COVID-19 in older adults: What are the differences with younger patients?

Abstract

Aim: The present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID-19), in comparison with those of younger patients, and to identify risk factors for mortality.

Methods: A retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID-19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic medical records.

Results: The dataset comprised 340 patients. Of them, 152 (44.6%) were aged >70 years. Comorbidities were more common in the older groups. Confusion was more common in older adults, whereas typical symptoms of COVID-19, such as fever, cough and myalgia, were less common. Oxygen saturation ≤93% on room air, neutrophilia, D-dimer >0.5 μg/mL, creatinine >1.5 mg/dL, lactate dehydrogenase ≥250 U/L and elevation of creatine kinase were higher in the older adult groups. Complications during hospitalization, such as acute respiratory distress syndrome (53.3% vs 33.2%, P < 0.001), acute kidney injury (11.8% vs 5.3%; P = 0.030) and mortality (28.9% vs 6.5%; P < 0.001) were more common in patients aged >70 years. Oxygen saturation ≤93% on room air on admission was a predictor of mortality (odds ratio 11.65, 95% confidence interval 3.26-41.66, P < 0.001) in patients aged >70 years.

Conclusions: Older adults with COVID-19 have more atypical presentation, more complications and higher mortality. Oxygen saturation ≤93% on room air on admission is a predictive factor of death. Geriatr Gerontol Int 2021; 21: 60-65.

Keywords: COVID-19; clinical characteristics; coronavirus; mortality; older adults.

Figure 1

Complications during admission (in percentages) of older patients and non‐older patients and P‐value. The variables were expressed as the percentage and compared with the χ²‐test. ‡Cardiac complications: heart failure, auricular arrhythmia, ventricular arrhythmia, myocardial infarction or myocarditis. §Multiorgan failure and shock are defined as the third international consensus definitions for sepsis and septic shock (Sepsis‐3). ¶Acute kidney injury was identified as an increase in serum creatinine by >0.3 mg/dL within 48 h or an increase in serum creatinine to >1.5‐fold baseline within the prior 7 days compared with the preceding 1 year of data in acute care medical records. †Acute respiratory distress syndrome (ARDS) is classified as severe by using an arterial partial pressure of oxygen to fraction of inspired oxygen threshold of 100 mmHg.