Presentation and Outcome of Coronavirus Disease (COVID-19) in Patients at a Geriatric Psychiatric Outpatient Clinic

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) disproportionally affects elderly patients leading to particularly high morbidity and mortality rates in this population. Age, gender, comorbidities, and housing context have been reported to be among the risk factors for mortality. Exposure to antipsychotics have been discussed to potentially impact the immune response and may pose additional risks. Furthermore, neuropsychiatric presentations are common among older patients and it is unclear how geriatric patients with preexisting psychiatric and neuropsychiatric problems recover from COVID-19. METHODS: In this retrospective observational study, we describe demographic characteristics of patients at a large geriatric psychiatric outpatient clinic in the New York metropolitan area, who had COVID-19. Our aim is to identify factors that may be associated with increased mortality and to evaluate whether those who survived returned to pre-COVID baseline function. We combined information provided by the treating psychiatrists with data that could be extracted from the electronic health records. RESULTS: Between February and September 2020, we identified 56 patients who were diagnosed with COVID-19 (mean age 76 years old). Thirteen patients (23.2%) died and we found that antipsychotics use at the time of COVID-19 infection is associated with increased risk of death (Fisher's exact test P= 0.009, odds ratio = 11.5, 95% confidence interval: 1.4 – 96.0). The result remains significant after adjusting for age, gender, housing context and presence of neurocognitive disorder (Logistic regression P=0.037, Beta=2.4). Furthermore, we found that most patients who survived COVID-19 recovered to baseline (88.4%) as indicated by the ratio of pre- and post-COVID Clinical Global Impressions Severity scale (mean ratio= 0.98, median=1.0, One-sample t-test P=0.48) in 33 patients. CONCLUSIONS: In conclusion, antipsychotics appear to be associated with higher mortality in our geriatric psychiatry outpatient cohort. However, it is encouraging to find that the majority of elderly patients who survived COVID-19 seems to recover to their baseline neuropsychiatric function. Future larger studies are needed to put these observations into a broader context as well as to explore underlying mechanisms of risk factors. FUNDING: NIH K08 AG054727