Patients in psychiatric inpatient settings have a higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and experience a higher proportion of mortality related to coronavirus disease-2019 (COVID-19) than the community at large, according to the results of a study published in The Lancet Psychiatry.
Studies have shown that people living in group situations or with dementia are more vulnerable to SARS-CoV-2 infection and that older people and those with multimorbidity have a higher rate of mortality if they become infected than the general population, but COVID-19-related outcomes in older inpatients in psychiatric units and in individuals with young-onset dementia have not yet been determined.
To evaluate the period prevalence, demographics, symptoms, management, and survival outcomes of COVID-19 in this population, data from 344 patients in 5 London mental health NHS Trusts who were ≥65 years of age or had dementia were analyzed.
A total of 38% of patients were diagnosed with COVID-19 between March 1 and April 30, 2020. The average age of patients diagnosed with COVID-19 was 75.3±8.2 years of age, 52% were women, and 36% identified as being from an ethnic minority group.
Of the individuals diagnosed with COVID-19, 12% were asymptomatic. The most common symptoms were fever (57%), new persistent cough (45%), fatigue (45%), and loss of appetite (34%).
The most common pathological abnormalities were increased D-dimer (83%), increased C-reactive protein (78%), increased ferritin (75%), low vitamin D (55%), and increased creatinine kinase (53%). The most common mental health complication was delirium or acute cognitive decline (35%), which was more common in those with dementia.
Of the patients clinically diagnosed with COVID-19, 15% perished. When adjusting for the number of comorbidities, no demographic factors were significantly associated with an increased risk for mortality from COVID-19.
Though not statistically significant, individuals diagnosed with dementia were found to be more likely to die when infected with COVID-19 than individuals without dementia, though no difference was observed in individuals diagnosed with young-onset dementia compared with late-onset dementia. Individuals who identified as belonging to an ethnic minority group did not have a higher mortality rate than White individuals, unlike what has been observed in the general population.
Limitations to this study include the inability for results to be applied outside the specific group of interest and the small number of included individuals, and a decreased level of cooperation in testing compared with the general population. Future studies investigating COVID-19-related outcomes in other patient populations are warranted.
The results of this study showed that inpatients in psychiatric units and those with dementia have a high rate of infection and death. A mortality rate of 15% observed in this group is much higher than the 3.2% figure the World Health Organization provides.
Livingston G, Rostamipour H, Gallagher P, et al. Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: A retrospective observational study [published online October 5, 2020]. Lancet Psychiatry. doi: 10.1016/S2215-0366(20)30434-X