COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Wu, Z.; McGoogan, J.M. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020, 323, 1239–1242. [Google Scholar] [CrossRef]
- Onder, G.; Rezza, G.; Brusaferro, S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA 2020, 323, 1775–1776. [Google Scholar] [CrossRef]
- National Institutes of Health, Malaysia. Clinical Update in Covid-19. Available online: http://www.nih.gov.my/covid-19 (accessed on 14 January 2021).
- Ministry of Health. Covid-19 Malaysia. Available online: http://covid-19.moh.gov.my/terkini (accessed on 14 January 2021).
- Guan, W.J.; Liang, W.H.; Zhao, Y.; Liang, H.R.; Chen, Z.S.; Li, Y.M.; Liu, X.Q.; Chen, R.C.; Tang, C.L.; Wang, T.; et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur. Respir. J. 2020, 55, 2000547. [Google Scholar] [CrossRef] [PubMed]
- Rawle, M.J.; Bertfield, D.L.; Brill, S.E. Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study. Aging Med. (Milton) 2020, 3, 237–244. [Google Scholar] [CrossRef] [PubMed]
- Davis, P.; Gibson, R.; Wright, E.; Bryan, A.; Ingram, J.; Lee, R.P.; Godwin, J.; Evans, T.; Burleigh, E.; Wishart, S.; et al. Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: A retrospective observational study in Glasgow, Scotland. Scott. Med. J. 2020. [Google Scholar] [CrossRef]
- Mustaffa, N.; Lee, S.Y.; Mohd Nawi, S.N.; Che Rahim, M.J.; Chee, Y.C.; Muhd Besari, A.; Lee, Y.Y. COVID-19 in the elderly: A Malaysian perspective. J. Glob. Health. 2020, 10, 020370. [Google Scholar] [CrossRef]
- Rockwood, K.; Theou, O. Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Can. Geriatr. J. 2020, 23, 210–215. [Google Scholar] [CrossRef]
- Sim, B.L.H.; Chidambaram, S.K.; Wong, X.C.; Pathmanathan, M.D.; Peariasamy, K.M.; Hor, C.P.; Chua, H.J.; Goh, P.P. Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study. Lancet Reg. Health West. Pac. 2020, 4, 100055. [Google Scholar] [CrossRef] [PubMed]
- Mendes, A.; Serratrice, C.; Herrmann, F.R.; Genton, L.; Périvier, S.; Scheffler, M.; Fassier, T.; Huber, P.; Jacques, M.C.; Prendki, V.; et al. Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study. J. Am. Med. Dir. Assoc. 2020, 21, 1546–1554.e3. [Google Scholar] [CrossRef] [PubMed]
- Wei, C.; Liu, Y.; Liu, Y.; Zhang, K.; Su, D.; Zhong, M.; Meng, X. Clinical characteristics and manifestations in older patients with COVID-19. BMC Geriatr. 2020, 20, 395. [Google Scholar] [CrossRef]
- Sun, H.; Ning, R.; Tao, Y.; Yu, C.; Deng, X.; Zhao, C.; Meng, S.; Tang, F.; Xu, D. Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, China: A retrospective study. J. Am. Geriatr. Soc. 2020, 68, E19–E23. [Google Scholar] [CrossRef]
- Zazzara, M.B.; Penfold, R.S.; Roberts, A.L.; Lee, K.A.; Dooley, J.; Sudre, C.H.; Welch, C.; Bowyer, R.C.E.; Visconti, A.; Mangino, M.; et al. Probable delirium is a presenting symptom of COVID-19 in frail, older adults: A cohort study of 322 hospitalised and 535 community-based older adults. Age Ageing 2021, 50, 40–48. [Google Scholar] [CrossRef]
- Kennedy, M.; Helfand, B.; Gou, R.Y.; Gartaganis, S.L.; Webb, M.; Moccia, J.M.; Bruursema, S.N.; Dokic, B.; McCulloch, B.; Ring, H.; et al. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw. Open 2020, 3, e2029540. [Google Scholar] [CrossRef]
- Poloni, T.E.; Carlos, A.F.; Cairati, M.; Cutaia, C.; Medici, V.; Marelli, E.; Ferrari, D.; Galli, A.; Bognetti, P.; Davin, A.; et al. Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study. EClinicalMedicine 2020, 26, 100490. [Google Scholar] [CrossRef] [PubMed]
- Achar, A.; Ghosh, C. COVID-19-Associated Neurological Disorders: The Potential Route of CNS Invasion and Blood-Brain Relevance. Cells 2020, 9, 2360. [Google Scholar] [CrossRef] [PubMed]
- Inouye, S.K.; Charpentier, P.A. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996, 275, 852–857. [Google Scholar] [CrossRef] [PubMed]
- Huang, J.T.; Ran, R.X.; Lv, Z.H.; Feng, L.N.; Ran, C.Y.; Tong, Y.Q.; Li, D.; Su, H.W.; Zhu, C.L.; Qiu, S.L.; et al. Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China. Clin. Infect Dis. 2020, 71, 2158–2166. [Google Scholar] [CrossRef] [PubMed]
- Faíco-Filho, K.S.; Passarelli, V.C.; Bellei, N. Is Higher Viral Load in SARS-CoV-2 Associated with Death? Am. J. Trop. Med. Hyg. 2020, 103, 2019–2021. [Google Scholar] [CrossRef]
- He, X.; Lau, E.H.Y.; Wu, P.; Deng, X.; Wang, J.; Hao, X.; Lau, Y.C.; Wong, J.Y.; Guan, Y.; Tan, X.; et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat. Med. 2020, 26, 672–675. [Google Scholar] [CrossRef] [PubMed]
- Liu, Y.L.; Liao, W.; Wan, L.; Xiang, T.; Zhang, W. Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19. Viral Immunol. 2020. [Google Scholar] [CrossRef]
- Shah, S.; Singhal, T.; Davar, N.; Thakkar, P. No correlation between Ct values and severity of disease or mortality in patients with COVID 19 disease. Indian J. Med. Microbiol. 2020. [Google Scholar] [CrossRef]
- Wölfel, R.; Corman, V.M.; Guggemos, W. Virological assessment of hospitalized patients with COVID-2019. Nature 2020, 581, 465–469. [Google Scholar] [CrossRef]
- Popkin, M.B.; Du, S.; Green, W.D.; Beck, M.A.; Algaith, T.; Herbst, C.H.; Alsukait, R.F.; Alluhidan, M.; Alazemi, N.; Shekar, M. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes. Rev. 2020, 21, e13128. [Google Scholar] [CrossRef]
- Leung, C. Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China. Mech. Ageing Dev. 2020, 188, 111255. [Google Scholar] [CrossRef]
- Chinnadurai, R.; Ogedengbe, O.; Agarwal, P.; Money-Coomes, S.; Abdurrahman, A.Z.; Mohammed, S.; Kalra, P.A.; Rothwell, N.; Pradhan, S. Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study. BMC Geriatr. 2020, 20, 409. [Google Scholar] [CrossRef] [PubMed]
- Zuin, M.; Guasti, P.; Roncon, L.; Cervellati, C.; Zuliani, G. Dementia and the risk of death in elderly patients with COVID-19 infection: Systematic review and meta-analysis. Int. J. Geriatr. Psychiatry 2021. [Google Scholar] [CrossRef]
- Hasmuk, K.; Sallehuddin, H.; Tan, M.P.; Cheah, W.K.; Ibrahim, R.; Chai, S.T. The Long Term Care COVID-19 Situation in Malaysia. Available online: https://ltccovid.org/wp-content/uploads/2020/05/Malaysia-LTC-COVID-situation-report-30-May.pdf (accessed on 11 January 2021).
- Emanuel, E.J.; Persad, G.; Upshur, R.; Thome, B.; Parker, M.; Glickman, A.; Zhang, C.; Boyle, C.; Smith, M.; Phillips, J.P. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N. Engl. J. Med. 2020, 382, 2049–2055. [Google Scholar] [CrossRef]
- O’Mara, L.; Streiter, S.; Orkaby, A.R.; Ouchi, K.; Bernacki, R. A Framework to Triage Older Adults with Covid-19 to Provide Patient-Centered Care. NEJM Catal. Innov. Care Deliv. 2020. [Google Scholar] [CrossRef]
- Ritchey, K.C.; Foy, A.; McArdel, E.; Gruenewald, D.A. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. Am. J. Hosp. Palliat Care 2020, 37, 992–997. [Google Scholar] [CrossRef] [PubMed]
- Rivi, V.; Melegari, G.; Blom, J.M. How to humanise the COVID-19 intensive care units. BMJ Evid. Based Med. 2021. [Google Scholar] [CrossRef] [PubMed]
All, N = 26 | Alive, N = 20 | Death, N = 6 | ||
---|---|---|---|---|
n (%) | n (%) | n (%) | p | |
Age, mean (SD) years | 76.2(8.2) | 74.5(7.6) | 81.8(8.0) | 0.053 |
Female | 15(57.7%) | 12(60.0%) | 3(50.0%) | >0.999 |
Nursing home resident | 8(30.8%) | 5(25.0%) | 3(50.0%) | 0.330 |
BADL a independent | 15(57.7%) | 13(65.0%) | 2(33.3%) | 0.348 |
Ambulation with aids/wheelchair | 12(46.2%) | 8(40.0%) | 4(66.7%) | 0.365 |
Clinical Frailty Scale ≥ 4 | 13(50.0%) | 8(40.0%) | 5(83.3%) | 0.160 |
Hospital-acquired COVID-19 | 9(34.6%) | 5(25.0%) | 4(66.7%) | 0.138 |
Comorbidities | ||||
Diabetes Mellitus | 16(61.5%) | 14(70.0%) | 2(33.3%) | 0.163 |
Hypertension | 22(84.6%) | 19(95.0%) | 3(50.0%) | 0.028 |
IHD/CCF b | 5(19.2%) | 5(25.0%) | 0 | 0.298 |
Chronic kidney disease | 5(19.2%) | 3(15.0%) | 2(33.3%) | 0.558 |
Dementia | 8(30.8%) | 4(20.0%) | 4(66.7%) | 0.051 |
Stroke | 8(30.8%) | 5(25.0%) | 3(50.0%) | 0.330 |
Charlson Comorbidity Index, median (IQR) | 6.0(3.5–7.0) | 6.0(3.0–7.0) | 5.5(4.0–7.3) | 0.458 |
Use of ARB/ACE-I c- before admission | 12(46.2%) | 11(55.0%) | 1(16.7%) | 0.170 |
Presenting symptoms | ||||
Symptomatic on admission | 23(88.5%) | 17(85.0%) | 6(100.0%) | >0.999 |
Fever | 11(42.3%) | 8(40.0%) | 3(50.0%) | >0.999 |
Respiratory symptoms d | 14(53.8%) | 12(60.0%) | 2(33.3%) | 0.365 |
Gastrointestinal symptoms e | 9(34.6%) | 9(45.0%) | 0 | 0.063 |
Loss of appetite | 10(38.5%) | 9(45.0%) | 1(16.7%) | 0.352 |
Lethargy | 10(38.5%) | 6(30.0%) | 4(66.7%) | 0.163 |
Delirium on presentation | 7(26.9%) | 3(15.0%) | 4(66.7%) | 0.028 |
Laboratory parameters | ||||
Haemoglobin, g/dL, mean (SD) | 12.15(2.48) | 12.09(1.91) | 12.38(4.27) | 0.889 |
White cell count ×109 L, median (Q1–Q3) | 6.90(5.90–9.90) | 6.60(5.30–7.88) | 8.10(6.16–13.10) | 0.628 |
Absolute lymphocyte count ×109 L, median (Q1–Q3) | 1.28(1.03–2.11) | 1.41(1.11–2.29) | 1.00(0.91–1.41) | 0.061 |
Absolute neutrophil count ×109 L, median (Q1–Q3) | 4.02(3.11–6.60) | 3.93(2.68–5.21) | 6.60(4.62–10.58) | 0.031 |
Urea, mmol/L, median (Q1–Q3) | 6.8(5.3–12.4) | 6.9(4.4–15.3) | 8.0(6.3–13.0) | 0.724 |
Creatinine, mmol/L median (IQR) | 78.0(68.0–103.0) | 89.0(52.5–114.5) | 78.0(73.5–149.5) | 0.667 |
Albumin, g/L, mean (SD) | 29.0(7.6) | 29.6(5.9) | 26.8(12.0) | 0.079 |
Ferritin, ng/mL, median (Q1–Q3) | 561(360–1174) | 556(360–784) | 1176(574–2224) | 0.090 |
C-Reactive Protein, mg/L, median (Q1–Q3) | 21.3(11.4–127.4) | 19.9(11.4–39.2) | 168.0(39.1–211.7) | 0.073 |
Lowest Ct-value f, mean(SD) | 22.35(5.29) | 23.11(5.77) | 19.58(1.56) | 0.032 |
Treatment | ||||
Concomitant antibiotic use | 18(69.2%) | 13(65.0%) | 5(83.3%) | 0.628 |
COVID-19 targeted therapy | 12(46.2%) | 11(55.0%) | 1(16.7%) | 0.170 |
VTE g prophylaxis | 9(34.6%) | 8(40.0%) | 1(16.7%) | 0.380 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Thiam, C.N.; Hasmukharay, K.; Lim, W.C.; Ng, C.C.; Pang, G.H.M.; Abdullah, A.; Saedon, N.I.; Khor, H.M.; Ong, T. COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis. Geriatrics 2021, 6, 25. https://doi.org/10.3390/geriatrics6010025
Thiam CN, Hasmukharay K, Lim WC, Ng CC, Pang GHM, Abdullah A, Saedon NI, Khor HM, Ong T. COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis. Geriatrics. 2021; 6(1):25. https://doi.org/10.3390/geriatrics6010025
Chicago/Turabian StyleThiam, Chiann Ni, Kejal Hasmukharay, Wan Chieh Lim, Chai Chen Ng, Gordon Hwa Mang Pang, Aimy Abdullah, Nor Izzati Saedon, Hui Min Khor, and Terence Ong. 2021. "COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis" Geriatrics 6, no. 1: 25. https://doi.org/10.3390/geriatrics6010025
APA StyleThiam, C. N., Hasmukharay, K., Lim, W. C., Ng, C. C., Pang, G. H. M., Abdullah, A., Saedon, N. I., Khor, H. M., & Ong, T. (2021). COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis. Geriatrics, 6(1), 25. https://doi.org/10.3390/geriatrics6010025