Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis

Yochai Levy*, Adi Turjeman, Lisa Cooper, Nadya Kagansky, Tatiana Nagulevich, Tamari Snir, Avital Hershkovitz, Avraham Weiss, Yichayaou Beloosesky, Yaara Leibovici Weissman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background/Aims: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening millions of people worldwide. This study aimed to describe clinical characteristics, outcomes, and risk factors of SARS-CoV-2-positive, asymptomatic, frail older adults. Methods: A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic at the time of their admission in these units. Residents' characteristics and symptoms were obtained via electronic medical records. The primary outcome was a composite of death or hospitalization by day 40. We looked at time to the primary outcome and used Cox regression for a multivariate analysis. Results: During March-November 2020, 849 residents met inclusion criteria. Median age was 84 years. Most were completely dependent for basic activities of daily living and showed cognitive impairment. Six hundred forty-one (75.5%) residents were discharged after considered cured from COVID-19, 125 (14.7%) were hospitalized, and 82 (9.7%) died in the facilities. In survival analysis, 35% reached the primary outcome of death or hospitalization by day 40. Age (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.1-1.4), male gender (HR 1.41; 95% CI: 1.1-1.88), and COPD (HR 1.8; 95% CI: 1.23-2.67) were significant risk factors. Conclusions: In this large cohort, we report care and prognosis of asymptomatic older adults with major functional or cognitive impairments during the COVID-19 pandemic. Most presymptomatic patients do not develop severe infection, and age stays a predominant risk factor, even in the frailest older adults.

Original languageEnglish
Pages (from-to)1393-1401
Number of pages9
Issue number12
StatePublished - 1 Dec 2022


  • Coronavirus disease
  • Frailty
  • Long-Term care
  • Older adults
  • Vitamin D


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