Christopher N Osuafor1,2, Catriona Davidson1, Alistair J Mackett1, Marie Goujon1, Lelane Van Der Poel1, Vince Taylor3, Jacobus Preller4, Robert J B Goudie5, Victoria L Keevil1,6,7. 1. Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK. 2. Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK. 3. Cancer Research UK, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK. 4. Department of Acute Internal Medicine and Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK. 5. Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK. 6. Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK. 7. Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
Abstract
INTRODUCTION: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty. METHODS: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio (HR), 95% Confidence Interval). RESULTS: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to nonfrail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs. 20.8%, p < 0.001) and were more likely to die (66% vs. 16%, p = 0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24). CONCLUSIONS: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission, and diagnosis should prompt early advanced care planning.
INTRODUCTION: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty. METHODS: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio (HR), 95% Confidence Interval). RESULTS: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to nonfrail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs. 20.8%, p < 0.001) and were more likely to die (66% vs. 16%, p = 0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24). CONCLUSIONS: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission, and diagnosis should prompt early advanced care planning.
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