A retrospective cohort study of risk factors and outcomes in older patients admitted to an inner-city geriatric unit in London during first peak of COVID-19 pandemic

Abstract

Purpose Compared to younger patients, coronavirus disease 2019 (COVID-19) clinical presentation in older people can be more heterogeneous and fatal. We aim to describe a cohort of older adults admitted in an inner-city London hospital during the first peak of the pandemic. Methods A retrospective observational study that enrolled older adults consecutively admitted into two geriatric wards with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We collected socio-demographic data, comorbidities, symptoms at presentation and/or during admission, biochemical and radiological data and outcomes at 28 days. Results One hundred twenty-four patients were included, and 75% were > 80 years old. 19.5% of COVID-19 cases were judged to be hospital-acquired. More than half presented or developed typical symptoms, respiratory failure or fatigue. 46.8% were diagnosed with delirium, 24.2% with falls and dysphagia was present in 13.7%. The mortality rate was 29.8% and was higher among males, those > 80 years, patients with a higher grade of frailty, a history of dementia or chronic kidney disease, as well as those diagnosed with respiratory failure, acute kidney injury or hypernatremia. Independent predictors of mortality were male sex, age > 80 years, respiratory failure and hypernatremia. Conclusion We have described a cohort of patients with SARS-CoV-2 infection in the first UK peak of the global pandemic. We found that these patients had significant frailty with multiple comorbidities. There was a high mortality and increased dependency and greater social care need in survivors. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02679-z.

Risk Factors for Dysphagia in Patients Hospitalized with COVID-19

“…In this study, Hispanic or Latino/a/x individuals were less likely to be significantly associated with having a dysphagia diagnosis versus non-Hispanic/Latino/a/x individuals per instrumental swallow study. This finding is inconsistent with current research that suggests that consequences of COVID-19 infections differ by ethnicity, with greater rates of COVID-19 infection and death in Black, Hispanic, and Asian populations [ 29 – 31 ]. Disparities in healthcare access, preexisting comorbidities, inability to limit exposure due to housing arrangements or occupations may influence COVID-19 outcomes between ethnic groups [ 29 , 31 ].…”

Predictive value of frailty in the mortality of hospitalized patients with COVID-19: a systematic review and meta-analysis

“…Over half of the studies included older adults (age ≥65 years), and 50.1% (13,187/26,303) of patients were female. Six frailty assessment tools were used, including the Clinical Frailty Score (CFS) (n=16) (7)(8)(9)11,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), the Hospital Frailty Risk Score (HFRS) (n=1) (26), the Geriatric Nutritional Risk Index (GRNI) (n=1) (27), the modified Frailty Index (mFI) (n=1) (28), the Multidimensional Prognostic Index (MPI) (n=1) (29), and the Frail Non-Disabled Survey (FIND) (n=1) (10). The prevalence of frailty ranged from 9.1-87.2%, with a summary estimate rate of 51.4% (95% CI: 39.9-62.9%; I 2 =99.49%; Figure 2).…”

The devastating trio of sarcopenia, frailty, and COVID-19 - A systematic review and meta-analysis

“…All of the included studies in this review that recorded mortality and frailty in COVID-19 patients identified older age and frailty as the leading causes of mortality. Increasing age was found as an independent risk factor for critical illness and higher mortality in COVID-19 patients [33,43]. Our results indicated that a significant difference was recorded (p < 0.001) according to age differences between frail and non-frail COVID 19 patients.…”

“…The percentage of older adults with frailty ranged from 21% [64] to 76.6% [33] of the total participants in each study.…”

“…Older age and frailty were described in all studies that addressed mortality and frailty as foremost risk factors associated with mortality in COVID-19 patients. Two studies indicated that the increased age is an independent risk factor for the development of critical illness and increased mortality among COVID-19 patients [33,43]. However, other studies (n ¼ 7) [39,45,53,55,60,67,69] stated that COVID-19 disease outcomes in terms of the development of severe conditions, critical illness, and mortality were better predicted by frailty than either age or comorbidity.…”