Divergent: Age, Frailty, and Atypical Presentations of COVID-19 in Hospitalized Patients

Abstract

Background Although frailty has been associated with atypical manifestations of infections, little is known about COVID-19 presentations in hospitalized frail patients. We aimed to investigate the association between age, frailty, and clinical characteristics of COVID-19 in hospitalized middle-aged and older adults. Methods Longitudinal observational study comprising 711 patients aged ≥50 years consecutively admitted to a university hospital dedicated to COVID-19 severe cases, between March and May 2020. We reviewed electronic medical records to collect data on demographics, comorbidities, COVID-19 signs/symptoms, and laboratory findings on admission. We defined frailty using the Clinical Frailty Scale (CFS=1-9; frail ≥5). We also documented in-hospital mortality. We used logistic regressions to explore associations between age, frailty, and COVID-19 signs/symptoms; and between typical symptoms (fever, cough, dyspnea) and mortality. Results Participants had a mean age of 66±11 years, and 43% were female. Overall, 25% were frail, and 37% died. The most common COVID-19 presentations were dyspnea (79%), cough (74%), and fever (62%), but patients aged ≥65 years were less likely to have a co-occurrence of typical symptoms, both in the absence (OR=0.56; 95%CI=0.39-0.79) and in the presence of frailty (OR=0.52; 95%CI=0.34-0.81). In contrast, older age and frailty were associated with unspecific presentations, including functional decline, acute mental change, and hypotension. After adjusting for age, sex, and frailty, reporting fever was associated with lower odds of mortality (OR=0.70; 95%CI=0.50-0.97). Conclusions Atypical COVID-19 presentations are common in frail and older hospitalized patients. Providers should be aware of unspecific disease manifestations during the management and follow-up of this population.

What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

“…All studies reported findings from acute hospitals (secondary care), with Crespo et al . [ 10 ] reporting specifically on renal transplant recipients, Doglietto on surgical patients [ 11 ] and three studies reported from COVID-19 dedicated hospitals (Marengoni [ 12 ], Mendes [ 13 ], Poco [ 14 ]); all the other studies reported outcomes for general, acute medical care. All studies described outcomes in people with clinically diagnosed and PCR-confirmed COVID-19, with the exception of Miles (contemporaneous matched controls), Owen and Aw (clinical and PCR positive versus clinically positive only) and Doglietto (historical matched controls).…”

“…Frailty was assessed using the CFS in 22 studies, one used the Hospital Frailty Risk Score (HFRS), one used both CFS and HFRS, one Fried’s frailty phenotype and one used the Frail Non-Disabled survey (FIND). Infection causing COVID-19 illness was confirmed using clinical features and a positive PCR in all studies though Hagg [ 17 ], Hewitt [ 18 ], Marengoni [ 12 ], Mendes [ 13 ], Owen [ 19 ], Poco [ 14 ] and Steinmeyer [ 20 ] also included people with clinical diagnoses but negative PCR tests.…”

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

“…SARAIVA 1,* , D. APOLINARIO 1,2,* , T.J. AVELINO-SILVA¹, C. DE ASSIS MOURA TAVARES 3 , I.F. GATTÁS-VERNAGLIA 4 , C. MARQUES FERNANDES 3 , L.M. RABELO 3 , S. TAVARES FERNANDES YAMAGUTI 2 , T. KARNAKIS 4 , R. KALIL-FILHO 3 , W. JACOB-FILHO¹, M.J. ROMERO ALIBERTI 1,5 proposed, consolidating the concept of life-space mobility (13,14).…”

“…GATTÁS-VERNAGLIA 4 , C. MARQUES FERNANDES 3 , L.M. RABELO 3 , S. TAVARES FERNANDES YAMAGUTI 2 , T. KARNAKIS 4 , R. KALIL-FILHO 3 , W. JACOB-FILHO¹, M.J. ROMERO ALIBERTI 1,5 proposed, consolidating the concept of life-space mobility (13,14). Life-space is characterized by the movement that extends from within one's home to beyond their town or region, and it can be evaluated by instruments like the Life-Space Assessment (LSA) (15).…”

What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

“…Thirteen of the 26 studies were from the UK, 13 from other European countries and one from Brazil. All studies reported findings from acute hospitals (secondary care), with Crespo et al [10] reporting specifically on renal transplant recipients, Doglietto on surgical patients [11] and three studies reported from COVID-19 dedicated hospitals (Marengoni [12], Mendes [13], Poco [14]) ; all the other studies reported outcomes for general, acute medical care. All studies described outcomes in people with clinically diagnosed and PCR-confirmed COVID-19, with the exception of Miles (contemporaneous matched controls), Owen and Aw (clinical and PCR positive versus clinically positive only) and Doglietto (historical matched controls).…”