As the population ages, the global cardiovascular disease burden will continue to increase, particularly among older adults. Increases in life expectancy and better cardiovascular care have significantly reshaped the epidemiology of cardiovascular disease and have created new patient profiles. The combination of older age, multiple comorbidities, polypharmacy, frailty, and adverse noncardiovascular outcomes is challenging our routine clinical practice in this field. In this review, we examine noncardiovascular factors that statistically interact in a relevant way with health status and quality of life in older people with cardiovascular disease. We focused on specific geriatric conditions (multimorbidity, polypharmacy, geriatric syndromes, and frailty) that are responsible for a major risk of functional decline and have an important impact on the overall prognosis in this patient population.

Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be examined more deeply to help reverse the adverse health-related outcomes. Specific inflammatory and physical health markers have been associated with the onset of frailty, but the associations between these factors and psycho-social health outcomes seem less studied. This systematic review aimed to identify, in the same study design, the potential associations between frailty and markers of inflammation, and physical or psycho-social health. A literature search was performed from inception until March 2021 using Medline, Psycinfo, and EMBASE. Three raters evaluated the articles and selected 22 studies, using inclusion and exclusion criteria (n = 17,373; 91.6% from community-dwelling samples). Regarding biomarkers, 95% of the included studies showed significant links between inflammation [especially the higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6)], and frailty status. Approximately 86% of the included studies showed strong links between physical health decline (such as lower levels of hemoglobin, presence of comorbidities, or lower physical performance), and frailty status. At most, 13 studies among the 22 included ones evaluated psycho-social variables and mixed results were observed regarding the relationships with frailty. Results are discussed in terms of questioning the medical perception of global health, centering mostly on the physical dimension. Therefore, the development of future research studies involving a more exhaustive view of frailty and global (bio-psycho-social) health is strongly encouraged.

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After a bumpy start (chronicled in the story of my first family meeting), the nursing home had adjusted my aunt's care to meet her needs, and it was responsive to my concerns and questions throughout her stay. As for me, I never became that caregiver who was present at meals or did my aunt's laundry. Instead, I visited; I talked with her, and I talked with the staff on duty. I assessed her myself, asked questions about her health, and then I advocated on her behalf. That was 2001. I am writing this on a random June Monday in 2020, with my office closed during the era of COVID-19. And I am wondering what my aunt's trajectory would have looked like if I had not been able to check in on her, talk to her, touch her, and then talk to her care team. From the stories circulating about the deaths of older adults, I can say with some degree of certitude that I would have felt helpless and broken if my experience took place in the era of COVID-19. 2,3 Whither the caregiver? As I write, most nursing homes, assisted living facilities, and other congregate living settings still have strict "no-visitor" policies that have been in place since March 2020. 4,5 Despite these rules, somewhere between 30% and 40% of all Americans who have died of COVID-19 lived in nursing homes. 4,6,7 Since March, we have learned that the virus is agnostic as to nursing home quality, and we now know that federal and state governments did not prioritize long-term care settings for COVID-19 testing supplies and personal protective equipment (PPE). 4,5,8 We've always known that infection control protocols are hard to follow when there are too few workers caring for too many residents. 8 And we know that, despite being underpaid and having no PPE, our hands-on direct care workforce showed up to care for our frailest older Americans. 4,5,8,9 They are among the unsung heroes of the COVID-19 pandemic and deserve our thanks. At best, keeping families, other caregivers, and surrogates away from older loved ones with "no-visitor" rules had a modest impact on preventing the spread of COVID-19 in nursing homes, given all the other factors in play. 8 At the same time, these rules have had a significant negative psychological impact on older adults and their families. As we grapple with how to let caregivers visit safely, we should view the situation through the lens of what matters to older adults and their loved ones. 10,11 If we do not, we will be doing our older loved ones a great disservice by continuing to leave their caregivers on the outside looking in to the longterm care facility.