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Clinical course and mortality in older patients with COVID-19: a cluster-based study in Hong Kong
E M Y Y Tam1, Y K Kwan1, Y Y Ng1
1Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
Insights
The third wave of coronavirus disease 2019 (COVID-19) in Hong Kong saw more frail older patients. Mortality in these elderly COVID-19 patients increased with age and frailty, highlighting the need for targeted care.
Area of Science:
- Gerontology
- Infectious Diseases
- Public Health
Background:
- The third wave of the COVID-19 pandemic in Hong Kong disproportionately affected frail older adults.
- Hospitalization was mandated for all older adults diagnosed with COVID-19 in Hong Kong.
- Understanding the clinical course and outcomes in this demographic is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of elderly patients (≥65 years) hospitalized with COVID-19 during the third wave in Hong Kong.
- To determine the association between age, Clinical Frailty Scale (CFS) score, and in-patient mortality in this patient group.
Main Methods:
- A retrospective observational study was conducted at Tuen Mun Hospital.
- Included were 101 patients aged 65 years and older admitted for COVID-19 between July 1 and August 31, 2020.
- Data collected included baseline characteristics, clinical presentation, laboratory results, complications, outcomes, and in-patient mortality, with analysis of age and CFS score associations.
Main Results:
- The study included 101 patients (median age 73 years), with 85% having pre-existing chronic diseases. Common symptoms were fever (80.2%) and cough (63.4%).
- Hypoxia developed in 51.5% of patients, often around day 8 post-symptom onset. 16 patients required intensive care, with 13 needing mechanical ventilation.
- The overall in-patient mortality rate was 16.8%. Mortality rates increased with age groups (9.1% for 65-69 to 30% for 80-89) and CFS scores (5.7% for 1-2 to 40% for ≥7).
Conclusions:
- Older patients with COVID-19 experienced significant clinical deterioration and a substantial mortality rate of 16.8%.
- A clear linear relationship exists between increasing age and Clinical Frailty Scale scores and in-patient mortality.
- These findings underscore the vulnerability of frail older adults to severe COVID-19 outcomes and the importance of frailty assessment in risk stratification.
Introduction:
Compared with previous waves of the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong, the third wave involved a greater number of frail older patients. Because local healthcare policy required hospitalisation for all older adults with COVID-19, we aimed to investigate the clinical course and outcomes in such patients.
Methods:
This retrospective observational study included all patients aged ≥65 years who were admitted to Tuen Mun Hospital for management of COVID-19 between 1 July 2020 and 31 August 2020. We reviewed baseline characteristics, clinical presentation, laboratory results, complications, and outcomes. We also investigated the associations of age and Clinical Frailty Scale (CFS) score with in-patient mortality.
Results:
In total, 101 patients were included (median age, 73 years); 52.5% were men and 85% had at least co-morbid chronic disease. The most common symptoms were fever (80.2%) and cough (63.4%). Fifty-two patients (51.5%) developed hypoxia, generally on day 8 (interquartile range, 5-11) after symptom onset. Of the 16 patients who required intensive care unit support, 13 required mechanical ventilation. The overall mortality rate was 16.8%. Patients aged 65-69, 70-79, 80-89, and ≥90 years had mortality rates of 9.1%, 10%, 30%, and 25%, respectively. Patients with CFS scores of 1-2, 3-4, 5-6, and ≥7 had mortality rates of 5.7%, 14.7%, 23.5%, and 40%, respectively. A linear relationship was confirmed between the two mortality trends.
Conclusion:
Clinical deterioration was common in older patients with COVID-19; their overall mortality rate was 16.8%. Mortality increased linearly with both age and CFS score.
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