Authors (including presenting author) :
Tam EMYY(1), Kwan YK(1), Ng YY(1), Yam PW(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
The third wave of COVID-19 outbreak in Hong Kong involved more elderly patients as compared to the previous two waves. With the current local healthcare policy, hospitalization rate for elderly COVID-19 patients was 100% irrespective of disease severity, allowing a comprehensive overview of the disease course and outcomes in such group of patients.
Objectives :
This study aimed to investigate the disease course and outcomes of elderly patients with COVID-19 infection, and to look for mortality rates among different age groups and frailty level within the study population.
Methodology :
This was a retrospective observational study. All elderly patients ≥65 years who were admitted to Tuen Mun Hospital between 1st July to 31st August 2020 for management of COVID-19 infection were recruited. Their demographic information, presentation, laboratory results and outcomes were reviewed. The association of age and Clinical Frailty Scale (CFS) with in-patient mortality was investigated.
Result & Outcome :
101 patients were recruited with a median age of 73 (range 65 to 96). 52.5% were male. 30.7% were at least mildly frail with CFS ≥5. 85% had at least 1 comorbid chronic disease. The most common symptoms were fever (80.2%) and cough (63.4%). Lymphopenia, hyponatremia and raised inflammatory markers were common laboratory findings.
Hypoxia was present in 52 patients (51.5%) and occurred on day 8 (IQR 5–11days) from symptom onset. 16 patients received ICU care. 13 were put on mechanical ventilation. The overall mortality rate was 16.8%. Mortality rate among those who developed hypoxia was 32.7%. Mortality in patients requiring ICU care and mechanical ventilation were 37.5% and 46.2% respectively. All patients who did not develop hypoxia survived.
The mortality rates in patients aged 65 – 69, 70 – 79, 80 – 89 and ≥90 years were 9.1% (3/33), 10% (3/30), 30% (9/30) and 25% (2/8) respectively.
Elderly who were very fit and well (CFS 1–2), managing well to vulnerable (CFS 3–4), mildly to moderately frail (CFS 5–6) and at least severely frail (CFS ≥7) had a mortality rate of 5.7% (2/35), 15.2% (5/33), 23.5% (4/17) and 40% (6/15) respectively.
To conclude, clinical deterioration was common in elderly with COVID-19. Advanced age and frailty level were both positively associated with in-patient mortality.
