Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality

Abstract

Purpose To describe the clinical features of COVID-19 in older adults, and relate these to outcomes. Methods Cohort study of 217 individuals (≥70 years) hospitalised with COVID-19, followed up for allcause mortality. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil : lymphocyte ratio were used as measures of immune activity. Results Cardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge. Conclusions COVID-19 may present without cardinal symptoms as well as implicate a possible role for agerelated changes in immunity in mediating the relationship between frailty and mortality.

Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients

“…The onset of delirium is due to a complex interaction between the baseline vulnerability of the patient or predisposing factors and noxious insults or precipitating factors; recent observations lead us to believe that frailty and immunosenescence constitute factors that explain the excess mortality in elderly subjects with COVID-19 (19).…”

“…Although the most frequent and life-threatening complications of coronavirus disease 19 (COVID- 19) are respiratory, there are increasing reports of neurological and psychiatric involvement (1).…”

Delirium in Patients with SARS‐CoV‐2 Infection: A Multicenter Study

“…Rates of morbidity and mortality associated with COVID‐19 have been found to be much higher in older adults than in all other age groups 1,2 . It has also been recognized that atypical presentations of COVID‐19 are more frequent in these segments of the population 3,4 …”

“…To date, delirium prevalence in COVID‐19 varies greatly between studies, with some, published in the early months of the pandemic, reporting high or very high rates, 3,8‐11 and other more recent ones finding lower prevalence 12‐14 . Furthermore, there are only a few studies that have investigated the risk factors of delirium in patients with COVID‐19 15,16 and there are contrasting findings regarding the potential association of delirium with mortality in this context 3,8,9,13‐15 . There is therefore a need for further exploration of these issues.…”

The frailty and mortality relationship in patients with COVID-19

“…I read with great interest the brief report by Knopp et al [ 1 ] entitled ‘Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality.’ The authors described the clinical characteristics and outcomes of older adults diagnosed with COVID-19. Results of particular interest include higher Clinical Frailty Scale (CFS) scores with decreases in C-reactive protein (CRP) ( p < 0.01), an age-related increase in mortality (HR 1.1, 95% CI 1.0–1.1, p < 0.01) but neither sex nor frailty was associated with mortality and a higher likelihood of death with rising CRP or higher neutrophil:lymphocyte ratio.…”