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. 2021 Feb 1;6(1):11.
doi: 10.3390/geriatrics6010011.

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study

Christopher N Osuafor  1   2 , Catriona Davidson  1 , Alistair J Mackett  1 , Marie Goujon  1 , Lelane Van Der Poel  1 , Vince Taylor  3 , Jacobus Preller  4 , Robert J B Goudie  5 , Victoria L Keevil  1   6   7
Affiliations

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study

Christopher N Osuafor et al. Geriatrics (Basel). .

Abstract

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty.

Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio (HR), 95% Confidence Interval).

Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to nonfrail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs. 20.8%, p < 0.001) and were more likely to die (66% vs. 16%, p = 0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24).

Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission, and diagnosis should prompt early advanced care planning.

Keywords: COVID-19; atypical presentation; frailty; mortality; older patients.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Venn Diagrams illustrating the prevalence of common geriatric illness by frailty with COVID-19 infection. Nonfrail: Clinical Frailty Score 1–4; Frail: Clinical Frailty Score 5–8; NOS: Nonspecific illness.
Figure 2
Figure 2
Survival after presentation with COVID-19 infection by Clinical Frailty Scale (CFS) Score. * The time from COVID-19 presentation is defined as the number of days from either admission to hospital or time from first positive swab if hospital acquired disease. For those discharged alive, follow-up was extended for the first 14 days after discharge.
See this image and copyright information in PMC

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