Clinical presentation and outcomes of COVID-19 in older hospitalised patients assessed by the record-based multidimensional prognostic index, a cross-sectional study.

PURPOSE: Older people are the most frequently hospital admitted patients with COVID-19. We aimed to describe the clinical presentation of COVID-19 among frail and nonfrail older hospitalised patients and to evaluate the potential association between frailty and clinical course, decision of treatment level with outcomes change in functional capacity and survival. METHODS: We performed a multi-center, retrospective cross-sectional cohort study examining data on clinical presentation and frailty-related domains for hospitalised people aged 75 + years with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test. Frailty was assessed at admission using record-based MPI (rMPI) and Clinical Frailty Scale (CFS). Decision on treatment level about invasive ventilation and cardiopulmonary resuscitation (CPR), change in CFS-score from admission to discharge, changed need of home care, and in-hospital, 30-day and 90-day mortality were registered. RESULTS: 100 patients (median age 82 years (IQR 78-86), 56% female) with COVID-19 were included. 54 patients were assessed moderately or severely frail (rMPI-score = 2 or 3) and compared to non-frail (rMPI-score = 1). At admission, frail patients presented more frequently with confusion. At discharge, functional decline measured by change in CFS and increased home care was more prevalent among frail than the non-frail. Decisions about no invasive ventilation or CPR were more prevalent among frail older patients with COVID-19 than non-frail. Ninety-day mortality was 70% among frail patients versus 15% in non-frail. CONCLUSION: Frailty seems to be associated with confusion, more frequent decisions about treatment level, larger functional decline at discharge and a higher mortality rate among older patients with COVID-19.

Non-surgically treated older women with operable early breast cancer in Denmark.

INTRODUCTION: Women ≥ 70 years of age, especially women with co-morbidity, have not achieved the same increase in survival as younger women with early breast cancer. Older patients with and without co-morbidity do not receive primary surgical treatment as often as younger women do. The primary aim of this study was to describe older women with operable early breast cancer who are not surgically treated. Secondarily to evaluate if there is a need for further research to clarify if the women may potentially benefit from comprehensive geriatric care (CGC) according to receiving surgery. METHODS: This was a descriptive cross-sectional study including 781 women ≥ 70 years of age with biopsy-verified early breast cancer in Denmark 2012-2017. Data were retrieved from the Danish Breast Cancer Cooperative Group registry and medical record reviews. RESULTS: Women ≥ 70 years of age with early breast cancer who did not receive surgical treatment represent a group of frail patients with the characteristics of a geriatric population. Among older women with early breast cancer, 14% had no primary surgical treatment. CGC may identify relevant health issues and interventions that could increase the possibility of surgical treatment in this group of patients. CONCLUSIONS: Women ≥ 70 years of age with early breast cancer who do not receive surgery represent a group of frail patients that may potentially benefit from special geriatric care. CGC may be a way to provide this special care. Further research is needed. FUNDING: none. TRIAL REGISTRATION: not relevant.