Department of Acute Geriatrics, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gerontology. 2022;68(12):1393-1401. doi: 10.1159/000521412. Epub 2022 Jan 31.
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.
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.
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 COVID-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.
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.
背景/目的：新型冠状病毒 SARS-CoV-2 已在全球范围内引发大流行，威胁着数百万人的生命。本研究旨在描述 SARS-CoV-2 阳性、无症状、虚弱的老年患者的临床特征、结局和危险因素。
这是一项在 6 个指定的 COVID-19 病房、在熟练护理养老院中进行的回顾性队列研究。研究对象为 SARS-CoV-2 检测阳性且入院时无症状的极度虚弱的老年患者。通过电子病历获取患者特征和症状。主要结局为第 40 天死亡或住院的复合结局。我们观察了主要结局的时间，并使用 Cox 回归进行多变量分析。
在 2020 年 3 月至 11 月期间，849 名符合条件的居民被纳入研究。中位年龄为 84 岁，大多数患者完全依赖于日常生活活动的基本自理能力，存在认知障碍。641 名（75.5%）患者被认为治愈了 COVID-19 后出院，125 名（14.7%）住院，82 名（9.7%）在院内死亡。在生存分析中，35%的患者在第 40 天达到了死亡或住院的主要结局。年龄（风险比 [HR] 1.23；95%置信区间 [CI] 1.1-1.4）、男性（HR 1.41；95% CI：1.1-1.88）和 COPD（HR 1.8；95% CI：1.23-2.67）是显著的危险因素。
在这项大型队列研究中，我们报告了在 COVID-19 大流行期间，有严重功能或认知障碍的无症状老年患者的护理和预后情况。大多数有症状前的患者不会发展为严重感染，年龄仍然是主要的危险因素，即使是最虚弱的老年患者也是如此。
