tetano
Editor, Senior Moderator
J Am Geriatr Soc
. 2022 Feb 18.
doi: 10.1111/jgs.17718. Online ahead of print.
Factors associated with hospital admission and severe outcomes for older patients with COVID-19
Jiyu Kim[SUP] 1 [/SUP], Caroline Blaum[SUP] 2 3 [/SUP], Rosie Ferris[SUP] 2 [/SUP], Mauricio Arcila-Mesa[SUP] 2 [/SUP], Hyungrok Do[SUP] 1 [/SUP], Claudia Pulgarin[SUP] 4 [/SUP], Johanna Dolle[SUP] 5 [/SUP], Jennifer Scherer[SUP] 6 [/SUP], Roopa Kalyanaraman Marcello[SUP] 5 [/SUP], Judy Zhong[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Morbidity and death due to coronavirus disease (COVID-19) experienced by older adults in nursing homes has been well described, but COVID-19's impact on community-living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID-19 risks and outcomes.
Methods: To investigate the relationship of advanced age (65+), on risk factors associated with COVID-19 outcomes in community-living elders, we identified an electronic health records (EHR) cohort of older patients aged 65+ with laboratory-confirmed COVID-19 with and without an ambulatory care visit in the past 24 months (n=47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID-19 hospitalization; severe outcomes (ICU, intubation, dialysis, stroke, in-hospital death), and in-hospital death. The exposures include demographic characteristics, and from those with ambulatory records, comorbidities, frailty, and laboratory results.
Results: The 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non-Hispanic white, 23.3% non-Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race/ethnicity, comorbidities and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID-19 hospitalization and severe outcomes; with strongest effect in the oldest group.
Conclusions: In this cohort of community-dwelling older adults, we provided evidence of age-specific risk factors for COVID-19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID-19 outcomes in community-living older adults, and the role of engagement in ambulatory care in mitigating severe disease. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; age-specific risk factors; ambulatory care; community-living older adults.
. 2022 Feb 18.
doi: 10.1111/jgs.17718. Online ahead of print.
Factors associated with hospital admission and severe outcomes for older patients with COVID-19
Jiyu Kim[SUP] 1 [/SUP], Caroline Blaum[SUP] 2 3 [/SUP], Rosie Ferris[SUP] 2 [/SUP], Mauricio Arcila-Mesa[SUP] 2 [/SUP], Hyungrok Do[SUP] 1 [/SUP], Claudia Pulgarin[SUP] 4 [/SUP], Johanna Dolle[SUP] 5 [/SUP], Jennifer Scherer[SUP] 6 [/SUP], Roopa Kalyanaraman Marcello[SUP] 5 [/SUP], Judy Zhong[SUP] 1 [/SUP]
Affiliations
- PMID: 35179781
- DOI: 10.1111/jgs.17718
Abstract
Background: Morbidity and death due to coronavirus disease (COVID-19) experienced by older adults in nursing homes has been well described, but COVID-19's impact on community-living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID-19 risks and outcomes.
Methods: To investigate the relationship of advanced age (65+), on risk factors associated with COVID-19 outcomes in community-living elders, we identified an electronic health records (EHR) cohort of older patients aged 65+ with laboratory-confirmed COVID-19 with and without an ambulatory care visit in the past 24 months (n=47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID-19 hospitalization; severe outcomes (ICU, intubation, dialysis, stroke, in-hospital death), and in-hospital death. The exposures include demographic characteristics, and from those with ambulatory records, comorbidities, frailty, and laboratory results.
Results: The 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non-Hispanic white, 23.3% non-Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race/ethnicity, comorbidities and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID-19 hospitalization and severe outcomes; with strongest effect in the oldest group.
Conclusions: In this cohort of community-dwelling older adults, we provided evidence of age-specific risk factors for COVID-19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID-19 outcomes in community-living older adults, and the role of engagement in ambulatory care in mitigating severe disease. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; age-specific risk factors; ambulatory care; community-living older adults.