Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

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%, I-2-95%) patients while 22% (95% CI- 16-28%, I-2-88%) were critically ill. Overall, 11% (95% CI- 5-21%, I-2-98%) patients died. The common comorbidities were hypertension (48, 95% CI- 36-60% I-2-92%), diabetes mellitus (22, 95% CI- 13-32%, I-2-86%) and cardiovascular disease (19, 95% CI - 11-28%, I-2-85%). Common symptoms were fever (83, 95% CI- 66-97%, I-2-91%), cough (60, 95% CI- 50-70%, I-2-71%) and dyspnoea (42, 95% CI- 19-67%, I-2-94%). Overall, 84% (95% CI- 60-100%, I-2-81%) required oxygen support and 21% (95% CI- 0-49%, I-2-91%) 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.