ORIGINAL ARTICLE Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 333-336

Epidemiological and clinical features of COVID-19 in elderly patients: A cross-sectional study

Bidhata Khatri1, Kena2, Shantha Kumari3, KK Shyamala4, Usha5
1 Independent Researcher, Bengaluru, Karnataka, India
2 Medical 0fficer, PHC, Yediyur, Karnataka, India
3 Department of Biochemistry, Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka, India
4 Department of Pulmonary Medicine, Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka, India
5 Department of NTEP, Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka, India

Date of Submission22-Mar-2022Date of Decision27-Jun-2022Date of Acceptance06-Jul-2022Date of Web Publication12-Nov-2022

Correspondence Address:
Dr. K K Shyamala
No. 58, 3rd Cross, 10th “A” Main, Indiranagar 2nd Stage, Bengaluru - 560 038, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijrc.ijrc_63_22

Background: Elderly population represents the most vulnerable group with increased risk of developing severe COVID-19 infection and high mortality. More research is needed in understanding the complexity of disease due to limited data as only few studies have been conducted till date in India. Objectives: This study aimed to identify the epidemiological and clinical features among elderly population with COVID-19 infection at a tertiary care center, south India. Materials and Methods: A prospective, cross-sectional study was conducted among reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 elderly patients ≥60 years admitted at a tertiary care center in south India from June 2021 to August 2021 after the institutional ethical committee clearance. Their demographic and clinical data were collected and analyzed. Results: A total of 32 RT-PCR–confirmed patients of age ≥60years were included. Majority (62.5%) of them were in the age group of 60–70 years, and the mean age was 70.25 ± 5.68 years. Females were predominant. Severe infection was found in 31.25% of the patients, and 56.25% had moderate infection. Hypertension (43.75%) was the predominant comorbidity followed by diabetes mellitus (34.37%). Cough (82%), dyspnea (70%), and fever (63%) were the most common presenting symptoms. The mean duration of symptoms to hospitalization was 4.7 ± 2.09 days, with majority of patients presenting bilateral lung involvement. Conclusion: There is high prevalence of COVID-19 in the age group of 60–70 years, predominantly female patients. Cough and dyspnea are common presenting symptoms. Hypertension and diabetes are major comorbidities. Most patients presented with bilateral lung involvement and longer duration of symptom onset to hospitalization. High index of suspicion with preventive strategies is required for better healthcare in elderly patients.

Keywords: Clinical features, comorbidities, COVID-19, elderly population

How to cite this article:
Khatri B, Kena, Kumari S, Shyamala K K, Usha. Epidemiological and clinical features of COVID-19 in elderly patients: A cross-sectional study. Indian J Respir Care 2022;11:333-6
How to cite this URL:
Khatri B, Kena, Kumari S, Shyamala K K, Usha. Epidemiological and clinical features of COVID-19 in elderly patients: A cross-sectional study. Indian J Respir Care [serial online] 2022 [cited 2022 Nov 12];11:333-6. Available from: http://www.ijrc.in/text.asp?2022/11/4/333/361034   Introduction 

COVID-19 (caused by SARS-CoV-2 coronavirus) is an infectious disease causing high mortality worldwide.[1] According to the World Health Organization, over 433 million confirmed cases and 5.9 million deaths have been reported globally as of March 2022, and India accounts for 46% of new cases of COVID-19 and quarter of deaths.[1] Increase in COVID-19 severity, poor treatment outcome, and high case-fatality rate among elderly patients are major concerns as reported in various studies[2],[3] as they are more vulnerable due to the immune factor deficiency and associated comorbidities.[4],[5] Elderly patients account for 53% of case fatalities due to COVID-19.[6] As per the ICMR National Guidance published in 2021, COVID-19 infection is categorized into mild (upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia), moderate (any one of respiratory rate ≥24/min, breathlessness, and SpO2 90–≤93%), and severe disease (any one of respiratory rate >30/min, breathlessness, and SpO2 <90%).[7] Very few studies have focused on the elderly population with COVID-19 in India and globally as well.[8],[9],[10],[11],[12] Increasing age and atypical presentation-associated comorbidities are the major determinants of prognosis and outcome of COVID-19 infection and pose diagnostic challenge among elderly patients. Further research is required to understand the complexity of disease among elderly patients in India.

Objectives

The study aimed to identify epidemiological and clinical features among elderly patients with COVID-19 infection at a tertiary care center, south India.

  Materials and Methods 

A prospective, cross-sectional study was conducted among reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients of 60 years and above age. The study included both male and female patients, who had visited the outpatient department and emergency room and were admitted to ward/intensive care unit according to the severity of clinical presentation as per the ICMR national guidelines[7] at a tertiary care center[7] in South India. The study was conducted from June 2021 to August 2021 after obtaining institutional ethics committee clearance and informed consent from patient and patient's relatives. Patients were selected by purposive sampling. Their demographic, clinical (clinical history, comorbidities, and severity assessment), and radiologic data were collected and analyzed.

Inclusion criteria

All patients of age ≥60 years, including both males and femalesRT-PCR–confirmed COVID patientsCOVID-19–suspect symptoms as per the ICMR national guidance.

Exclusion criteria

Negative RT-PCRAge <60 yearsNot willing to participate.

Statistics

Data were entered into Microsoft Excel 2019 (MS-Excel). Descriptive statistics analysis was carried out. Results on continuous and categorical measurements were presented in mean, standard deviation, frequencies, and percentage. Chi-square test was used to calculate the difference and significance is assessed at 5% level of significance with P ≤ 0.05.

  Results 

Out of 48 elderly patients aged ≥60 years and RT-PCR–confirmed COVID-19 patients, a total of 32 eligible participants were included. Of the 46 study population, 14 of them who were not interested to participate in the study and did not give consent for the study therefore were excluded from the study as per the exclusion criteria. Most of the study participants were in the age group of 60–70 years (62.5%). Mean age of the study population was 70.25 ± 5.68 years. Majority of them were female patients (59.3%) and found to have severe infection (18.75%) compared to males (12.5%), and 18.75% of the patients were smokers [Table 1].

Clinical characteristics

Cough and dyspnea were the most common presenting symptoms. Majority of patients had moderate infection (56.25%), while severe infection was seen in 31.25% [Table 2] and [Figure 1].

The mean duration of symptoms to hospitalization was 4.7 ± 2.09 days.

Comorbidities

One-third of patients (34.37%) had more than one comorbidity. Hypertension and diabetes mellitus were the common comorbidities found among the patients [Figure 2].

Severity of infection

Out of the total patients, high prevalence of moderate-to-severe disease was found in the age group of 60–70 years (P = 0.002) [Figure 3].

Among the severely infected patients (31.25%), majority of them were female patients (18.75%) and were found to have significantly increased severity compared to males (12.5%, P = 0.008) [Table 3].

Radiological presentations

Majority of patients (84.37%) presented with bilateral infiltrates with consolidation and ground-glass opacity, and one patient (3.12%) had peripheral lung involvement which was consistent with acute respiratory distress syndrome (ARDS) features based on clinical correlation.

  Discussion 

COVID-19 infection poses a major threat to the elderly population and is associated with poor treatment outcome and high mortality.[8],[13] In the present study, the prevalence of COVID-19 was high in the age group of 60–70 years (62.5%), indicating higher transmissibility, susceptibility, and vulnerability of elderly subjects during the second COVID wave, which is similar to the results of previous studies.[12] Many studies have reported that males are more affected than females;[12],[13] however, in our study, we found females (59.3%) more affected compared to males. Most of the patients presented with moderate (56.25%) to severe disease (31.25%). In a study conducted in India during the second wave, it was found that young people were more affected than the elderly population.[14] Various other studies have reported fever and cough as the major symptoms.[9],[10],[11],[12] However, in our study, cough and dyspnea were the major presenting symptoms which may be one of the factors for delayed hospitalization. It was noticed that hypertension and diabetes were the most common comorbidities associated with the infection in our study, which is similar to the findings from other studies as well.[12],[15] Elderly patients with comorbidities are at increased risk of developing the severe disease and poor outcome;[13],[16],[17] the present study showed that 34.37% of patients had more than one comorbidity which is high compared to other studies.[12],[16] Similar to previous studies,[9],[12] in the current study, majority of the patients had bilateral lung involvement. Our study findings showed increased mean duration of symptom onset to hospitalization, which is reported in other studies[12],[13] as well for being important factor for poorer prognosis.

Limitation of the study

Sample size was small as it was a single-center, prospective study and the study period was latter part of the peak of the second COVID wave. Outcome of the study subjects could not be followed upon due to nonaccessibility of some of the study participants.

Future studies are required with larger sample size, multicenter, and outcome analysis.

  Conclusion 

There is a high prevalence of moderate-to-severe infection of COVID-19 in the elderly, particularly in the age group of 60–70 years and predominantly female patients. Hypertension and diabetes were the common comorbidities found in patients. Majority of the patients had cough and dyspnea as symptoms with increased mean duration from symptom onset to hospital admission. High index of suspicion for early diagnosis and treatment of COVID-19 infection along with preventive strategies is needed for better healthcare outcomes in the elderly patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/. [Last accessed on 2022 Mar 06].  
    2.Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020;323:1775-6.  
    3.Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect 2020;80:e14-8.  
    4.Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: How age influences the host immune response to coronavirus infections? Front Physiol 2020;11:571416.  
    5.Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J 2014;44:1055-68.  
    6.Mudgal P, Wardhan R. The increased risk of elderly population in India in COVID-19 pandemic. Int J Health Sci Res 2020;10:166-75.  
    7.A Clinical Guidance for Management of Adult COVID-19 Patients, Ministry of Health and Family Welfare, Government of India; May, 2021.  
    8.Lithander FE, Neumann S, Tenison E, Lloyd K, Welsh TJ, Rodrigues JC, et al. COVID-19 in older people: A rapid clinical review. Age Ageing 2020;49:501-15.  
    9.Chen T, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China: A single-centered, retrospective study. J Gerontol A Biol Sci Med Sci 2020;75:1788-95.  
    10.Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with coronavirus disease 2019 (COVID-19) outside Wuhan. Clin Infect Dis 2020;71:740-7.  
    11.Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80:639-45.  
    12.Pednekar SJ, Sabesan S, Pandey D, Mirg S, Pawar N, Nandwani J, et al. Study of clinical spectrum of severe COVID-19 infection in elderly patients and its outcome – A major Mumbai tertiary care hospital observations. J Assoc Physicians India 2022;70:11-2.  
    13.Leung C. Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China. Mech Ageing Dev 2020;188:111255.  
    14.Jain VK, Iyengar KP, Vaishya R. Differences between First wave and Second wave of COVID-19 in India. Diabetes Metab Syndr 2021;15:1047-8.  
    15.Singhal S, Kumar P, Singh S, Saha S, Dey AB. Clinical features and outcomes of COVID-19 in older adults: A systematic review and meta-analysis. BMC Geriatr 2021;21:321.  
    16.Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med 2020;2:1069-76.  
    17.Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: Understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020;8:782-92.  
    
  [Figure 1], [Figure 2], [Figure 3]
 
 
  [Table 1], [Table 2], [Table 3]