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

Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK

Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK

Cancer Research UK, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK

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Department of Acute Internal Medicine and Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK

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Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK

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Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK

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Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK

Author to whom correspondence should be addressed.

Academic Editors: Phyo Kyaw Myint and Jonathan Hewitt

Geriatrics 2021, 6(1), 11; https://doi.org/10.3390/geriatrics6010011

Received: 4 January 2021 / Revised: 26 January 2021 / Accepted: 27 January 2021 / Published: 1 February 2021

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

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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. View Full-Text

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

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MDPI and ACS Style

Osuafor, C.N.; Davidson, C.; Mackett, A.J.; Goujon, M.; Van Der Poel, L.; Taylor, V.; Preller, J.; Goudie, R.J.B.; Keevil, V.L. Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study. Geriatrics 2021, 6, 11. https://doi.org/10.3390/geriatrics6010011

AMA Style

Osuafor CN, Davidson C, Mackett AJ, Goujon M, Van Der Poel L, Taylor V, Preller J, Goudie RJB, Keevil VL. Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study. Geriatrics. 2021; 6(1):11. https://doi.org/10.3390/geriatrics6010011

Chicago/Turabian Style

Osuafor, Christopher N., Catriona Davidson, Alistair J. Mackett, Marie Goujon, Lelane Van Der Poel, Vince Taylor, Jacobus Preller, Robert J.B. Goudie, and Victoria L. Keevil. 2021. "Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study" Geriatrics 6, no. 1: 11. https://doi.org/10.3390/geriatrics6010011

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

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