Introduction Older adults with COVID-19 have disproportionately higher rates of severe disease and mortality. It is unclear whether this is attributable to age or attendant age-associated risk factors. This retrospective cohort study aims to characterize hospitalized older adults and examine if comorbidities, frailty and acuity of clinical presentation exert an age-independent effect on COVID-19 severity. Methods We studied 275 patients admitted to the National Centre of Infectious Disease, Singapore. We measured: 1)Charlson Comorbidity Index(CCI) as burden of comorbidities; 2)Clinical Frailty Scale(CFS) and Frailty Index(FI); and 3)initial acuity. We studied characteristics and outcomes of critical illness, stratified by age groups (50–59,60–69 and ≥70). We conducted hierarchical logistic regression in primary model( N = 262, excluding direct admissions to intensive care unit) and sensitivity analysis( N = 275): age and gender in base model, entering CCI, frailty (CFS or FI) and initial acuity sequentially. Results The ≥70 age group had highest CCI( p <.001), FI( p <.001) and CFS( p <.001), and prevalence of geriatric syndromes (polypharmacy,53.5%; urinary symptoms,37.5%; chronic pain,23.3% and malnutrition,23.3%). Thirty-two (11.6%) developed critical illness. In the primary regression model, age was not predictive for critical illness when a frailty predictor was added. Significant predictors in the final model (AUC 0.809) included male gender ( p =.012), CFS ( p =.038), and high initial acuity ( p =.021) but not CCI or FI. In sensitivity analysis, FI ( p =.028) but not CFS was significant. Conclusions In hospitalized older adults with COVID-19, geriatric syndromes are not uncommon. Acuity of clinical presentation and frailty are important age-independent predictors of disease severity. CFS and FI provide complimentary information in predicting interval disease progression and rapid disease progression respectively.
【저자키워드】 COVID-19, frailty, geriatric assessment,