COVID-19 and cardiovascular disease in elderly patients: a challenge in the challenge

On 11 March 2020, the World Health Organization declared a pandemic state, in relation to the spread of the severe acute respiratory syndrome-coronavirus disease- 2, responsible for the coronavirus disease- 2019 (COVID-19). The pandemical blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. Frail individual aged >65 years affected by cardiovascular disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate compared to general population. In this brief article, we will focus on the management of issues related to cardiovascular patients facing coronavirus infection, in particular in the most fragile groups of the population such as the elderly, increasingly numerous and affected by multimorbidity. Protecting aged populations will be a central question, probably primary in everyone’s interest.

Management of frailty at individual level – clinical management: Systematic literature review

IntroductionTo deliver quality management of a frail individual, a clinician should understand the concept of frailty, be aware of its epidemiology and be able to screen for frailty and assess it when it is present, and, finally, to recommend successful interventions.MethodologyA systematic literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published in the period from 2002 to 2017. From 67432 initial hits, 27 publications were selected.ResultsUseful interventions to address frailty are supplementation of vitamin D, proper nutrition, multicomponent training, home-based physiotherapy and comprehensive geriatric assessment, particularly when performed in geriatric wards.ConclusionComprehensive geriatric assessment is an effective way to decrease frailty status especially when performed in geriatric wards. Multicomponent physical training and multidimensional interventions (physical training, nutrition, vitamin D supplementation and cognitive training) are effective measures to reduce frailty.

Prevalence of phenotypic frailty during the aging process in a Portuguese community

The present study is based on the conceptual model defined by Fried which explains phenotypic frailty through the presence of the following criteria: weight loss; exhaustion; low physical activity; slowness and weakness. The aim of the present study was to identify the behaviour of phenotypic frailty and outline the profile of the frail elderly person. In order to do this, a random stratified sample of 339 individuals residing in the community was obtained. A frailty protocol was developed, composed of measures related to the aging process and phenotypic frailty. The results indicated a high prevalence of this syndrome (34.9%). It occurs more frequently among women (40.9%) and at more advanced ages (60.4%). The criteria that appeared most frequently in association with frailty are low physical activity (88.9%) and slowness (86.4%). Frail elderly individuals were characterized by being widow/separated/divorced (46.7%); illiterate (71.1%); living within a family with some degree of dependence (41.6%); living in unsuitable conditions (44.9%); having limited social relations (54.2%) and not receiving social support (37.6%). It can be concluded that frailty is a prevalent condition, and that the profile of the frail individual is associated with a set of characteristics that result in greater vulnerability, which suggests possible areas of intervention to minimize and delay this syndrome.