard. Baltimore, MD: John Hopkins University; 2021 [updated 2021/04/30; cited 2021 04/30]. Available from: https://coronavirus.jhu.edu/map.html
3 Government of Canada. COVID-19 daily epidemiology update. 2021 [updated April 30 2021; cited 2021 April 30]. Available from: https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html
4 Kline KA, Bowdish DM. Infection in an aging population. Curr Opin Microbiol. 2016;29:63–7. Epub 2015/12/18. doi: 10.1016/j.mib.2015.11.003
5 Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669–77. Epub 2020/04/03. doi: 10.1016/s1473-3099(20)30243-7
6 Santesmasses D, Castro JP, Zenin AA, et al. COVID-19 is an emergent disease of aging. Aging Cell. 2020;19(10):e13230. Epub 2020/10/03. doi: 10.1111/acel.13230
7 Cihan FG, Gökgöz Durmaz F. Evaluation of COVID-19 phobia and the feeling of loneliness in the geriatric age group. Int J Clin Pract. 2021;75(6):e14089. Epub 2021/02/12. doi: 10.1111/ijcp.14089
8 Chen J, Jiang Q, Xia X, et al. Individual variation of the SARS-CoV-2 receptor ACE2 gene expression and regulation. Aging Cell. 2020;19(7):e13168. Epub 2020/06/20. doi: 10.1111/acel.13168
9 Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Gobbens RJJ, Ebadi A, Ghaedamini Harouni G. The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis. BMC Geriatr. 2020;20(1):526. doi: 10.1186/s12877-020-01935-8
10 Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36. Epub 1977/04/08. doi: 10.1126/science.847460
11 Fillit HM, Rockwood K, Young J. Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, eighth ed. Amsterdam: Elsevier; 2016.
12 Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections? Front Physiol. 2021;11(1793). doi: 10.3389/fphys.2020.571416
13 Stahl EC, Brown BN. Cell therapy strategies to combat immunosenescence. organogenesis. 2015;11(4):159–72. Epub 2015/11/21. doi: 10.1080/15476278.2015.1120046
14 Weyand CM, Goronzy JJ. Aging of the immune system. Mechanisms and therapeutic targets. Ann Am Thorac Soc. 2016;13(Suppl 5):S422–S428. Epub 2016/12/23. doi: 10.1513/AnnalsATS.201602-095AW
15 Brunner S, Herndler-Brandstetter D, Weinberger B, Grubeck-Loebenstein B. Persistent viral infections and immune aging. Ageing Res Rev. 2011;10(3):362–69. Epub 2010/08/24. doi: 10.1016/j.arr.2010.08.003
16 Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging. 2020;24(9):938–47. Epub 2020/11/07. doi: 10.1007/s12603-020-1469-2
17 Palmer K, Monaco A, Kivipelto M, et al. The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing. Aging Clin Exp Res. 2020;32(7):1189–94. Epub 2020/05/28. doi: 10.1007/s40520-020-01601-4
18 Briguglio M, Giorgino R, Dell’Osso B, et al. Consequences for the elderly after COVID-19 isolation: FEaR (frail elderly amid restrictions). Front Psychol. 2020;11(2433). doi: 10.3389/fpsyg.2020.565052
19 Tan LF, Seetharaman S. Preventing the spread of COVID-19 to nursing homes: experience from a Singapore Geriatric Centre. J Am Geriatr Soc. 2020;68(5):942. Epub 2020/04/02. doi: 10.1111/jgs.16447
20 Heffner KL, Waring ME, Roberts MB, Eaton CB, Gramling R. Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults. Soc Sci Med. 2011;72(9):1482–88. Epub 2011/04/16. doi: 10.1016/j.socscimed.2011.03.016
21 Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci USA. 2013;110(15):5797–801. Epub 2013/03/27. doi: 10.1073/pnas.1219686110
22 Yu B, Steptoe A, Chen LJ, Chen YH, Lin CH, Ku PW. Social isolation, loneliness, and all-cause mortality in patients with cardiovascular disease: a 10-year follow-up study. Psychosom Med. 2020;82(2):208–14. Epub 2019/12/17. doi: 10.1097/psy.0000000000000777
23 Yang YC, Chou CL, Kao CL. Exercise, nutrition, and medication considerations in the light of the COVID pandemic, with specific focus on geriatric population: a literature review. J Chin Med Assoc. 2020;83(11):977–80. Epub 2020/07/18. doi: 10.1097/jcma.0000000000000393
24 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. Geroscience. 2020;42(2):505–14. Epub 2020/04/11. doi: 10.1007/s11357-020-00186-0
25 Fisman DN, Bogoch I, Lapointe-Shaw L, McCready J, Tuite AR. Risk factors associated with mortality among residents with coronavirus disease 2019 (COVID-19) in long-term care facilities in Ontario, Canada. JAMA Netwk Open. 2020;3(7):e2015957. Epub 2020/07/23. doi: 10.1001/jamanetworkopen.2020.15957
26 Wu J, Zhang J, Sun X, et al. Influence of diabetes mellitus on the severity and fatality of SARS-CoV-2 (COVID-19) infection. Diabetes Obes Metab. 2020;22(10):1907–14. Epub 2020/06/05. doi: 10.1111/dom.14105
27 Zhang P, Wang M, Wang Y, et al. Risk factors associated with the progression of COVID-19 in elderly diabetes patients. Diabetes Res Clin Pract. 2021;171:108550. Epub 2020/11/25. doi: 10.1016/j.diabres.2020.108550
28 Al-Salameh A, Lanoix JP, Bennis Y, et al. Characteristics and outcomes of COVID-19 in hospitalized patients with and without diabetes. Diabetes Metab Res Rev. 2021;37(3):e3388. Epub 2020/07/20. doi: 10.1002/dmrr.3388
29 Azwar MK, Setiati S, Rizka A, Fitriana I, Saldi SRF, Safitri ED. Clinical profile of elderly patients with COVID-19 hospitalised in Indonesia’s National General Hospital. Acta Med Indones. 2020;52(3):199–205. Epub 2020/10/07.
30 McMichael TM, Currie DW, Clark S, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005–11. Epub 2020/03/27. doi: 10.1056/NEJMoa2005412
31 Mendes A, Serratrice C, Herrmann FR, et al. Predictors of in-hospital mortality in older patients with COVID-19: The COVIDAge Study. J Am Med Dir Assoc. 2020;21(11):1546–54. Epub 2020/11/04. doi: 10.1016/j.jamda.2020.09.014
32 Zeng F, Deng G, Cui Y, et al. A predictive model for the severity of COVID-19 in elderly patients. Aging. 2020;12(21):20982–96. Epub 2020/11/11. doi: 10.18632/aging.103980
33 Hwang J, Ryu HS, Kim HA, Hyun M, Lee JY, Yi HA. Prognostic factors of COVID-19 infection in elderly patients: a multicenter study. J Clin Med. 2020;9(12):3932. Epub 2020/12/10. doi: 10.3390/jcm9123932
34 Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing. 2021;50(3):617–30. doi: 10.1093/ageing/afab026
35 Liu G, Zhang S, Mao Z, Wang W, Hu H. Clinical significance of nutritional risk screening for older adult patients with COVID-19. Eur J Clin Nutr. 2020;74(6):876–83. Epub 2020/05/15. doi: 10.1038/s41430-020-0659-7
36 Aw D, Woodrow L, Ogliari G, Harwood R. Association of frailty with mortality in older inpatients with Covid-19: a cohort study. Age Ageing. 2020;49(6):915–22. Epub 2020/08/12. doi: 10.1093/ageing/afaa184
37 Collins JT, Short R, Carter B, et al. The clinical frailty scale: estimating the prevalence of frailty in older patients hospitalised with COVID-19. The COPE Study. Geriatrics. 2020;5(3):58. Epub 2020/09/25. doi: 10.3390/geriatrics5030058
38 Pranata R, Henrina J, Lim MA, et al. Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr. 2021;93:104324. Epub 2020/12/15. doi: 10.1016/j.archger.2020.104324
39 Plotnikov G, Waizman E, Tzur I, Yusupov A, Shapira Y, Gorelik O. The prognostic role of functional dependency in older inpatients with COVID-19. BMC Geriatr. 2021;21(1):219. Epub 2021/04/02. doi: 10.1186/s12877-021-02158-1
40 Blomaard LC, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, et al. Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study. Age Ageing. 2021;50(3):631–40. Epub 2021/01/31. doi: 10.1093/ageing/afab018.
41 Yan X, Wang S, Ma P, Yang B, Si D, Liu G, et al. Cardiac injury is associated with inflammation in geriatric COVID-19 patients. J Clin Lab Anal. 2021;35(1):e23654. Epub 2020/11/20. doi: 10.1002/jcla.23654
42 Hacquin A, Putot S, Barben J, et al. Bedside chest ultrasound to distinguish heart failure from pneumonia-related dyspnoea in older COVID-19 patients. ESC Heart Fail. 2020;7(6):4424–28. Epub 2020/10/14. doi: 10.1002/ehf2.13017
43 Covino M, De Matteis G, Burzo ML, Russo A, Forte E, Carnicelli A, et al. Predicting In-Hospital Mortality in COVID-19 Older Patients with Specifically Developed Scores. J Am Geriatr Soc. 2021;69(1):37–43. Epub 2020/11/17. doi: 10.1111/jgs.16956.
44 Zerah L, Baudouin É, Pépin M, et al. Clinical characteristics and outcomes of 821 older patients with SARS-Cov-2 infection admitted to acute care geriatric wards: a multicenter retrospective cohort study. J Gerontol A Biol Sci Med Sci. 2021;76(3):e4–e12. Epub 2020/08/28. doi: 10.1093/gerona/glaa210
45 Recinella G, Marasco G, Tufoni M, et al. Clinical role of lung ultrasound for the diagnosis and prognosis of coronavirus disease pneumonia in elderly patients: a pivotal study. Gerontology. 2021;67(1):78–86. Epub 2020/12/04. doi: 10.1159/000512209
46 Lidoriki I, Frountzas M, Schizas D. Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? Med Hypotheses. 2020;144:109946. Epub 2020/06/02. doi: 10.1016/j.mehy.2020.109946
47 Recinella G, Marasco G, Serafini G, et al. Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study. Aging Clin Exp Res. 2020;32(12):2695–701. Epub 2020/10/10. doi: 10.1007/s40520-020-01727-5
48 Zuo T, Zhang F, Lui GCY, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology. 2020;159(3):944–55. Epub 2020/05/23. doi: 10.1053/j.gastro.2020.05.048
49 Annweiler C, Beaudenon M, Gautier J, et al. COvid-19 and high-dose VITamin D supplementation TRIAL in high-risk older patients (COVIT-TRIAL): study protocol for a randomized controlled trial. Trials. 2020;21(1):1031. Epub 2020/12/30. doi: 10.1186/s13063-020-04928-5
50 Annweiler C, Hanotte B, de l’Eprevier CG, Sabatier JM, Lafaie L, Célarier T. Vitamin D and survival in COVID-19 patients: a quasi-experimental study. J Steroid Biochem Mol Biol. 2020;204:105771. Epub 2020/10/17. doi: 10.1016/j.jsbmb.2020.105771
51 Ménager P, Brière O, Gautier J, et al. Regular Use of VKA prior to COVID-19 associated with lower 7-day survival in hospitalized frail elderly COVID-19 patients: the GERIA-COVID Cohort Study. Nutrients. 2020;13(1). Epub 2020/12/31. doi: 10.3390/nu13010039
52 Gao Y, Liu T, Zhong W, et al. Risk of metformin in patients with type 2 diabetes with COVID-19: a preliminary retrospective report. Clin Transl Sci. 2020;13(6):1055–59. Epub 2020/09/22. doi: 10.1111/cts.12897
53 Lally MA, Tsoukas P, Halladay CW, O’Neill E, Gravenstein S, Rudolph JL. Metformin is associated with decreased 30-day mortality among nursing home residents infected with SARS-CoV2. J Am Med Dir Assoc. 2021;22(1):193–98. Epub 2020/11/25. doi: 10.1016/j.jamda.2020.10.031
54 Genet B, Vidal JS, Cohen A, et al. COVID-19 in-hospital mortality and use of renin-angiotensin system blockers in geriatrics patients. J Am Med Dir Assoc. 2020;21(11):1539–45. Epub 2020/11/04. doi: 10.1016/j.jamda.2020.09.004
55 Myint PK, Carter B, Barlow-Pay F, et al. Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19. Ther Adv Drug Saf. 2021;12:2042098620985690. Epub 2021/03/09. doi: 10.1177/2042098620985690
56 Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement Ther Clin Pract. 2020;39:101166. Epub 2020/05/08. doi: 10.1016/j.ctcp.2020.101166
57 Levi N, Ganchrow K, Gheva M. Decision-making: physical therapist intervention for patients with COVID-19 in a geriatric setting. Phys Ther. 2020;100(9):1465–68. Epub 2020/06/27. doi: 10.1093/ptj/pzaa116
58 Li T, Zhang Y, Gong C, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020;74(6):871–75. Epub 2020/04/22. doi: 10.1038/s41430-020-0642-3
59 Pawelec G, McElhaney J. Unanticipated efficacy of SARS-CoV-2 vaccination in older adults. Immun Ageing. 2021;18(1):7. doi: 10.1186/s12979-021-00219-y
60 Hansen CH, Michlmayr D, Gubbels SM, Mølbak K, Ethelberg S. Assessment of protection against reinfection with SARS-CoV-2 among 4 million PCR-tested individuals in Denmark in 2020: a population-level observational study. Lancet. 2021;397(10280):1204–12. Epub 2021/03/21. doi: 10.1016/s0140-6736(21)00575-4
61 Pawelec G, Bronikowski A, Cunnane SC, et al. The conundrum of human immune system “senescence”. Mech Ageing Develop. 2020;192:111357. doi: https://doi.org/10.1016/j.mad.2020.111357
62 Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Eng J Med. 2020;383(27):2603–15. doi: 10.1056/NEJMoa2034577
63 Walsh EE, Frenck RW, Falsey AR, et al. Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates. N Eng J Med. 2020;383(25):2439–50. doi: 10.1056/NEJMoa2027906
64 Sahin U, Muik A, Derhovanessian E, et al. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. Nature. 2020;586(7830):594–99. doi: 10.1038/s41586-020-2814-7
65 Vabret N, Britton GJ, Gruber C, et al. Immunology of COVID-19: current state of the science. Immunity. 2020;52(6):910–41. Epub 2020/06/09. doi: 10.1016/j.immuni.2020.05.002
66 Oja AE, Saris A, Ghandour CA, et al. Divergent SARS-CoV-2-specific T and B cell responses in severe but not mild COVID-19. Eur J Immunol. 2020;50(12):1998–2012. doi: 10.1101/2020.06.18.159202
67 Kim SJ, Nguyen VG, Park YH, Park BK, Chung HC. A novel synonymous mutation of SARS-CoV-2: is this possible to affect their antigenicity and immunogenicity? Vaccines. 2020;8(2):220. Epub 2020/05/20. doi: 10.3390/vaccines8020220
68 Lee CH, Pinho MP, Buckley PR, et al. Potential CD8+ T Cell cross-reactivity against SARS-CoV-2 conferred by other coronavirus strains. Front Immunol. 2020:2878. doi: 10.3389/fimmu.2020.579480
69 Le Bert N, Tan AT, Kunasegaran K, et al. SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls. Nature. 2020;584(7821):457–62. Epub 2020/07/16. doi: 10.1038/s41586-020-2550-z
70 Sauer K, Harris T. An effective COVID-19 vaccine needs to engage T Cells. Front Immunol. 2020:2371. doi: 10.3389/fimmu.2020.581807
71 Parry HM, Bruton R, Tut G, et al. Single vaccination with BNT162b2 or ChAdOx1 in older people induces equivalent antibody generation but enhanced cellular responses after ChAdOx1. SSRN [Preprint]. 2021. doi: http://dx.doi.org/10.2139/ssrn.3825573
72 Parry HM, Tut G, Faustini S, et al. BNT162b2 vaccination in people over 80 years of age induces strong humoral immune responses with cross neutralisation of P.1 Brazilian variant. SSRN [Preprint]. 2021. doi: http://dx.doi.org/10.2139/ssrn.3816840
73 Angyal A, Longet S, Moore S, et al. T-Cell and antibody responses to first BNT162b2 vaccine dose in previously SARS-CoV-2-infected and infection-naive UK healthcare workers: a multicentre, prospective, observational cohort study. SSRN [Preprint]. 2021. doi: http://dx.doi.org/10.2139/ssrn.3812375
74 Sohrabi Y, Dos Santos JC, Dorenkamp M, et al. Trained immunity as a novel approach against COVID-19 with a focus on Bacillus Calmette-Guérin vaccine: mechanisms, challenges and perspectives. Clin Transl Immunol. 2020;9(12):e1228. Epub 2020/12/29. doi: 10.1002/cti2.1228
75 Kennedy M, Helfand BKI, Gou RY, et al. Delirium in older patients with COVID-19 presenting to the emergency department. JAMA Netwk Open. 2020;3(11):e2029540. Epub 2020/11/20. doi: 10.1001/jamanetworkopen.2020.29540
76 Alkeridy WA, Almaghlouth I, Alrashed R, et al. A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19. J Am Geriatr Soc. 2020;68(7):1382–84. Epub 2020/05/10. doi: 10.1111/jgs.16536
77 Zazzara MB, 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(1):40–48. Epub 2020/09/29. doi: 10.1093/ageing/afaa223
78 Duggan MC, Van J, Ely EW. Delirium assessment in critically ill older adults: considerations during the COVID-19 pandemic. Crit Care Clin. 2021;37(1):175–90. Epub 2020/11/17. doi: 10.1016/j.ccc.2020.08.009
79 Mattace-Raso F, Polinder-Bos H, Oosterwijk B, et al. Delirium: a frequent manifestation in COVID-19 older patients. Clin Interv Aging. 2020;15:2245–47. Epub 2020/12/10. doi: 10.2147/cia.S280189
80 Mendes A, Herrmann FR, Périvier S, Gold G, Graf CE, Zekry D. Delirium in older patients with COVID-19: prevalence, risk factors and clinical relevance. J Gerontol A Biol Sci Med Sci. 2021;76(8):142–48. Epub 2021/02/05. doi: 10.1093/gerona/glab039
81 Mok VCT, Pendlebury S, Wong A, et al. Tackling challenges in care of Alzheimer’s disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimers Dement. 2020;16(11):1571–81. Epub 2020/08/14. doi: 10.1002/alz.12143
82 Castagna A, Manzo C, Ruotolo G. Comprensive Geriatric Assessment in hospitalized older patients with COVID-19. Geriatr Gerontol Int. 2021;21(1):118–19. Epub 2020/12/02. doi: 10.1111/ggi.14103
83 Canevelli M, Valletta M, Blasi MT, et al. Facing dementia during the COVID-19 outbreak. J Am Geriatr Soc. 2020;68(8):1673–76. Epub 2020/06/10. doi: 10.1111/jgs.16644
84 Padala KP, Parkes CM, Padala PR. Neuropsychological and functional impact of COVID-19 on mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2020;35:1533317520960875. Epub 2020/09/25. doi: 10.1177/1533317520960875
85 Hwang TJ, Rabheru K, Peisah C, Reichman W, Ikeda M. Loneliness and social isolation during the COVID-19 pandemic. Int Psychogeriatr. 2020;32(10):1217–20. Epub 2020/05/27. doi: 10.1017/s1041610220000988
86 Kuiper JS, Zuidersma M, Voshaar RC, et al. Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39–57. Epub 2015/05/10. doi: 10.1016/j.arr.2015.04.006
87 Matias-Guiu JA, Pytel V, Matías-Guiu J. Death rate due to COVID-19 in Alzheimer’s disease and frontotemporal dementia. J Alzheimers Dis. 2020;78(2):537–41. Epub 2020/10/20. doi: 10.3233/jad-200940
88 Suzuki M, Hotta M, Nagase A, et al. The behavioral pattern of patients with frontotemporal dementia during the COVID-19 pandemic. Int Psychogeriatr. 2020;32(10):1231–34. Epub 2020/06/10. doi: 10.1017/S104161022000109X
89 Yu Y, Travaglio M, Popovic R, Leal NS, Martins LM. Alzheimer’s and Parkinson’s diseases predict different COVID-19 outcomes: a UK Biobank study. Geriatrics. 2021;6(1):10. Epub 2021/02/04. doi: 10.3390/geriatrics6010010
90 Meng H, Xu Y, Dai J, Zhang Y, Liu B, Yang H. Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Res. 2020;289:112983. Epub 2020/04/11. doi: 10.1016/j.psychres.2020.112983
91 Mowla A, Ghaedsharaf M, Pani A. Psychopathology in elderly COVID-19 survivors and controls. J Geriatr Psychiatry Neurol. 2021:8919887211002664. Epub 2021/03/23. doi: 10.1177/08919887211002664
92 El Haj M, Altintas E, Chapelet G, Kapogiannis D, Gallouj K. High depression and anxiety in people with Alzheimer’s disease living in retirement homes during the covid-19 crisis. Psychiatry Res. 2020;291:113294. Epub 2020/08/09. doi: 10.1016/j.psychres.2020.113294
93 Goveas JS, Shear MK. Grief and the COVID-19 pandemic in older adults. Am J Geriatr Psychiatry. 2020;28(10):1119–25. Epub 2020/06/27. doi: 10.1016/j.jagp.2020.06.021
94 Fässberg MM, van Orden KA, Duberstein P, et al. A systematic review of social factors and suicidal behavior in older adulthood. Int J Environ Res Public Health. 2012;9(3):722–45. Epub 2012/06/13. doi: 10.3390/ijerph9030722
95 Novotney A. The risks of social isolation. Monitor Psychol. 2019;50(5):32. Available from: https://www.apa.org/monitor/2019/05/ce-corner-isolation
96 Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019—a perfect storm? [Viewpoint] JAMA Psychiatry. 2020;77(11):1093–94. Epub 2020/04/11. doi: 10.1001/jamapsychiatry.2020.1060
97 Chen LK. Older adults and COVID-19 pandemic: resilience matters. Arch Gerontol Geriatr. 2020;89:104124. Epub 2020/06/01. doi: 10.1016/j.archger.2020.104124
98 Ransing R, da Costa MP, Adiukwu F, et al. Yoga for COVID-19 and natural disaster related mental health issues: challenges and perspectives. Asian J Psychiatr. 2020;53:102386. Epub 2020/09/13. doi: 10.1016/j.ajp.2020.102386
99 Mohanty S, Sharma P, Sharma G. Yoga for infirmity in geriatric population amidst COVID-19 pandemic: comment on “Age and Ageism in COVID-19: elderly mental health-care vulnerabilities and needs”. Asian J Psychiatr. 2020;53:102199. Epub 2020/06/27. doi: 10.1016/j.ajp.2020.102199
100 Viana RB, de Lira CAB. Exergames as coping strategies for anxiety disorders during the COVID-19 QUARANTINE PERIOD. Games Health J. 2020;9(3):147–49. Epub 2020/05/07. doi: 10.1089/g4h.2020.0060
101 Callow DD, Arnold-Nedimala NA, Jordan LS, et al. The mental health benefits of physical activity in older adults survive the COVID-19 pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046–57. Epub 2020/07/28. doi: 10.1016/j.jagp.2020.06.024
102 Carriedo A, Cecchini JA, Fernandez-Rio J, Méndez-Giménez A. COVID-19, psychological well-being and physical activity levels in older adults during the nationwide lockdown in Spain. Am J Geriatr Psychiatry. 2020;28(11):1146–55. Epub 2020/09/14. doi: 10.1016/j.jagp.2020.08.007
103 Burhan AM, Safi A, Blair M, O’Reilly R. Electroconvulsive therapy for geriatric depression in the COVID-19 era: reflection on the ethics. Am J Geriatr Psychiatry. 2020;28(8):900–02. Epub 2020/05/20. doi: 10.1016/j.jagp.2020.05.007
104 Sienaert P, Lambrichts S, Popleu L, Van Gerven E, Buggenhout S, Bouckaert F. Electroconvulsive therapy during COVID-19-times: our patients cannot wait. Am J Geriatr Psychiatry. 2020;28(7): 772–75. Epub 2020/04/30. doi: 10.1016/j.jagp.2020.04.013
105 Shapira S, Yeshua-Katz D, Cohn-Schwartz E, Aharonson-Daniel L, Sarid O, Clarfield AM. A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak. Internet Interv. 2021;24:100368. Epub 2021/02/03. doi: 10.1016/j.invent.2021.100368
106 Doraiswamy S, Jithesh A, Mamtani R, Abraham A, Cheema S. Telehealth use in geriatrics care during the COVID-19 pandemic-a scoping review and evidence synthesis. Int J Environ Res Public Health. 2021;18(4):1755. doi: 10.3390/ijerph18041755
107 Parker SJ, Jessel S, Richardson JE, Reid MC. Older adults are mobile too! Identifying the barriers and facilitators to older adults’ use of mHealth for pain management. BMC Geriatr. 2013;13(1):43. doi: 10.1186/1471-2318-13-43
108 Gould CE, Hantke NC. Promoting technology and virtual visits to improve older adult mental health in the face of COVID-19. Am J Geriatr Psychiatry. 2020;28(8):889–90. Epub 2020/05/15. doi: 10.1016/j.jagp.2020.05.011
109 Hantke NC, Gould C. Examining older adult cognitive status in the time of COVID-19. J Am Geriatr Soc. 2020;68(7):1387–89. Epub 2020/04/29. doi: 10.1111/jgs.16514
110 Zubatsky M, Berg-Weger M, Morley J. Using telehealth groups to combat loneliness in older adults through COVID-19. J Am Geriatr Soc. 2020;68(8):1678–79. Epub 2020/05/12. doi: 10.1111/jgs.16553
111 Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry. 2021;8(5):416–27. doi: 10.1016/S2215-0366(21)00084-5
112 Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: a longitudinal prospective study nested to a population cohort. Eur J Neurol. 2021;28(10):3245–53. Epub 2021/02/13. doi: 10.1111/ene.14775
113 Pilotto A, Cristillo V, Piccinelli SC, Zoppi N, Bonzi G, Sattin D, et al. Long-term neurological manifestations of COVID-19: prevalence and predictive factors. Neurol Sci. 2021;42(12):4903–07. doi: 10.1101/2020.12.27.20248903.
114 Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8(2):130–40. Epub 2020/11/13. doi: 10.1016/s2215-0366(20)30462-4
115 Vrillon A, Mhanna E, Aveneau C, et al. COVID-19 in adults with dementia: clinical features and risk factors of mortality-a clinical cohort study on 125 patients. Alzheimers Res Ther. 2021;13(1):77. Epub 2021/04/12. doi: 10.1186/s13195-021-00820-9
116 Blazhenets G, Schröter N, Bormann T, et al. Slow but evident recovery from neocortical dysfunction and cognitive impairment in a series of chronic COVID-19 patients. J Nuclear Med. 2021;62(7):910–15. doi: 10.2967/jnumed.121.262128.
117 United Nations. Issue Brief: Older persons and COVID-19: A defining moment for informed, inclusive and targeted respons. New York: United Nations Department of Economics and Social Affairs; 2020.
118 Butler RN. Age-ism: another form of bigotry. The Gerontologist. 1969;9(4Part1):243–46. doi: 10.1093/geront/9.4_Part_1.243
119 Webb L. COVID-19 lockdown: a perfect storm for older people’s mental health. J Psychiatr Ment Health Nurs. 2021;28(2):300. Epub 2020/05/01. doi: 10.1111/jpm.12644
120 Jimenez-Sotomayor MR, Gomez-Moreno C, Soto-Perez-de-Celis E. Coronavirus, ageism, and twitter: an evaluation of tweets about older adults and COVID-19. J Am Geriatr Soc. 2020;68(8):1661–65. Epub 2020/04/28. doi: 10.1111/jgs.16508
121 Cesari M, Proietti M. COVID-19 in Italy: ageism and decision making in a pandemic. J Am Med Dir Assoc. 2020;21(5):576–77. Epub 2020/04/01. doi: 10.1016/j.jamda.2020.03.025
122 Hogan DB, MacKnight C, Madden KM, Montero-Odasso M, Stall N. Canadian geriatrics in the time of COVID-19. J Am Geriatr Soc. 2020;68(6):1173–74. Epub 2020/04/29. doi: 10.1111/jgs.16518
123 Farrell TW, Ferrante LE, Brown T, et al. AGS Position Statement: Resource allocation strategies and age-related considerations in the COVID-19 era and beyond. J Am Geriatr Soc. 2020;68(6):1136–42. Epub 2020/05/07. doi: 10.1111/jgs.16537
124 Colenda CC, Reynolds CF, Applegate WB, et al. COVID-19 pandemic and ageism: a call for humanitarian care [Editorial]. J Am Geriatr Soc. 2020;68(8):1627–28. Epub 2020/07/14. doi: 10.1111/jgs.16663
125 Calderón-Larrañaga A, Dekhtyar S, Vetrano DL, Bellander T, Fratiglioni L. COVID-19: risk accumulation among biologically and socially vulnerable older populations. Ageing Res Rev. 2020;63:101149. Epub 2020/08/17. doi: 10.1016/j.arr.2020.101149
126 Flint AJ, Bingham KS, Iaboni A. Effect of COVID-19 on the mental health care of older people in Canada. Int Psychogeriatr. 2020;32(10):1113–16. Epub 2020/04/24. doi: 10.1017/S1041610220000708
127 Webster P. COVID-19 highlights Canada’s care home crisis. Lancet. 2021;397(10270):183. Epub 2021/01/18. doi: 10.1016/s0140-6736(21)00083-0.
128 Government of Ontario, Ontario’s Long-Term Care COVID-19 Commission. Ontario’s Long-Term Care COVID-19 Commission: Final Report (Marrocco FN, Coke A, Kitts J, commissioners). Toronto: 2021.
129 Anderson M, Perrin A. Tech adoption climbs among older adults. Washington, DC: Pew Research Center; 2017.
130 UK Office for National Statistics. Internet users, UK: 2020 [updated 2021/04/06; cited 2020 04/30]. Available from: https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2020
131 Kunz R, Minder M. COVID-19 pandemic: palliative care for elderly and frail patients at home and in residential and nursing homes. Swiss Med Wkly. 2020;150(1314). Epub 2020/03/26. doi: 10.4414/smw.2020.20235
132 Mills JP, Kaye KS, Mody L. COVID-19 in older adults: clinical, psychosocial, and public health considerations. JCI Insight. 2020;5(10):e139292. doi: 10.1172/jci.insight.139292
133 Turner J, Hodgson LE, Leckie T, Eade L, Ford-Dunn S. A dual-center observational review of hospital-based palliative care in patients dying with COVID-19. J Pain Symptom Manage. 2020;60(2):e75–e8. Epub 2020/05/06. doi: 10.1016/j.jpainsymman.2020.04.031
134 Prendki V, Tau N, Avni T, et al. A systematic review assessing the under-representation of elderly adults in COVID-19 trials. BMC Geriatr. 2020;20(1):538. Epub 2020/12/22. doi: 10.1186/s12877-020-01954-5
135 Córdova LDS, Vega APM, Luján-Carpio E, et al. Clinical characteristics of older patients with COVID-19: a systematic review of case reports. Dement Neuropsychol. 2021;15(1):1–15. Epub 2021/04/29. doi: 10.1590/1980-57642021dn15-010001
Canadian Geriatrics Journal, Vol. 25, No. 2, June 2022