| Review Finding | CERQual Assessment of Confidence in the Evidence | Explanation of CERQual Assessment | Studies Contributing to the Review Finding |
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| Symptoms | | Most Common: Hospitalized older COVID-19 patients were commonly reported to experience fever or cough, and to a lesser extent dyspnea, fatigue (with or without myalgia), sputum production, chest tightness, or diarrhea (in order from most to least commonly reported). | Moderate | 6 studies with minor to moderate methodological limitations, of which selection bias due to admission of severe patients was noted. Relatively adequate data pertaining to 1285 older COVID-19 patients. 13 studies originating in China, which leads to moderate concerns of lack of geographic diversity in reported data. High coherence. | 10-18, 19, 20, 22, 24-26 | | Less Common: Less commonly observed symptoms in the elderly COVID-19 population included: headache, sore throat, GI symptoms, dizziness, delirium, nasal congestion, chills, chest pain, pharyngalgia, abnormal gait, syncope, nausea and vomiting (in no particular order). | | Comorbidities | | Most Common: Hypertension is the most commonly reported comorbidity in elderly COVID-19 patients, followed by cardiovascular disease, diabetes, chronic lung disease, and hypercholesterolemia. | Moderate | 9 studies with minor to moderate methodological limitations. 2 studies had incomplete medical history of relevant patients, and 1 study revolved around COVID-19 presentation specifically in fracture patients. In total, adequate data, pertaining to 2288 patients, with reported comorbidities was present. Notably, smoking history was under-reported. Despite a predominance of studies from China, almost half of patients contributing to comorbidity conclusion stemmed from Italy, USA, and Israel. High coherence. | 10-15, 17- 21, 24-28 | | Less common: Minority of studies reported patients with chronic renal, hepatic, cerebrovascular disease or malignancy. Elderly COVID-19 patients with a variety of other immune, endocrine, nutritional, and neurological comorbidities were also occasionally reported. | | Radiological Findings | | Description: Ground Glass Opacities (GGO) was the most commonly reported observation in radiological imaging of older COVID-19 patients. Also, isolated consolidations or in combination with GGO were, to a lesser extent, documented with occasional cases of pleural effusion. Few patients demonstrate normal imaging findings. | Low | 4 studies with minor to moderate methodological limitations. Gaps and inconsistency in reporting of radiological findings was observed. Inadequate data, pertaining to only 402 elderly COVID-19 patients. Moreover, only 2 studies originating from regions other than China (Israel and Italy), which raises concern for lack of geographic diversity. Insufficient reported radiological findings clouds coherency judgement, however reasonable coherence can be seen from preliminary data. | 12, 14, 15, 18, 20, 22-24, 26 | | Distribution: Adults ≥60 years old experience multiple lobe involvement in a bilateral distribution mainly. With primary data showing peripheral tendency of COVID-19. | | Outcome | | Almost half of total patients were still hospitalized as of date of individual study publication. However, hospitalized elderly COVID-19 patients with clear outcome show an evident risk for mortality. Majority of studies show an estimated mortality rate of >15%, with the total combined mortality rate being close to 20%. Hospital stay duration ranges from a few days to few weeks, with a common median of hospitalization being >10 days. | Low | 14 studies with minor to significant methodological limitations. Possible selection bias due to hospital admission of mainly serious cases was noted in 7 studies, and in 1 study involvement of strictly ICU patients was observed. The dynamic nature of the situation led to short follow up time by majority of studies, which raises concerns for inadequacy of data. Reasonable coherence. | 10-12,14,15, 18 - 21, 24, 26-29 | | Laboratory findings | | Lymphopenia (<1.1 x 109/L) and elevated inflammatory markers, CRP (>10 mg/L) and ESR (>35 mm/h), are commonly observed in the elderly COVID-19 patients. Occasionally, thrombocytopenia (<150x109/L), higher levels of LDH (>300 U/L), D-dimers (>1.0 mg/L), and renal markers (creatinine & BUN) can be seen. Other markers indicating organ damage, such as hepatic or cardiac, are mainly within normal range. IL-6 was an underreported biochemical variable. | Moderate | 6 studies with minor to moderate methodological limitations. Minor concern for underlying comorbidities, baseline health, and associated medication use influence on results in 3 studies. Relatively adequate data pertaining to 1194 elderly COVID-19 patients. Overwhelming majority of data stemming from one geographic region (China), raises concern for lack of diversity. Moderate to high coherence. | 10-18, 24-26, 28 | | Complications | | Besides a risk for secondary infection or ARDS, older COVID-19 patients are prone to renal injury over the course of the disease. Hepatic injury and cardiovascular related complications (including cardiac insufficiency or arrhythmia) can be observed to a lesser extent. | Low | 7 studies with minor to significant methodological limitations. 3 studies admitted mainly severe cases of COVID-19, raising concern for potential selection bias. 6 studies had short observation time (<1 month), and large proportion of patients still hospitalized. Despite relatively adequate patient sample with reported complications (3241 patients), inconsistency in the documentation detail of complication is observed. Reasonable coherence. | 10, 12, 15-18, 24, 26, 29 | | Treatments | | Drugs: Antiviral therapy is the main treatment approach for elderly COVID-19 patients, of which Lopinavir, Ritonavir, and Umifenovir are most commonly used. This is usually in combination with antibiotics, immunoglobulins, glucocorticoids, or interferon therapy. | Very Low | 5 studies with minor to significant methodological limitations. Inadequate data, with detailed treatment plans and use of medication only pertaining to 476 patients. Moreover, all studies, except 1, originated from China raising substantial concerns regarding data reflectiveness of different international treatment approaches. Reasonable coherence | 11, 12, 14, 15, 17, 18, 24,26, 28 | | Supplementary Oxygen: Almost 4 in 5 hospitalized older COVID-19 patients require supplementary oxygen inhalation. | Moderate | 6 studies with minor to moderate methodological limitations. 1 study revolved around ICU patients. Relatively adequate data pertaining to 1424 hospitalized elderly COVID-19 patients. Studies were predominantly from China, however considerable amount of total reported patients were from other regions such as Italy, USA, and France. Moderate to high coherence. | 11, 14, 15, 16, 18, 21, 24,26,27 | | Mechanical Ventilation: 20% to 50% of severely affected elderly patients may require invasive mechanical ventilation. | Low | 4 studies with moderate methodological limitations. 4 studies admitting mainly severe cases. Concerns for restricted mechanical ventilation use due to limitations of available resources or overflow of patients. Relatively adequate data (4018 patients) from 3 geographic regions (USA, Italy, China). Generally low coherence, however reasonable coherence is observed amongst studies with mainly serious cases. | 12, 14, 15, 17, 18, 21, 29, 24,26,27 |
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