Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study

Abstract

Objective COVID-19 leads to highly variable clinical outcomes among older people with psychiatric and medical co-morbidities. Evidence guiding management of future outbreaks among this vulnerable population in in-patient psychiatry settings are sparse. Hence, we aimed to investigate the correlates of poor clinical outcomes related to COVID-19 and to explore the perspectives of COVID-19 survivors in in-patient psychiatry settings. Method We investigated the correlates of poor clinical outcomes related to COVID-19 using retrospective chart review of 81 older people in in-patient psychiatry settings. Correlates of clinical outcomes related to COVID-19 were assessed by multiple logistic regression models. Moreover, we explored the perspectives of 10 of those COVID-19 survivors by qualitative interviews. We analysed the qualitative data using thematic analysis. Results Although 25.9% (n = 21) participants were asymptomatic, there was high COVID-19 related mortality rate (14.8%; n = 12). Vitamin-D deficiency, anticholinergic burden, and isolation policies within psychiatric wards were significantly ( P < 0.05) associated with COVID-19 related deaths. Participants emphasised the importance of strengthening local support networks and making vaccination centres more accessible. Conclusions Reducing anticholinergic prescriptions and improving isolation policies may mitigate poor clinical outcomes. Future research investigating the impact of vitamin-D supplementation on COVID-19 related outcomes are warranted.