COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Prognosis Singhal S, Kumar P, Singh S, et al. Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis. BMC Geriatr. 2021 May 19;21(1):321. doi: 10.1186/s12877-021-02261-3.

BACKGROUND: Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients.

METHODS: A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age = 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support.

RESULT: Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI- 36-65%, I2-95%) patients while 22% (95% CI- 16-28%, I2-88%) were critically ill. Overall, 11% (95% CI- 5-21%, I2-98%) patients died. The common comorbidities were hypertension (48, 95% CI- 36-60% I2-92%), diabetes mellitus (22, 95% CI- 13-32%, I2-86%) and cardiovascular disease (19, 95% CI - 11-28%, I2-85%). Common symptoms were fever (83, 95% CI- 66-97%, I2-91%), cough (60, 95% CI- 50-70%, I2-71%) and dyspnoea (42, 95% CI- 19-67%, I2-94%). Overall, 84% (95% CI- 60-100%, I2-81%) required oxygen support and 21% (95% CI- 0-49%, I2-91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes.

CONCLUSION: Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

Discipline / Specialty Area Score
Emergency Medicine
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Internal Medicine
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Comments from MORE raters

Emergency Medicine rater

Interesting and well statistically processed review and meta-analysis data from first wave Covid-19 of patients >60.

Internal Medicine rater

This is not a good systematic review. For instance, they conclude that about 10% of older patients with Covid-19 die from the disease, but they don't present patient and study inclusion criteria satisfactorily. I guess, the 10% goes for older patients that ARE HOSPITALIZED with covid-19.

Respirology/Pulmonology rater

This meta-analysis attempts to better characterize the clinical course of Covid-19 in patients over 60 years of age. The quality of the data and study bias limit the results to some degree. The findings do not bring new concepts to consider in older patients with Covid-19.