Geriatric Syndromes in Older Adults Hospitalized with COVID-19 in Montreal, Canada

Abstract

Background Older adults are more vulnerable to severe infection and mortality due to COVID-19. They have atypical presentations of the disease without respiratory symptoms, making early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older (≥70 yrs & ≥90 yrs) and younger (<70 yrs) patients hospitalized with COVID-19. Methods Retrospective review of 429 consecutive patients hospitalized at two tertiary care hospitals in Montreal, Canada, with PCR-confirmed COVID-19. Baseline characteristics, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older versus younger individuals. Additional subgroup analyses were performed amongst patients ≥70 stratifying by sex, living situation, and those presenting with geriatric syndromes compared to those without. Results Patients ≥70 (n=260) presented less frequently with respiratory symptoms compared to patients <70 (n=169) (52% vs. 32%). 11% of patients ≥70 and 24% of patients ≥90 presented with a geriatric syndrome as their sole symptom compared to 3% of those <70. Older adults were more likely to develop disease complications (including delirium, acute kidney injury, and hypernatremia) and had higher in-hospital mortality (32% vs. 13%). Subgroup analyses revealed heightened vulnerability to complications in older men, those from long-term care, and those with at least one geriatric syndrome upon presentation. Conclusions Older adults presenting to hospital with COVID-19 often have no respiratory symptoms and can present with only a geriatric syndrome. New geriatric syndromes in older individuals should trigger evaluation for COVID-19 and consideration for early initiation of multidisciplinary care to prevent complications.

Geriatric care model for older patients with COVID-19 at a community treatment facility in Hong Kong

“…We proactively identified and managed geriatric syndromes, which may be the clinical manifestations or complications of COVID-19 in older people. 5 In the present study, the prevalences of geriatric syndromes (eg, delirium, pressure injuries, falls during hospitalisation, poor oral feeding or anorexia, and urinary retention) ranged from 3.9% to 29.6%; poor oral feeding or anorexia was most common. These findings highlight the importance of multidisciplinary care for older people with COVID-19.…”

“…Anorexia is common in patients with COVID-19. 4,5 It occurred in approximately one-third of our patients. Older patients are at risk for poor oral feeding or anorexia because of their pre-existing comorbidities.…”

“…3 In addition, older people often display exacerbations of pre-existing comorbidities, functional and cognitive decline, and development of geriatric syndromes (eg, delirium, falls, poor oral feeding, and psychological problems). [4][5][6] These phenomena are particularly common in older people with frailty and multiple comorbidities, as well as those living in long-term care facilities. 7,8 In March 2022, understanding the complex health problems, the care and support needs of older people, a geriatric team comprising geriatricians, geriatric nurses, and allied health professionals was established in the CTF to focus on clinical management and discharge planning for older patients.…”

Impact of Hospitalization on Patients Ability to Perform Basic Activities of Daily Living

“…This matches prior observations that the social isolation of the COVID-19 pandemic and higher social vulnerability are associated with worse functional status among older adults. (14)(15)(16) Our findings demonstrate a need for a greater focus on improving ADL function for tasks that require more mobility (using the toilet and getting in and out of bed). Strategies during hospitalization (e.g., through exercise (17) ) are needed to bring patients back to their pre-admission functional levels.…”