Results

The rate of hospitalisation and letality of Covid19 increased with ageing while the physical performans (PP) did not really change in those covid19 elderly patients.

The pseudo grippal signs (cough, dyspena, fever) were more frequent, the were also asthenia, anorexie and non symptom in the elderly patients with covid19 postive.

Discussion

The mean age was 68,8 years old [60-92] with 60-74 years old group age most frequent (76%) and men sex predominant (sex ratio =2,3). Our results are similare than Jiangshan and Chen N studie in China for respectively mean age (68 years old) and the sex ratio [5,6]. The major patients of our study were retires, married and living at home. It was the global tendancee of sub saharien african country life style for those group of age. Comorbidities were at least one (1) found in 70% cases, the same result was found in Guo T (69,5%) study in Hunan but in Chen N study in Wuhan the result for comorbidies was inferior (51%) than our result. The difference could be explain by the age of patient inclusion who wa at 55,5 years old in wuhan study [7]. We did found data about those groupe age in Sub saharian countries. High blood pressure was found in 50% in our study, superior than in Guo T (43,3%) study but inferior than in Leung C study who found 53% of HTA [7]. The diabetes was found in 24,1% in our study as like in Guo T one in Hunan province [7]. In Europe, A large number of patients affected by COVID-19 had highlighted cardiovascular and metabolic comorbidities in explaining the excess of mortality among older people. However, to our knowledge, there are no studies assessing the impact of geriatric syndromes on patient’s outcomes [8]. The most frequent signs found in our study were cought (63,1%), dyspnea (49%) and fever (44,6%). Annweiler C and al in French and Guo T in Hunan present the same profil of signs than in our study but in Leung C study we found the predominace of fever (67,7%), cough (51,6%) then dyspnea (40%) [7,9]. There were also signs likes asthenia, anorexie and asymptomatic found in elderly patients in our study. In our context, the selfmedication is frequent and could explain for exemple fever unfrequent, no symptoms and atypic signs. In very old people affected by Covid-19, the common symptoms is delirium who is commonly hypoactive or mixed [10,11]. Delirium is a strong predictor of mortality and its incidence in elderly patients hospitalized. There is no guidelines available in our knowledge to improve the clinical approach to elderly affected by COVID-19 along geriatrics syndroms the suggest is to adopt screening protocols, such as 4AT, for the early diagnosis of delirium and to monitor psychological, behavioural, and physical functions and to implement non-pharmacological and pharmacological treatments for delirium patients [12]. In our context, according to the consideration of geriatrics physicians in Covid19 managements, practice tools (Figure 1) & (Graphics 2 & 3) to screen rapidly elderly patients for hospital treatment or home take care by mobile team were proposed. The letality in our study was higher in hospitalised patient (80%) and the severity of infection Covid-19. The hospilised patient increase with aged patient. The global letality was 29% and important in young old patient than old oldest one probably due to the high number of young old in Niger and sub saharien country. The demography transition is not effective in africa, the major class of population is young. The context is differ in Europe who had a demography and epidemiological transition. The median age of patients dying of COVID-19 is 80 [IQR 73-85], which is more than 15 years higher than the median age of patients diagnosed with COVID-19 in Italy [13]. Current data suggest that elderly patient with 70 years old constituted 85% of deaths in Italy [14]. In hospitals there is a clear correlation between age and mortality rates, who reaches 55% among very old patients (> 85 years). Moreover, 92% of hospital deaths occur among people aged 65 and over. There is no data about geriatrics syndroms and Covid-19 outcomes, However, the mortality rate in hospitalized subjects with severe dementia reached 65% in patients with an average age of 80 years old [15]. The management of old patient with Covid-19 at home was focus on regulary evaluated and surveillance physically or by cell phone with physicians’ team. The social distancing rules, adherence of pharmacological treatment, were explained by patient or their relatives. Complete isolation could not be possible in our context. However Older people living at home in self-isolation, in particular those affected by chronic conditions, need surveillance to ensure adherence to pharmacological treatments, and access to nutritious food, social and mental health support and information to maintain their emotional well-being [16].

The impact of COVID-19 has been devastating on long term care (LTC) facilities, with both high prevalence and mortality among residents with a rate fourfold higher than expected in LTC [17,18]. The isolation from their relatives may have had consequences on the psychological, cognitive, behavioral and physical status of older and frail people in Europe. The management of older patient who need hospitalization is doing like general adult population in our country and sub-Sahara areas. So, we should adapt specifics areas for elderly patient management. The clinical course of the disease and eventual side effects of medications should be regularly evaluated. Family members should be instructed to protect themselves from the risk of infection. GPs should consider hospitalization in case of worsening symptoms (i.e., fever, asthenia, dyspnea, confusion) or whenever the family is unable to provide adequate support.

All our patients hospitalized were treated with hydroxychloroquin associated Azithromycin) after realized electrocardiogram systematically. The older patients followed at home took Azithromycin only. The global sides effects non tolerable were 11%. In Europe, for older patients who need hospitalization, the suggest the creation of specific areas within the hospitals, to guarantee treatments tailored for frail patients. For instance, it is well known that non-pharmacological approaches are more effective than pharmacological ones in the prevention and treatment of hyperactive delirium [19]. Lowintensity hospital wards, with high capacity for supportive and palliative care should also be arranged, with attention to comfort and end-of-life issues [20].

Hospitalization should be limited to cases that cannot be managed in LTC facilities, and should be considered only after an assessment of the patient’s general health, cognitive, functional status and after an evaluation of patient’s priorities. Monitoring of possible contagion among health care professionals should be systematically carried out, and the availability and correct use of PPE should be periodically assessed [21].

Conclusion

The most severe consequences of the COVID-19 pandemic impact the elderly, so geriatricians should be implicated in health-policy decision-making, in the drafting of guideliness and in deciding the allocation of resources. Howerver, we should be able to repertoring and tracing all frails elderly in order to making early efficient strategy to fight against epidemic for elderly. It’s should be easy and possible because in sub saharian areas, the major rate of population is young.

In 60-70 years old , elderly patients who had not covid19 clinical suspect criteria specially mental statut and or activities daily living/ instrumentals dysfunctions, stable cormorbidities avaible or not; the avaibility of thoses criteria are necessary to contact mobile team for treatment at home to elderly patient with covid19. But the presence of one or more criteria in the same group age (70-70 ans) and an eldery patient who had over than 70 years old should be hospitalised for treatment.

References

1. Huang C, Wang Y, Li X, Ren L, Zhao J, et al.(2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223): 497-506.
2. Liu Y, Gayle AA, Wilder-Smith A, Rocklov J (2020) The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 27(2): taaa021.
3. World Health Organization. Coronavirus disease 2019 (COVID-19), Geneva: WHO; 2020. Situation Report 40.
4. Cesari M, Marzetti E, Thiem U, Pérez-Zepeda MU, Abellan Van Kan G, et al. (2016)The geriatric manage- ment of frailty as paradigm of "The end of the disease era". Eur J Intern Med 31: 11-14.
5. Chen N, Zhou M, Dong X, Qu J, Gong F (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223): 507-513.
6. Jiangshan L, Xi J, Shaorui H, Cai H, Zhang S, et al. (2020) Analysis of Epidemiological and clinical features in older patients with coronavirus disease 2019 ( COVID-19) outside wuhan. Clin Infect Dis 71(15): 740-747.
7. Guo T, Shen Q, Guo W, He W, Li J, et al. ( 2020) Clinical characteristics of Elderly patients with COVID-19 in Hunan province, China: A multicenter retrospective study. Gerontology 66(5): 467-475.
8. Angelo, Giuseppe B, Fabio G , Marengoni A , Padovani A, et al. (2020) Improving the care of older patients during the COVID‐19 pandemic. Aging Clin Exp Res 32(9): 1883-1888.
9. Cannweiller C, Guillaume S, Nathalie S, Jean-Pierre A, Gautier J, et al. (2021) National French Survey of Coronavirus Disease (COVID-19) Symptoms in People Aged 70 and Over. Clin Infect Dis 72(3): 490-494.
10. Nanda A, Krishna Vura NVR, Gravenstein S (2020) COVID-19 in older adults. Aging Clin Exp Res 32(7): 1199-1202.
11. Bellelli G, Nobili A, Annoni G, Morandi A, CD (2015) Under-detection of delirium and impact of neurocognitive de cits on in-hospital mortality among acute geriatric and medical wards. Eur J Intern Med 26(9): 696-704.
12. Vardy E (2020) British Geriatrics Society and European Delirium Association Old Age Psychiatry Faculty (Royal College of Psychiatrists). Coronavirus: Managing delirium in con rmed and suspected cases.
13. (2020) Italian National Institute of Health. Characteristics of COVID-19 patients dying in Italy.
14. Onder G, Rezza G, Brusaferro S (2020) Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 323(18): 1775-1776.
15. Bianchetti A, Rozzini R, Guerini F (2020) Clinical presentation of COVID19 in dementia patients. J Nutr Health Aging 24(6): 560-562.
16. Cudjoe TKM, Kotwal AA (2020) "Social Distancing" amid a crisis in social isolation and loneliness. J Am Geriatr Soc 68(6): E27-E29.
17. Michael TM, Currie DW, Clark S, Pogosjans S, Kay M, et al. (2020) Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med 382(21): 2005-2011.
18. Italian National Institute of Health (2020) Survey nazionale sul contagio COVID-19 nelle structure residenzialie sociosanitarie, Second report.
19. Lauretani F, Bellelli G, Pelà G , Morganti S, Tagliaferri S, et al. (2020) Treatment of delirium in older persons: what we should not do! Int J Mol Sci 21(7): 2397.
20. Arya A, Buchman S, Gagnon B , Downar J (2020) Pandemic palliative care: beyond ventilators and saving lives. CMAJ 192(15): E400- E404.
21. Gordon AL, Goodman C, Achterberg W, Barker RO, Burns E, et al. (2020) COVID in care homes-challenges and dilemmas in healthcare delivery. Age Ageing 49(5): 701-705.