COVID-19 in Older Adults: A Series of 76 Patients Aged 85 Years and Older with COVID-19

J Am Geriatr Soc. 2020 Oct 12. doi: 10.1111/jgs.16894. Online ahead of print.

Abstract

Background: Clinical presentation and risk factors of death in COVID-19 in oldest adults have not been well characterized.

Objectives: To describe clinical features and outcome of COVID-19 in patients older than 85 years and study risk factors for mortality.

Design: Prospective cohort.

Participants and setting: Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand-Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days.

Measurements: Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death.

Results: From March 14 to April 11, 2020, 76 patients (median age = 90 (86-92) years; women = 55.3%) were admitted for confirmed COVID-19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID-19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8-17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9-19.5) days. Independent predictive factors of death were C-reactive protein level at admission and lymphocyte count at nadir.

Conclusion: Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID-19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.

Keywords: COVID-19; SARS-CoV-2; clinical research; mortality; older adults; risk factors.