Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung's parenchyma and airways that increase with aging. 1 Globally and in India, the growing burden of COPD is due to continuous exposure to the risk factors like environmental tobacco smoke, outdoor and indoor air pollution, and population aging. 2 This is the third leading cause of death worldwide and the second leading cause of disease burden in India, causing 8.7% of total deaths in India. 2,3 Over 80% of these deaths occur in low-and middle-income countries. 3 Prevalence of COPD in India has increased from 3.3% in 1990 to 4.2% in 2016, according to the global burden of disease study. 2 Whereas the prevalence and morbidity of COPD in older adults are high, it is often undiagnosed and remains undertreated in India. 2,4 Most patients with COPD have an extra-pulmonary component which leads to morbidity and mortality. 5 These extra-pulmonary

Background The World Health Organization has conceptualised the health and healthcare of older adults around the concept of healthy ageing. Healthy ageing is defined as “the process of developing and maintaining the functional ability that enables well-being in older age”. This functional ability is the sum of two key factors: intrinsic capacity and interacting environment. This concept of intrinsic capacity encompasses a wide spectrum of health characteristics including the physiological and psychological changes associated with the ageing process. In general, IC declines from a high and stable state to an impaired status as people age. Monitoring individuals for changes in intrinsic capacity in the context of their environment will provide a holistic method of tracking the functioning of older adults at both a population and individual level, providing an opportunity to address any reversible factors of decline. However, this would require a clear and objective conceptualisation of the concept of intrinsic capacity. Methodology One hundred subjects were recruited via invitation by advertisement on the institute campus. Study participants underwent detailed physical examination and measurement of various physical and chemical biomarkers which were likely to represent intrinsic capacity as evidenced by the literature review. Outcomes measured were a decline in ADL, IADL, mortality and hospitalisation over a follow-up period of six months. Exploratory factor analysis (EFA) was done to obtain a clinical construct of the proposed entity of intrinsic capacity. Unpaired t -test and univariate logistic regression were used to check for the association between the composite score (IC) and its domains with the decline in ADL, IADL, mortality and hospitalisation. Results One composite score (composite IC score) and eight subfactors emerged. The composite score and subfactor domains showed good construct validity. Composite intrinsic capacity score and subdomains of strength and cognition were significantly different among subjects with and without ADL and IADL decline. Univariate logistic regression showed that composite intrinsic capacity score was a predictor of decline in ADL and IADL even after adjusting for age, sex, comorbidity status and education level of the subject with an adjusted odds ratio of 0.99 and 0.98, respectively. Subdomains of strength and cognition also predicted a decline in ADL and IADL independently. Conclusion The development of an objective construct of the concept of intrinsic capacity, using commonly measured clinical and biochemical parameters, is feasible and predictive of the subsequent functionality of an individual.

Background : Age-related changes in the cardiovascular system are significant, increasing the risk of cardiovascular diseases (CVDs) in older adults. CVDs are currently the leading cause of mortality among older Indian adults, yet very few studies are presently available evaluating the older adults for CVDs and risk factors. We aim to assess the very old adults for the prevalence of CVDs and risk factors using non-invasive assessment tools. Methodology : This hospital-based cross-sectional study included 200 adults aged 75 years and above, visiting a tertiary care hospital in India. They underwent routine clinical evaluation, a comprehensive geriatric assessment and detailed cardiovascular evaluation using non-invasive tools like echocardiography and blood investigations. Results : The overall prevalence of CVDs in this population was 76%. Among the cardiovascular risk factors, hyperhomocysteinemia was present in 83.5%, hypertension in 59.5%, dyslipidemia in 41.5%, sedentary lifestyle in 35%, and obesity in 30.5%, and Diabetes Mellitus in 24.5%. In echocardiographic assessment, valvular dysfunction was present in 33% of the population, though moderate to severe valvular disease was seen in 6.5%. Left ventricular diastolic dysfunction was seen in 81%, systolic dysfunction in 10% and pulmonary hypertension in 5% of the subjects. Conclusion : The very old adults had significant age-related changes in echocardiographic assessment, along with the high prevalence of cardiovascular diseases and risk factors. These findings should encourage physicians to screen the very old adults for cardiovascular risk factors and diseases, for their early identification and effective management.