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.

Assessment of brainstem responses is feasible in sedated critically ill patients and loss of selected responses is predictive of mortality and altered mental status.