Frailty, covid-19 disease severity and outcome among hospitalised older adults

Aim To examine the characteristics and outcomes of hospitalised older adults with COVID-19. Methods Retrospective, multi-centre, cohort observational study. Data from sixty-nine hospitalised patients aged over 70 years with reverse transcriptase polymerase chain reaction-confirmed COVID-19 at three Irish hospitals were collected from health records. Symptom profile, COVID-19 severity level based on Irish Thoracic Society guidelines, Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores, laboratory and radiological data were reviewed. Results Patient mortality rate was 23.2% (n=16). Median survivor age was 81.5 years (IQR 76.5-86.5). Mean CFS and CIRS-G scores were 5; (SD1.6) and 8.19; (SD4.4). Most patients (n=56, 81.1%) were categorised as mild COVID-19 cases. Five patients (n=5, 7%) were asymptomatic. Atypical symptom presentation was 7%(n=5). Delirium was noted in almost one-third of patients (n=21, 30.4%). Seven patients (n=7,10.1%) required intubation and intensive care unit admission. Over 1/3 of delirious patients died (n=8, 38%). Frail patients were older (P= 0.005), more likely to have dementia (P=0.04) and required less ventilatory support than non-frail patients (P=0.001) but were categorised as mild COVID-19 on admission (P=0.004). Conclusion Despite mild COVID-19 symptoms, mortality and delirium rates remained high. Low co-morbidity burden & atypical symptom rates were recorded despite high frailty rates.