Abstract and Introduction
Background: Clinical presentation and risk factors of death in COVID-19 in oldest adults have not been well characterized.
Objectives: To describe clinical features and outcome of COVID-19 in patients older than 85 years and study risk factors for mortality.
Design: Prospective cohort.
Participants and Setting: Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand-Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days.
Measurements: Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death.
Results: From March 14 to April 11, 2020, 76 patients (median age = 90 (86–92) years; women = 55.3%) were admitted for confirmed COVID-19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID-19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8–17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9–19.5) days. Independent predictive factors of death were C-reactive protein level at admission and lymphocyte count at nadir.
Conclusion: Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID-19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.
The oldest-old (people aged ≥85 years) population usually has a different burden of disease incidence than the general population, including high incidence and more severe symptoms requiring specific explorations and care. Although their proportion is increasing dramatically worldwide, little is known about the specific features of COVID-19 in this population of older adults.
A novel coronavirus, designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of COVID-19 in Wuhan, China, at the end of 2019. It has spread rapidly to the rest of the world, with more than 27 million cases worldwide reported by the World Health Organization as of September 4, 2020. The clinical spectrum of SARS-CoV-2 pneumonia ranges from mild to critical cases. Although age and comorbidities are considered to be the main risk factors for severe form and death in patients with COVID-19, clinical description in oldest-old patients is still underexplored. So far, COVID-19 is limited in descriptive report of epidemiological findings, clinical presentation, and clinical outcomes of patients older than 65 years.[5–7]
We report a prospective cohort of patients, aged 85 years and older, sequentially admitted for confirmed SARS-CoV-2 in an academic hospital in Paris, France.
J Am Geriatr Soc. 2020;68(12):2735-2743. © 2020 Blackwell Publishing