Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis
Yochai Levy, Adi Turjeman, Lisa Cooper, Nadya Kagansky, Tatiana Nagulevich, Tamari Snir, Avital Hershkovitz, Avraham Weiss, Yichayaou Beloosesky, Yaara Leibovici Weissman
Gerontology, doi:10.1159/000521412
Background/Aims: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening millions of people worldwide. This study aimed to describe clinical characteristics, outcomes, and risk factors of SARS-CoV-2-positive, asymptomatic, frail older adults. Methods: A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic at the time of their admission in these units. Residents' characteristics and symptoms were obtained via electronic medical records. The primary outcome was a composite of death or hospitalization by day 40. We looked at time to the primary outcome and used Cox regression for a multivariate analysis. Results: During March-November 2020, 849 residents met inclusion criteria. Median age was 84 years. Most were completely dependent for basic activities of daily living and showed cognitive impairment. Six hundred forty-one (75.5%) residents were discharged after considered cured from CO-VID-19, 125 (14.7%) were hospitalized, and 82 (9.7%) died in the facilities. In survival analysis, 35% reached the primary outcome of death or hospitalization by day 40. Age (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.1-1.4), male gender (HR 1.41; 95% CI: 1.1-1.88), and COPD (HR 1.8; 95% CI: 1.23-2.67) were significant risk factors. Conclusions: In this large cohort, we report care and prognosis of asymptomatic older adults with major functional or cognitive impairments during the COVID-19 pandemic. Most presymptomatic patients do not develop severe infection, and age stays a predominant risk factor, even in the frailest older adults.
Conflict of Interest Statement The authors have no conflicts, financial or others, to disclose.
Author Contributions Y.L. initiated the study, contributed to data collection, analysis, and interpretation, and drafted the manuscript. A.T. contributed to data analysis and interpretation. L.C. provided critical revisions. N.K. contributed to data acquisition. N.T. contributed to data acquisition. T.S. contributed to data acquisition. A.H. provided critical revisions. A.W. provided critical revisions. Y.B. provided critical revisions. Y.L.W. contributed to data analysis and interpretation and drafted the manuscript.
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'abstract': '<jats:p>Background/Aims: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening '
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'A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing '
'homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic '
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'obtained via electronic medical records. The primary outcome was a composite of death or '
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