Background/objective: The COVID-19 epidemic is particularly serious in older adults. The symptomatology and epidemic profile remain little known in this population, especially in disabled oldest-old people with chronic diseases living in nursing homes. The objective of the present study was to comprehensively describe symptoms and chronological aspects of the diffusion of the SARS-CoV-2 virus in a nursing home, among both residents and caregivers. Design: Five-week retrospective cohort study. Setting: A middle-sized nursing home in Maine-et-Loire, west of France. Participants: Eighty-seven frail older residents (87.9 ± 7.2years; 71 % female) and 92 staff members (38.3 ± 11.7years; 89 % female) were included. Measurements: Mass screening for SARS-CoV-2 was performed in both residents and staff. Attack rate, mortality rate, and symptoms among residents and staff infected with SARS-CoV-2 were recorded. Results: The attack rate of COVID-19 was 47 % in residents (case fatality rate, 27 %), and 24 % in staff. Epidemic curves revealed that the epidemic started in residents before spreading to caregivers. Residents exhibited both general and respiratory signs (59 % hyperthermia, 49 % cough, 42 % polypnea) together with geriatric syndromes (15 % falls, 10 % altered consciousness). The classification tree revealed 100 % COVID-19 probability in the following groups: i) residents younger than 90 with dyspnea and falls; ii) residents older than 90 with anorexia; iii) residents older than 90 without anorexia but with altered consciousness. Finally, 41 % of staff members diagnosed with COVID-19 were asymptomatic. Conclusions: The pauci-symptomatic expression of COVID-19 in older residents, together with the high prevalence of asymptomatic forms in caregivers, justifies mass screening in nursing homes, possibly prioritizing residents with suggestive combinations of clinical signs including dyspnea, falls, anorexia and/or altered consciousness.

Background. Vitamin K concentrations are inversely associated with the clinical severity of COVID-19. The objective of this cohort study was to determine whether the regular use of vitamin K antagonist (VKA) prior to COVID-19 was associated with short-term mortality in frail older adults hospitalized for COVID-19. Methods. Eighty-two patients consecutively hospitalized for COVID-19 in a geriatric acute care unit were included. The association of the regular use of VKA prior to COVID-19 with survival after 7 days of COVID-19 was examined using a propensity-score-weighted Cox proportional-hazards model accounting for age, sex, severe undernutrition, diabetes mellitus, hypertension, prior myocardial infarction, congestive heart failure, prior stroke and/or transient ischemic attack, CHA2DS2-VASc score, HAS-BLED score, and eGFR. Results. Among 82 patients (mean ± SD age 88.8 ± 4.5 years; 48% women), 73 survived COVID-19 at day 7 while 9 died. There was no between-group difference at baseline, despite a trend for more frequent use of VKA in those who did not survive on day 7 (33.3% versus 8.2%, p = 0.056). While considering “using no VKA” as the reference (hazard ratio (HR) = 1), the HR for 7-day mortality in those regularly using VKA was 5.68 [95% CI: 1.17; 27.53]. Consistently, COVID-19 patients using VKA on a regular basis had shorter survival times than the others (p = 0.031). Conclusions. Regular use of VKA was associated with increased mortality at day 7 in hospitalized frail elderly patients with COVID-19.

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La pandémie de Covid-19 est particulièrement sévère chez la personne âgée. Notre objectif était d'identifier, à partir de la littérature internationale, les symptômes les plus fréquents chez la personne âgée infectée par le virus SARS-CoV-2. Cette revue systématique de la littérature a été conduite à partir de Medline sur la période du 1er décembre 2019 au 13 avril 2020. L'analyse des biais a été réalisée selon une méthode d'évaluation de la qualité méthodologique des séries de cas et rapports de cas. Sur 260 articles initialement identifiés, seules deux études ont finalement été incluses dans la synthèse qualitative. L'âge moyen était peu élevé, entre 71 et 74 ans en moyenne. Les symptômes de Covid-19 étaient les suivants : fièvre, toux sèche, dyspnée, asthénie, anorexie, oppression thoracique, diarrhées, et dans une moindre mesure myalgies, pharyngite, nausées, vertiges, céphalées, douleurs abdominales et enfin vomissements. Une lymphopénie était retrouvée à la numération sanguine. En conclusion, cette revue systématique de la littérature internationale révèle un manque de données concernant la sémiologie du Covid-19 chez la personne âgée, notamment chez les très âgés fragiles qui définissent communément la population gériatrique. L'enquête nationale de la Société franç aise de gériatrie et gérontologie permettra de combler ce scotome sémiologique.