Background: Age has been implicated as the main risk factor for COVID-19-related mortality. Yet, critical factors relevant to older patients, such as baseline function and life-sustaining treatment preferences, have not been considered. The objective of this study was to determine patient factors associated with mortality in hospitalized older adults with COVID-19.
Methods: A retrospective cohort study of all older adults 65+ (N=4,969), hospitalized between 3/1/20-4/20/20 with confirmed COVID-19 was conducted across a large health system in New York. Data included patient demographics and clinical presentation. Multivariate logistic regression was used to evaluate associations between demographics, comorbidities, history of dementia, arrival to the hospital from a facility, early do-not-resuscitate order (DNR; within 24 hours of admission), severity of acute illness and hospital mortality.
Results: Average age 77.3 (SD 8.4), 56.0% male, 46.8% White, 20.8% African American, 15.1% Hispanic. Common comorbidities included hypertension (61.1%) and diabetes (36.8%); average number of comorbidities was 3.4 (SD=2.8) and 13.0% had dementia. 20.8% arrived from a facility and 5.7% had early DNR orders. On hospital arrival, average Modified Early Warning Score (MEWS) was 4.2 (SD=1.7), only 26.7% were febrile, and 79.6% required oxygen therapy. 35.3% of patients expired. In a multivariate analysis, male gender (OR=1.47), higher comorbidity index (OR=1.10), admission from a facility (lower baseline function; OR=1.71), early DNR (declining life-sustaining treatments, OR=2.45), and higher illness severity (higher MEWS, OR=6.26, and higher oxygen requirements, OR=15.00) were associated with mortality, while age was not (p = 0.22).
Conclusions: Our findings highlight the need to look beyond age in hospitalized older adults with COVID-19 when considering prognosis and treatment decisions.