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. 2022;68(12):1393-1401.
doi: 10.1159/000521412. Epub 2022 Jan 31.

Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis

Yochai Levy  1   2 , Adi Turjeman  2   3 , Lisa Cooper  1   2 , Nadya Kagansky  2   4 , Tatiana Nagulevich  5 , Tamari Snir  5 , Avital Hershkovitz  2   6 , Avraham Weiss  1   2 , Yichayaou Beloosesky  1   2 , Yaara Leibovici Weissman  2   7
Affiliations

Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis

Yochai Levy et al. Gerontology. 2022.

Abstract

Background/aims: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening millions of people worldwide. This study aimed to describe clinical characteristics, outcomes, and risk factors of SARS-CoV-2-positive, asymptomatic, frail older adults.

Methods: A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic at the time of their admission in these units. Residents' characteristics and symptoms were obtained via electronic medical records. The primary outcome was a composite of death or hospitalization by day 40. We looked at time to the primary outcome and used Cox regression for a multivariate analysis.

Results: During March-November 2020, 849 residents met inclusion criteria. Median age was 84 years. Most were completely dependent for basic activities of daily living and showed cognitive impairment. Six hundred forty-one (75.5%) residents were discharged after considered cured from COVID-19, 125 (14.7%) were hospitalized, and 82 (9.7%) died in the facilities. In survival analysis, 35% reached the primary outcome of death or hospitalization by day 40. Age (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.1-1.4), male gender (HR 1.41; 95% CI: 1.1-1.88), and COPD (HR 1.8; 95% CI: 1.23-2.67) were significant risk factors.

Conclusions: In this large cohort, we report care and prognosis of asymptomatic older adults with major functional or cognitive impairments during the COVID-19 pandemic. Most presymptomatic patients do not develop severe infection, and age stays a predominant risk factor, even in the frailest older adults.

Keywords: Coronavirus disease; Frailty; Long-term care; Older adults; Vitamin D.

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Conflict of interest statement

The authors have no conflicts, financial or others, to disclose.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Kaplan-Meier curve for severe symptomatic disease-free survival. Cum survival, cumulative survival; duration, duration of follow-up (days).
See this image and copyright information in PMC

References

    1. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2020;19:141–54. - PMC - PubMed
    1. Tehrani S, Killander A, Åstrand P, Jakobsson J, Gille-Johnson P. Risk factors for death in adult COVID-19 patients: frailty predicts fatal outcome in older patients. Int J Infect Dis. 2021;102:415–21. - PMC - PubMed
    1. Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health. 2020;5:e444–51. - PMC - PubMed
    1. Grabowski DC, Mor V. Nursing home care in crisis in the wake of COVID-19. JAMA. 2020;324:23–4. - PubMed
    1. Ouslander JG, Grabowski DC. COVID-19 in nursing homes: calming the perfect storm. J Am Geriatr Soc. 2020;68:2153–62. - PubMed