Discontinuing nutrition and hydration at the end of life can be a difficult decision for both caregivers and families. It is a process with an enormous symbolic significance value, involving high emotional and affective charge. There is a lack of knowledge among healthcare teams about the pathophysiology of stopping nutrition and hydration, creating a fear of “starving or dehydrating” the patient. The understanding of the pathophysiological mechanisms and symptoms related to prolonged fasting were acquired thanks to the American and British experiences during the Second World War. Therefore, we are able to explain this process to families or teams in pain to try to alleviate their apprehension regarding the situation. The present work attempts to summarize these issues in order to provide caregivers with avenues to anticipate their questions and those of the patients’ families regarding nutrition and hydration withdrawal in the advanced palliative situation.

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

This article provides some insight into the clinical presentation of depression among the elderly, along with some management paths pertaining to this common, morbid, and at times potentially lethal syndrome. Diagnosis may be challenging because of complaints frequently related to ageing, comorbidities, and polypharmacy. Nonetheless, diagnosis should be made as early as possible. As first step, we must emphasize the relevance of spending time with seniors, thereby improving their communication skills. Several methods borrowed from cognitive rehabilitation may be proposed thereafter. This article is a summary of the twentieth annual meeting organized by the geriatric service association of the CHU, UCL Namur, Belgium.