COVID-19 in older people: a rapid clinical review

Lithander, Fiona E; Neumann, Sandra; Tenison, Emma; Lloyd, Katherine; Welsh, Tomas; Rodrigues, Jonathan; Higgins, Julian P T; Scourfield, Lily; Christensen, Hannah; Haunton, Victoria J.; Henderson, Emily

doi:10.1093/ageing/afaa093

Cited by 200 publications

(200 citation statements)

References 66 publications

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“…The in uence of frailty (frailty score of 5 or more) upon mortality outweighed that of age in our cohort (MV model 3; OR: 4.3; p=0.002 vs OR:1.03; p=0.10), possibly due to the distribution of frailty which affected patients as young as 65 years of age. Several studies have reported age as a risk factor associated with mortality (32)(33)(34), and our ndings are also supported by the recently published multicentre study in the United Kingdom showing a positive association between frailty and mortality (35).…”

Section: Discussionsupporting

confidence: 88%

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Chinnadurai

Ogedengbe

Agarwal

et al. 2020

Preprint

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Background There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations.MethodsWe describe the clinical characteristics of all consecutive COVID-19 positive patients (n=215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020. ResultsThe median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p<0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p<0.001) and respiratory diseases (group 2: 38 vs group 1: 25 %, p=0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p=0.03), frailty (OR 5.1; p<0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p=0.01) were strong and independent predictors of inpatient mortality. KM curves showed a clear significantly shorter survival time in the frail older patients. ConclusionOlder age and frailty are strong and independent risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

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Section: Discussionsupporting

confidence: 88%

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Chinnadurai

Ogedengbe

Agarwal

et al. 2020

Preprint

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“…High prevalence of delirium associated with COVID-19 infection has been identi ed in other studies [28] yet local and national guidelines often fail to emphasise the importance of delirium as a potential indicator of COVID-19 illness [32]. Therefore, our ndings on the prevalence of delirium and the range of other presenting features of COVID-19 in older adults, support recommendations which suggest lower thresholds for COVID-19 testing [5] in this population group during periods of signi cant community viral transmission.…”

Section: Discussionsupporting

confidence: 76%

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

Osuafor

Davidson

Mackett

et al. 2020

Preprint

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Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.

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“…Accordingly, people who need extra precautions are, among others, elderly people with chronic diseases. A clinical review on testing, treatment and prognosis of COVID-19 in the elderly supports the association of age and presence of comorbidities with increased severity and mortality [5].…”

Section: Introductionmentioning

confidence: 76%

The Situation of Elderly With Cognitive Impairment Living at Home During Lockdown in the Corona-pandemic in Germany

Thyrian

Kracht

Nikelski

et al. 2020

Preprint

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Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods: This analysis is based on data of a telephone-based assessment in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results: The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions: The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

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COVID-19 in older people: a rapid clinical review

Cited by 200 publications

References 66 publications

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- A cohort study

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

The Situation of Elderly With Cognitive Impairment Living at Home During Lockdown in the Corona-pandemic in Germany

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