[COVID-19 in old age-The geriatric perspective].
COVID-19 im Alter – Die geriatrische Perspektive.
Aging
Geriatrics
Pandemia
Rehabilitation
SARS-CoV-2
Journal
Zeitschrift fur Gerontologie und Geriatrie
ISSN: 1435-1269
Titre abrégé: Z Gerontol Geriatr
Pays: Germany
ID NLM: 9506215
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
24
01
2021
accepted:
02
02
2021
pubmed:
18
2
2021
medline:
13
3
2021
entrez:
17
2
2021
Statut:
ppublish
Résumé
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons. Schwerwiegend verlaufende COVID-19-Erkrankungen betreffen vorwiegend die ältere Bevölkerung. Die Mortalität der hospitalisierten COVID-19-Patienten im Alter über 80 Jahre liegt international bei bis zu 54 %. Daher ist ein Blick auf die Erkrankung aus geriatrischer Perspektive erforderlich. Diagnostik und Therapie der COVID-19-Erkrankung unterscheiden sich bei den älteren Patienten nicht grundsätzlich von der bei jüngeren Patienten. Allerdings ist bei Patienten im hohen Alter gehäuft mit einer atypischen Symptomatik zu rechnen. Der Rehabilitationsbedarf nach durchgemachter Infektion ist bei älteren COVID-19-Patienten deutlich höher als bei jüngeren Patienten. Paradoxerweise steht der Notwendigkeit vermehrter Rehabilitationsleistungen jedoch ein sinkendes Angebot geriatrischer Rehabilitationsmöglichkeiten gegenüber, da viele Abteilungen entweder geschlossen oder deren Behandlungskapazitäten reduziert wurden. Generell sollten Quarantäne- und Isolationsmaßnahmen in der älteren Bevölkerung verstärkt auf ihre Verhältnismäßigkeit überprüft werden, da die gesundheitlichen und emotionalen Auswirkungen gravierend sein können. Angesichts der ungünstigen Prognose bei hochaltrigen COVID-19-Patienten kommt der Berücksichtigung des Patientenwillens eine besondere Bedeutung zu. Daher sollten Angehörige und Ärzte sich frühzeitig, d. h. möglichst bereits vor dem Auftreten einer Infektion, bemühen, diesen zu eruieren und angemessen zu dokumentieren. Erfreulicherweise lassen die bisherigen Daten hoffen, dass die Impfung mit den in Deutschland zugelassenen mRNA-Impfstoffen gegen SARS-CoV‑2 auch im hohen Alter gut wirksam ist.
Autres résumés
Type: Publisher
(ger)
Schwerwiegend verlaufende COVID-19-Erkrankungen betreffen vorwiegend die ältere Bevölkerung. Die Mortalität der hospitalisierten COVID-19-Patienten im Alter über 80 Jahre liegt international bei bis zu 54 %. Daher ist ein Blick auf die Erkrankung aus geriatrischer Perspektive erforderlich. Diagnostik und Therapie der COVID-19-Erkrankung unterscheiden sich bei den älteren Patienten nicht grundsätzlich von der bei jüngeren Patienten. Allerdings ist bei Patienten im hohen Alter gehäuft mit einer atypischen Symptomatik zu rechnen. Der Rehabilitationsbedarf nach durchgemachter Infektion ist bei älteren COVID-19-Patienten deutlich höher als bei jüngeren Patienten. Paradoxerweise steht der Notwendigkeit vermehrter Rehabilitationsleistungen jedoch ein sinkendes Angebot geriatrischer Rehabilitationsmöglichkeiten gegenüber, da viele Abteilungen entweder geschlossen oder deren Behandlungskapazitäten reduziert wurden. Generell sollten Quarantäne- und Isolationsmaßnahmen in der älteren Bevölkerung verstärkt auf ihre Verhältnismäßigkeit überprüft werden, da die gesundheitlichen und emotionalen Auswirkungen gravierend sein können. Angesichts der ungünstigen Prognose bei hochaltrigen COVID-19-Patienten kommt der Berücksichtigung des Patientenwillens eine besondere Bedeutung zu. Daher sollten Angehörige und Ärzte sich frühzeitig, d. h. möglichst bereits vor dem Auftreten einer Infektion, bemühen, diesen zu eruieren und angemessen zu dokumentieren. Erfreulicherweise lassen die bisherigen Daten hoffen, dass die Impfung mit den in Deutschland zugelassenen mRNA-Impfstoffen gegen SARS-CoV‑2 auch im hohen Alter gut wirksam ist.
Identifiants
pubmed: 33595696
doi: 10.1007/s00391-021-01864-0
pii: 10.1007/s00391-021-01864-0
pmc: PMC7887547
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
152-160Références
Barazzoni R, Bischoff SC, Breda J et al (2020) ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV‑2 infection. Clin Nutr 39:1631–1638
pubmed: 32305181
pmcid: 7138149
doi: 10.1016/j.clnu.2020.03.022
Barbaro RP, Maclaren G, Boonstra PS et al (2020) Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 396:1071–1078
pubmed: 32987008
pmcid: 7518880
doi: 10.1016/S0140-6736(20)32008-0
Bedock D, Bel Lassen P, Mathian A et al (2020) Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN 40:214–219
pubmed: 33183539
pmcid: 7500887
doi: 10.1016/j.clnesp.2020.09.018
Beigel JH, Tomashek KM, Dodd LE et al (2020) Remdesivir for the treatment of Covid-19—final report. N Engl J Med 383:1813–1826
pubmed: 32445440
doi: 10.1056/NEJMoa2007764
Berlit P, Bosel J, Gahn G et al (2020) “Neurological manifestations of COVID-19”—guideline of the German society of neurology. Neurol Res Pract 2:51
pubmed: 33283160
pmcid: 7708894
doi: 10.1186/s42466-020-00097-7
Bonanad C, Garcia-Blas S, Tarazona-Santabalbina F et al (2020) The effect of age on mortality in patients with COVID-19: a meta-analysis with 611,583 subjects. J Am Med Dir Assoc 21:915–918
pubmed: 32674819
pmcid: 7247470
doi: 10.1016/j.jamda.2020.05.045
Boulos C, Salameh P, Barberger-Gateau P (2017) Social isolation and risk for malnutrition among older people. Geriatr Gerontol Int 17:286–294
pubmed: 26790629
doi: 10.1111/ggi.12711
Cacioppo S, Capitanio JP, Cacioppo JT (2014) Toward a neurology of loneliness. Psychol Bull 140:1464–1504
pubmed: 25222636
pmcid: 5130107
doi: 10.1037/a0037618
Curci C, Negrini F, Ferrillo M et al (2021) Functional outcome after inpatient rehabilitation in post-intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. https://doi.org/10.23736/S1973-9087.20.06660-5
doi: 10.23736/S1973-9087.20.06660-5
pubmed: 33650841
De Biase S, Cook L, Skelton DA et al (2020) The COVID-19 rehabilitation pandemic. Age Ageing 49:696–700
pubmed: 32470131
doi: 10.1093/ageing/afaa118
Deutsche Gesellschaft Für Geriatrie (2020) Aktuelle Meldungen: Generation 80+: Impfbereitschaft gut, Erreichbarkeit der Impfzentren schlecht. https://www.dggeriatrie.de/presse/pressemeldungen/1755-pm-generation-80-impfbereitschaft-gut,-erreichbarkeit-der-impfzentren-schlecht . Zugegriffen: 23.01.2021
Di Filippo L, De Lorenzo R, D’amico M et al (2020) COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: a post-hoc analysis of a prospective cohort study. Clin Nutr. https://doi.org/10.1016/j.clnu.2020.10.043
doi: 10.1016/j.clnu.2020.10.043
pubmed: 33160700
pmcid: 7598735
Donovan NJ, Blazer D (2020) Social isolation and loneliness in older adults: review and commentary of a National Academies report. Am J Geriatr Psychiatry 28:1233–1244
pubmed: 32919873
pmcid: 7437541
doi: 10.1016/j.jagp.2020.08.005
Editorial (2020) Meeting the challenge of long COVID. Nat Med 26:1803
doi: 10.1038/s41591-020-01177-6
Franke C, Ferse C, Kreye J et al (2020) High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms. Brain Behav Immun. https://doi.org/10.1016/j.bbi.2020.12.022
doi: 10.1016/j.bbi.2020.12.022
pubmed: 33359380
pmcid: 7834471
Frontera JA, Sabadia S, Lalchan R et al (2020) A prospective study of neurologic disorders in hospitalized COVID-19 patients in New York City. Neurology 90(4):e575–e586. https://doi.org/10.1212/WNL.0000000000010979
doi: 10.1212/WNL.0000000000010979
Gandhi S, Srivastava AK, Ray U et al (2020) Is the collapse of the respiratory center in the brain responsible for respiratory breakdown in COVID-19 patients? ACS Chem Neurosci 11:1379–1381
pubmed: 32348111
doi: 10.1021/acschemneuro.0c00217
Grasselli G, Greco M, Zanella A et al (2020) Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med 180:1345–1355
pubmed: 32667669
doi: 10.1001/jamainternmed.2020.3539
Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-coV‑2 admitted to ICUs of the Lombardy region, Italy. JAMA 323:1574–1581
pubmed: 32250385
pmcid: 7136855
doi: 10.1001/jama.2020.5394
Grund S, Gordon AL, Bauer JM et al (2021) The COVID rehabilitation paradox: why we need to protect and develop geriatric rehabilitation services in the face of the pandemic. Age Ageing. https://doi.org/10.1093/ageing/afab009
doi: 10.1093/ageing/afab009
pubmed: 33443544
pmcid: 7929382
Hajek A, Konig HH (2017) The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey. BMC Geriatr 17:204
pubmed: 28874139
pmcid: 5584003
doi: 10.1186/s12877-017-0602-5
Helms J, Kremer S, Merdji H et al (2020) Neurologic features in severe SARS-CoV‑2 infection. N Engl J Med 382:2268–2270
pubmed: 32294339
doi: 10.1056/NEJMc2008597
pmcid: 32294339
Heneka MT, Golenbock D, Latz E et al (2020) Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther 12:69
pubmed: 32498691
pmcid: 7271826
doi: 10.1186/s13195-020-00640-3
Ho FK, Petermann-Rocha F, Gray SR et al (2020) Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. Plos One 15:e241824
pubmed: 33152008
pmcid: 7644030
doi: 10.1371/journal.pone.0241824
Iannaccone S, Alemanno F, Houdayer E et al (2020) COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units. J Rehabil Med 52:jrm73
pubmed: 32516421
doi: 10.2340/16501977-2704
Iannaccone S, Castellazzi P, Tettamanti A et al (2020) Role of rehabilitation department for adult individuals with COVID-19: the experience of the San Raffaele Hospital of Milan. Arch Phys Med Rehabil 101:1656–1661
pubmed: 32505489
pmcid: 7272153
doi: 10.1016/j.apmr.2020.05.015
Jung C, Bruno RR, Wernly B et al (2020) Frailty as a prognostic indicator in intensive care. Dtsch Arztebl Int 117:668–673
pubmed: 33357351
pmcid: 7838379
Karagiannidis C, Mostert C, Hentschker C et al (2020) Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 8:853–862
pubmed: 32735842
pmcid: 7386882
doi: 10.1016/S2213-2600(20)30316-7
Kennedy M, Helfand BKI, Gou RY et al (2020) Delirium in older patients with COVID-19 presenting to the emergency department. JAMA Netw Open 3:e2029540
pubmed: 33211114
pmcid: 7677760
doi: 10.1001/jamanetworkopen.2020.29540
Kluge S, Janssens U, Welte T et al (2021) S2k guideline—recommendations for inpatient therapy of patients with COVID-19. Pneumologie. https://doi.org/10.1055/a-1334-1925
doi: 10.1055/a-1334-1925
pubmed: 33450783
Kobayashi LC, Steptoe A (2018) Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study. Ann Behav Med 52:582–593
pubmed: 29860361
pmcid: 6377432
doi: 10.1093/abm/kax033
Kremer HJ, Thurner W (2020) Age dependence in COVID-19 mortality in Germany. Dtsch Arztebl Int 117:432–433
pubmed: 32885782
pmcid: 7490456
Liotta EM, Batra A, Clark JR et al (2020) Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol 7:2221–2230
pubmed: 33016619
pmcid: 7664279
doi: 10.1002/acn3.51210
Livingston E, Bucher K (2020) Coronavirus disease 2019 (COVID-19) in Italy. JAMA 323:1335
pubmed: 32181795
doi: 10.1001/jama.2020.4344
Maghbooli Z, Sahraian MA, Ebrahimi M et al (2020) Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. Plos One 15:e239799
pubmed: 32976513
pmcid: 7518605
doi: 10.1371/journal.pone.0239799
Marckmann G, Neitzke G, Schildmann J et al (2020) Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic: clinical and ethical recommendations of DIVI, DGINA, DGAI, DGIIN, DGNI, DGP, DGP and AEM. Med Klin Intensivmed Notfmed 115:115–122
pubmed: 32728768
doi: 10.1007/s00063-020-00709-9
Marengoni A, Zucchelli A, Vetrano DL et al (2020) Beyond chronological age: Frailty and multimorbidity predict in-hospital mortality in patients with coronavirus disease 2019. J Gerontol A Biol Sci Med Sci. https://doi.org/10.1093/gerona/glaa291
doi: 10.1093/gerona/glaa291
pubmed: 31125398
pmcid: 7756707
Mattos Dos Santos R (2020) Isolation, social stress, low socioeconomic status and its relationship to immune response in Covid-19 pandemic context. Brain Behav Immun Health 7:100103
pubmed: 32835298
pmcid: 7326413
doi: 10.1016/j.bbih.2020.100103
Meinhardt J, Radke J, Dittmayer C et al (2020) Olfactory transmucosal SARS-CoV‑2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci 24(2):168–175. https://doi.org/10.1038/s41593-020-00758-5
doi: 10.1038/s41593-020-00758-5
pubmed: 33257876
Meppiel E, Peiffer-Smadja N, Maury A et al (2020) Neurologic manifestations associated with COVID-19: a multicentre registry. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2020.11.005
doi: 10.1016/j.cmi.2020.11.005
pubmed: 33189873
pmcid: 7661948
Michels G, Sieber CC, Marx G et al (2019) Geriatric intensive care: consensus paper of DGIIN, DIVI, DGAI, DGGG, OGGG, OGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG. Z Gerontol Geriatr 52:440–456
pubmed: 31278486
doi: 10.1007/s00391-019-01584-6
Morley JE, Kalantar-Zadeh K, Anker SD (2020) COVID-19: a major cause of cachexia and sarcopenia? J Cachexia Sarcopenia Muscle 11:863–865
pubmed: 32519505
doi: 10.1002/jcsm.12589
Mueller AL, Mcnamara MS, Sinclair DA (2020) Why does COVID-19 disproportionately affect older people? Aging 12:9959–9981
pubmed: 32470948
pmcid: 7288963
doi: 10.18632/aging.103344
Neumann B, Schmidbauer ML, Dimitriadis K et al (2020) Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms. J Neurol Sci 418:117090
pubmed: 32805440
pmcid: 7417278
doi: 10.1016/j.jns.2020.117090
Neurologie. DGF Leitlinien der Deutschen Gesellschaft für Neurologie. https://dgn.org/leitlinien/ . Zugegriffen: 23.01.2021
Panagiotou OA, Kosar CM, White EM et al (2021) Risk factors associated with all-cause 30-day mortality in nursing home residents with COVID-19. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020.7968
doi: 10.1001/jamainternmed.2020.7968
pubmed: 33394006
Pantel J (2021) Gesundheitliche Risiken von Einsamkeit und sozialer Isolation im Alter. Geriatr Rep (im Druck)
Paterson RW, Brown RL, Benjamin L et al (2020) The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain 143:3104–3120
pubmed: 32637987
doi: 10.1093/brain/awaa240
Pecanha T, Goessler KF, Roschel H et al (2020) Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. Am J Physiol Heart Circ Physiol 318:H1441–H1446
pubmed: 32412779
pmcid: 7303725
doi: 10.1152/ajpheart.00268.2020
Pironi L, Sasdelli AS, Ravaioli F et al (2020) Malnutrition and nutritional therapy in patients with SARS-CoV‑2 disease. Clin Nutr. https://doi.org/10.1016/j.clnu.2020.08.021
doi: 10.1016/j.clnu.2020.08.021
pubmed: 33349485
pmcid: 7450234
Plagg B, Engl A, Piccoliori G et al (2020) Prolonged social isolation of the elderly during COVID-19: between benefit and damage. Arch Gerontol Geriatr 89:104086
pubmed: 32388336
pmcid: 7196375
doi: 10.1016/j.archger.2020.104086
Polack FP, Thomas SJ, Kitchin N et al (2020) Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 383:2603–2615
doi: 10.1056/NEJMoa2034577
Pourhassan M, Sieske L, Janssen G et al (2020) The impact of acute changes of inflammation on appetite and food intake among older hospitalised patients. Br J Nutr 124:1069–1075
pubmed: 32618518
doi: 10.1017/S0007114520002160
Recinella G, Marasco G, Serafini G et al (2020) Prognostic role of nutritional status in elderly patients hospitalized for COVID-19: a monocentric study. Aging Clin Exp Res 32:2695–2701
pubmed: 33034016
doi: 10.1007/s40520-020-01727-5
Richardson S, Hirsch JS, Narasimhan M et al (2020) Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 323:2052–2059
pubmed: 32320003
pmcid: 7177629
doi: 10.1001/jama.2020.6775
Riessen R, Haap M, Marckmann G et al (2020) Rational therapeutic decisions in intensive care patients. Dtsch Med Wochenschr 145:1470–1475
pubmed: 33022728
doi: 10.1055/a-1216-7614
Robb CE, De Jager CA, Ahmadi-Abhari S et al (2020) Associations of social isolation with anxiety and depression during the early COVID-19 pandemic: a survey of older adults in London, UK. Front Psychiatry 11:591120
pubmed: 33132942
pmcid: 7566017
doi: 10.3389/fpsyt.2020.591120
Robert Koch-Institut (2021) COVID-19-Dashboard am 29.01.21. https://experience.arcgis.com/experience/478220a4c454480e823b17327b2bf1d4 . Zugegriffen: 29.01.2021
Robert Koch-Institut (2021) Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19). 28.01.2021 – aktualisierter Stand für Deutschland. https://www.rki.de/de/content/infaz/n/neuartiges_coronavirus/situationsberichte/jan_2021/2021-01-28-de.Pdf?__blob=publicationfile . Zugriffen: 28.01.2021
Rohr S, Muller F, Jung F et al (2020) Psychosocial impact of quarantine measures during serious coronavirus outbreaks: a rapid review. Psychiatr Prax 47:179–189
pubmed: 32340047
pmcid: 7295307
doi: 10.1055/a-1159-5562
Russell DW, Cutrona CE, De La Mora A et al (1997) Loneliness and nursing home admission among rural older adults. Psychol Aging 12:574–589
pubmed: 9416627
doi: 10.1037/0882-7974.12.4.574
pmcid: 9416627
Salimi S, Hamlyn JM (2020) COVID-19 and crosstalk with the hallmarks of aging. J Gerontol A Biol Sci Med Sci 75:e34–e41
pubmed: 32544216
doi: 10.1093/gerona/glaa149
pmcid: 32544216
Salzberger B, Buder F, Lampl B et al (2020) Epidemiology of SARS-CoV‑2 infection and COVID-19. Internist 61:782–788
doi: 10.1007/s00108-020-00834-9
Seifert A, Hassler B (2020) Impact of the COVID-19 pandemic on loneliness among older adults. Front Sociol. https://doi.org/10.3389/fsoc.2020.590935
doi: 10.3389/fsoc.2020.590935
Sieske L, Janssen G, Babel N et al (2019) Inflammation, appetite and food intake in older hospitalized patients. Nutrients. https://doi.org/10.3390/nu11091986
doi: 10.3390/nu11091986
pubmed: 31443557
pmcid: 6770921
Silva DFO, Lima S, Sena-Evangelista KCM et al (2020) Nutritional risk screening tools for older adults with COVID-19: a systematic review. Nutrients. https://doi.org/10.3390/nu12102956
doi: 10.3390/nu12102956
pubmed: 33396963
pmcid: 7824615
Soo A, Zuege DJ, Fick GH et al (2019) Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care 23:186
pubmed: 31122276
pmcid: 6533687
doi: 10.1186/s13054-019-2459-9
Tan CW, Ho LP, Kalimuddin S et al (2020) Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B12 in combination on progression to severe outcomes in older patients with coronavirus (COVID-19). Nutrition 79/80:111017
doi: 10.1016/j.nut.2020.111017
Vilches-Moraga A, Price A, Braude P et al (2020) Increased care at discharge from COVID-19: the association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study. BMC Med 18:408
pubmed: 33334341
pmcid: 7746415
doi: 10.1186/s12916-020-01856-8
Vink EE, Azoulay E, Caplan A et al (2018) Time-limited trial of intensive care treatment: an overview of current literature. Intensive Care Med 44:1369–1377
pubmed: 30136140
doi: 10.1007/s00134-018-5339-x
Volkert D, Beck AM, Cederholm T et al (2019) ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 38:10–47
pubmed: 30005900
doi: 10.1016/j.clnu.2018.05.024
Wong SYS, Zhang D, Sit RWS et al (2020) Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. Br J Gen Pract 70:e817–e824
pubmed: 32988955
pmcid: 7523921
doi: 10.3399/bjgp20X713021