Geriatric Syndromes in Older Adults Hospitalized with COVID-19 in Montreal, Canada

  1. Sandrine Couture
  2. Marc-Antoine Lepage
  3. Claire Godard-Sebillotte
  4. Nadia Sourial
  5. Catherine Talbot-Hamon
  6. Richard Kremer
  7. Amichai Grunbaum

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Abstract

Background Older adults are more vulnerable to severe infection and mortality due to COVID-19. They have atypical presentations of the disease without respiratory symptoms, making early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older (≥70 yrs & ≥90 yrs) and younger (<70 yrs) patients hospitalized with COVID-19. Methods Retrospective review of 429 consecutive patients hospitalized at two tertiary care hospitals in Montreal, Canada, with PCR-confirmed COVID-19. Baseline characteristics, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older versus younger individuals. Additional subgroup analyses were performed amongst patients ≥70 stratifying by sex, living situation, and those presenting with geriatric syndromes compared to those without. Results Patients ≥70 (n=260) presented less frequently with respiratory symptoms compared to patients <70 (n=169) (52% vs. 32%). 11% of patients ≥70 and 24% of patients ≥90 presented with a geriatric syndrome as their sole symptom compared to 3% of those <70. Older adults were more likely to develop disease complications (including delirium, acute kidney injury, and hypernatremia) and had higher in-hospital mortality (32% vs. 13%). Subgroup analyses revealed heightened vulnerability to complications in older men, those from long-term care, and those with at least one geriatric syndrome upon presentation. Conclusions Older adults presenting to hospital with COVID-19 often have no respiratory symptoms and can present with only a geriatric syndrome. New geriatric syndromes in older individuals should trigger evaluation for COVID-19 and consideration for early initiation of multidisciplinary care to prevent complications.

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  1. Version published to 10.5770/cgj.25.579
  2. ScreenIT

    SciScore for 10.1101/2021.02.27.21252596: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics Approval: MUHC institutional review board approval was obtained for data collection.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis: Data was analyzed using IBM SPSS Statistics for Mac version 27.0 (SPSS Inc. Chicago, IL).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our study has limitations. First, the study only included patients within one center of the Montreal area (MUHC), but we included every patient, giving a comprehensive portrait in the most affected geographic area during the first wave of COVID-19 in Quebec. Second, the retrospective nature of the study required reliance on review of medical records for data extraction. Certain information was missing from baseline assessment, was based on other physicians’ interpretation of findings, or relied on patients’ recall of events. We only assessed short-term follow-up for all patients, limiting our assessment of long-term repercussions of the disease. Lastly, we performed statistical analyses for our pre-defined hypotheses regarding frequency of non-respiratory presentations, geriatric syndromes, and mortality. All other comparisons are descriptive. Caution should be taken regarding the reproducibility of the findings, with results viewed as hypothesis generating and to be validated in larger studies. Conclusion: This is the first study reporting clinical presentation, in-hospital course, and outcomes of elderly patients hospitalized with COVID-19 in Canada. The data emphasizes the importance of non-respiratory presentations, and especially of geriatric syndromes as presenting features of COVID-19 in older adults. Our findings further demonstrate the heightened vulnerability of older adults to complications related to dehydration in hospital, emphasizing the need for e...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.27.21252596v1 on medRxiv