Direct and Indirect Impact of COVID-19 In Older Populations

Study Overview
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Brief Summary
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This study propose to describe risk factors for acute and long term mortality of COVID 19 in patients up to 70 years old.

Detailed Description
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In December 2019, Wuhan city in China, became the center of an outbreak of pneumonia due to a novel coronavirus SARS-CoV-2, which disease was named coronavirus disease 2019 (COVID19) in February, 2020, by WHO. The COVID19 is much more dangerous for people over 60 with a death rate of 3.6% after 60, 8.0% after 70 and 14.8% after 80 -and according to our Italian colleagues over 20% after 90- against 2.3% in the general population. The elderly patients exhibits more complications (ARDS, delirium, cardiac and renal insufficiency) needing intensive care, and often had multiple comorbidities and in particular: cardiovascular disease (10.5% mortality), diabetes (7.3%), chronic respiratory disease (6.3%) and hypertension (6%). Very few data are available the specific burden of Infectious diseases (ID) in older populations. The large majority of literature is often related to intrahospital or direct mortality and only recently arise the idea of indirect impact of ID particularly in that populations. In that meaning, ID may be considered as a trigger of other medical events such as myocardial infarction, stroke, or other specific outcomes such as functional decline; For the last 10 years, the Specific interest group  GInGer ( Groupe Infectio-Geriatrique ) a network of infectiologist and geriatrician SPILF/SFGG) carried out several studies on different aspects of ID in theses populations and recently demonstrated the indirect and long term impact of influenza and Clostridioides difficile infections. As an example, In influenza study, death-rate increases from 12,2 % in hospital related death to 25% at 3 months with high rate of complications (57%), high rates of rehospitalisation (25%) and functional decline (35%) leading to high increase in nursing home admission. The cost of these indirect impact is high and underestimated. Because of incidence and comorbidities rates, severity of the actual French older COVID 19-infected older populations and because of the potential indirect and long term impact of COVID19 in these populations, it seems essential to know whether 3 month related death is largely higher as for influenza, to determine risk factors for intra hospital and long term death, measure acute and long term complications, and describe the impact of COVID 19 on specific ageing outcomes such as functional status at Month 3 (M3).

Official Title
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COVID-19 Chez la Personne âgée de Plus de 70 Ans : Impact Direct et Indirect à 3 Mois.

Conditions
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Risk Factors for COVID-19 Outcomes in Elderly Populations

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: + positive PCR confirmed COVID 19 (confirmed case) or positive Thoracic CT Scan - (probable case) Exclusion Criteria: Direct admission in Intensive care.

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality | 3-month survival curve | 3 months | 
| Risk factors for death | Specific COVID 19 risk factors for death and geriatric risk factors for death | 3 months | 
| mortality | 12 month survival curve | 12 months | 
| Risk factors for death | Specific COVID 19 risk factors for death and geriatric risk factors for death | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Describe clinical symptoms specific to old population | clinical symptoms (respiratory , non respiratory symptoms and Geriatric syndromes) | before and at admission | 
| describe specific and non-specific treatments used for COVID 19 | Prevalence and duration of specific treatments and non-specific treatments | through study completion, an average of 1 year | 
| describe all acute complications | prevalence of all medical usual complications and geriatric acquired complications, such as delirium, falls, complications, such as delirium, falls, malnutrition, pressure sore) | through study completion, an average of 1 year | 
| functional decline | rates of Functional decline between basal status (before admission) and admission,and between basal and 3 months, and between Discharge and 3 month. | 3 months post acute phase | 
| Rehospitalisation | Prevalence of readmission to hospital | 3 months post acute phase | 
| medical complications | Prevalence of medical complication s ( new infectious disease, c cardiovascular, metabolic diseases and geriatric acquired complications, such as delirium, falls, complications, such as delirium, falls, malnutrition, pressure sore) | 3 months post acute phase | 
| Admission in nursing home | Prevalence of new nursing home admission | 3 months post acute phase | 
| risk factors for 3-month functional decline, acute complication and admission to nursing home | Determine risk factors for 3-month functional decline, acute complication and admission to nursing home | 3 months post acute phase | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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elderly, COVID 19, mortality, functional status