The following is a summary of “Health trajectories in older patients hospitalized for COVID-19: Results from the GeroCovid multicenter study,” published in the JANUARY 2023 issue of Pulmonology by Trevisan, et al.
Older persons have been disproportionately impacted by COVID-19. However, the healthcare journeys taken by elderly patients hospitalized with COVID-19 have not been studied. For a study, researchers sought to estimate the likelihood that older persons admitted to COVID-19 acute wards would switch between levels of severity and pinpoint the variables influencing such dynamics.
The multicenter GeroCovid project-acute wards substudy included COVID-19 patients aged ≥60 years hospitalized between March and December 2020. Health and socio-demographic information were taken from medical records. A seven-category scale, spanning from hospital discharge to death, was used to classify clinical conditions experienced during hospitalization. First, they classified patients’ clinical courses as positive (only improvements), negative (only deterioration), or oscillating based on the changes between these states (both improvements and worsening). Second, they concentrated on the discrete changes in clinical states and calculated their probabilities (using multistage Markov modeling) and contributing variables (with proportional intensity models).
A favorable clinical course was taken by 637 (62.2%), a fluctuating one by 66 (6.4%), and a negative one by 321 (31.3%) of the 1,024 patients that were included (mean age 78.1 years, 51.1% women). Patients with a variable clinical course tended to be younger, more mobile and cognitively advanced, and less ill, while cardiovascular disease and obesity were more common. When considering the single transitions, the likelihood that older COVID-19 patients had clinical changes within a 10-day period was greater, particularly for milder clinical states. Age, male sex, poorer level of mobility, multimorbidity, and hospitalization during the first wave of COVID-19 (compared to the second wave) were all linked to a higher risk of worsening clinical symptoms or a slower rate of recovery.
The clinical course of COVID-19 in older inpatients was intricate and complicated. It may be possible to better coordinate clinical management across locations and healthcare resources by identifying those more prone to a changing clinical course and rapid deterioration.
Reference: resmedjournal.com/article/S0954-6111(22)00353-5/fulltext