Background There is limited information describing the characteristics and outcomes of hospitalized older patients with confirmed coronavirus disease 2019 (COVID-19). Methods We conducted a multicentric retrospective cohort study in 13 acute COVID-19 geriatric wards, from March 13 to April 15, 2020, in Paris area. All consecutive patients aged ≥ 70 years, with confirmed COVID-19, were enrolled. Results Of the 821 patients included in the study, the mean (SD) age was 86 (7) years; 58% were female; 85% had ≥ 2 comorbidities; 29% lived in an institution; and the median (interquartile range) Activities of Daily Living Scale (ADL) score was 4 [2-6]. The most common symptoms at COVID-19 onset were asthenia (63%), fever (55%), dyspnea (45%), dry cough (45%) and delirium (25%). The in-hospital mortality was 31% (95% confidence interval [CI], 27 to 33). On multivariate analysis, at COVID-19 onset, the probability of in-hospital mortality was increased with male gender (odds ratio [OR], 1.85; 95% CI, 1.30 to 2.63), ADL score < 4 (OR, 1.84; 95% CI, 1.25 to 2.70), asthenia (OR, 1.59; 95% CI, 1.08 to 2.32), quick Sequential Organ Failure Assessment score ≥ 2 (OR, 2.63; 95% CI, 1.64 to 4.22) and specific COVID-19 anomalies on chest computerized tomography (OR, 2.60; 95% CI, 1.07 to 6.46). Conclusions This study provides new information about older patients with COVID-19 who are hospitalized. A quick bedside evaluation at admission of sex, functional status, systolic arterial pressure, consciousness, respiratory rate and asthenia can identify older patients at risk of unfavorable outcomes.

Objective The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARB) and an ACE inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19. Design This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020. Setting and Participants: All consecutive 201 patients hospitalized for COVID-19 (confirmed by RT-PCR methods) were included. All non-deceased patients had 30 days of follow-up and no patient was lost to follow-up. Methods Demographic, clinical, biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models. Results Mean age of the population was 86.3 (8.0) years old, 62.7% of patients were institutionalized, 88.6% had dementia and 53.5% had severe disability (ADL score < 2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB nor ACEI (22.2% (14) vs. 37.7% (52), HR = 0.54 (95% CI = 0.30-0.97), p=0.03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, CRP and white blood cells count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR = 0.52 (0.27−0.99), p=0.048). Conclusion and Implications In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI prior to the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.