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      Age, frailty and comorbidity as prognostic factors for short-term outcomes in patients with COVID-19 in geriatric care

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          Abstract

          Objectives

          To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19).

          Design

          Single-center observational study.

          Setting

          and Participants: Patients admitted to geriatric care in a large hospital in Sweden, between March 1 st – June 11 th 2020; 250 were treated for COVID-19 and 717 for other diagnoses.

          Methods

          COVID-19 diagnosis was clinically confirmed by positive RT-PCR test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used.

          Results

          Among the COVID-19 patients, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR]=1.05 per each year, 95% confidence interval [CI]=1.01-1.08) and lower probability of home discharge (HR=0.97, 95% CI=0.95-0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR=1.93, 95% CI=1.02-3.65 and HR=1.27, 95% CI=1.02-1.58, respectively). Patients with CFS>5 had a lower probability of being discharged home (HR=0.38, 95% CI=0.25-0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome.

          Conclusions and Implications

          Of all geriatric COVID-19 patients, three out of four survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients.

          Abstract

          Age, frailty and comorbidities are associated with in-hospital mortality and a decreased probability to be discharged to home in geriatric COVID-19 patients from a large hospital in Stockholm, Sweden.

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          Author and article information

          Contributors
          Journal
          J Am Med Dir Assoc
          J Am Med Dir Assoc
          Journal of the American Medical Directors Association
          Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.
          1525-8610
          1538-9375
          14 August 2020
          14 August 2020
          Affiliations
          [1 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
          [2 ]Theme Aging, Karolinska University Hospital, Huddinge, Sweden
          [3 ]Department of Neurobiology, Care Sciences and Society (NVS), division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
          [4 ]Department of Neurobiology, Care Sciences and Society (NVS), Division of Nursing, Karolinska Institutet, Stockholm, Sweden
          [5 ]Research & development unit, Stockholms Sjukhem, Stockholm, Sweden
          Author notes
          [# ]Corresponding author: Sara Hägg Department of Medical Epidemiology and Biostatistics Karolinska Institutet 171 77 Stockholm Sweden Sara.hagg@ 123456ki.se
          [∗]

          Shared 1 st author position.

          Article
          S1525-8610(20)30704-0
          10.1016/j.jamda.2020.08.014
          7427570
          © 2020 Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          Categories
          Article

          covid-19, frailty, comorbidity, geriatrics, survival, aging

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