COVID-19, Vulnerability, and Long-Term Mortality in Hospitalized and Nonhospitalized Older Persons.
Mauro Di Bari, Francesco Tonarelli, Daniela Balzi and 6 others
PMID 34990587WHAT IT FOUND
Older ED patients with higher vulnerability scores had more deaths.
Hospitalized patients with COVID-19 died more often than hospitalized patients without it. Among patients not admitted, COVID-19 raised death risk most in those with lower vulnerability scores.
Key findings
01In the cohort, 8134 (21.8%) participants died, and increasing DSC class, diagnosis of COVID-19, and hospital admission each independently predicted death.
02Among hospitalized participants, mortality was 48.4% with adjudicated COVID-19 and 33.9% without it, and excess mortality associated with COVID-19 remained significant within each DSC class, with hazard ratios ranging between 1.6 and 2.2.
03Among nonhospitalized participants, mortality was 28% with linked COVID-19 and 8.7% without it, while the excess mortality associated with COVID-19 decreased from a hazard ratio of 5.3 in DSC class I to 2.0 in class IV.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an observational administrative cohort, so it shows associations and cannot prove that COVID-19, vulnerability, or hospital admission caused death. The study had no detailed clinical information beyond the DSC, including severity of illness, reason for emergency department access, and many comorbidities. For nonhospitalized participants, the reason and timing of emergency department access and the cause of death were not ascertained. The DSC was available only after emergency department access, so people who received care in the community or were never taken to the emergency department were not included. The findings describe a period before widespread vaccination, so current mortality patterns may differ.
Declared interests
No funding or conflict-of-interest declaration is provided in the supplied text. The publication types note research support from a non-U.S. government source.
The easy way to misread this
Do not conclude that a high vulnerability score alone caused death or that this administrative score should directly guide treatment decisions. The study used records from older emergency department patients before widespread vaccination, did not measure clinical severity or reason for ED access, and cannot separate the effects of COVID-19, vulnerability, and hospitalization.