Mortality and survival in nonagenarians during the COVID-19 pandemic: Unstable equilibrium of aging

Abstract

IntroductionAging puts the human body under an immense stress and makes it extremely susceptible to many diseases, often leading to poor outcomes and even death. Long-living individuals represent a unique group of people who withstood the stress of time and offer an abundance of information on the body’s ability to endure the pressure of aging. In this study, we sought to identify predictors of overall one-year mortality in 1641 long-living individuals. Additionally, we analyzed risk factors for COVID-19-related morality, since statistics demonstrated an extreme vulnerability of older adults.MethodsWe conducted a two-stage evaluation, including a comprehensive geriatric assessment for major aging-associated: frailty, cognitive impairment, frontal lobe dysfunction, chronic pain, anxiety, risk of falls, sensory deficit, depression, sarcopenia, risk of malnutrition, fecal and urinary incontinence, dependence in Activities of Daily Living, dependence in Instrumental Activities of Daily Living, polypragmasia, and orthostatic hypotension; extensive blood testing, a survey, and a one-year follow-up interview.ResultsThe most reliable predictors of overall mortality were cognitive impairment, malnutrition, frailty, aging-associated diseases and blood markers indicating malnutrition-induced metabolic dysfunctions (decreased levels of protein fractions, iron, 25-hydroxyvitamin D, and HDL), and aging biomarkers, such as IGF-1 and N-terminal pro b-type natriuretic peptide. In post-COVID 19 participants, the most significant mortality predictors among geriatric syndromes were depression, frontal lobe dysfunction and frailty, and similar to overall mortality blood biomarkers - 25-hydroxyvitamin D, IGF-1, HDL as well as high white blood cell, neutrophils counts and proinflammatory markers. Based on the results, we built a predictive model of overall mortality in the long-living individuals with f-score=0.76.ConclusionThe most sensitive and reliable predictors of mortality were modifiable. This is another evidence of the critical importance of proper geriatric care and support for individuals in their “golden years”. These results could facilitate geriatric institutions in their pursuit for providing improved care and could aid physicians in detecting early signs of potentially deadly outcomes. Additionally, our findings could be used in developing day-to-day care guidelines, which would greatly improve prevention statistics.

Acute kidney injury in nonagenarians: clinical characteristics and mortality

“…Advancing age leads to several clinical and epidemiological differences between young and elderly patients. Even among the elderly, age groups should be considered in the patient's clinical management, since studies have shown differences in clinical profile and outcomes when comparing different age groups among patients aged 60 or older [9][10][11] In the studied group, there was a high prevalence of CKD patients (40%). Published studies suggest that these patients have a higher incidence of AKI 12 .…”

COVID‐19 and sarcopenia-related traits: a bidirectional Mendelian randomization study

“…These factors might act as competitive confounders in an observational study or mediating factors in a MR study. Cognitive impairment, frailty and other aging-associated diseases had the potential to serve as candidate factors ( 47 , 48 ). On the basis of these observations and our MR results, we highlighted that older people should pay more attention to prevention, diagnosis, and treatment of SP instead of specific interactions between COVID-19 and SP, which would make it easier to break the dangerous vicious cycle and improve quality of life.…”