Older Adults with Epilepsy and COVID-19: Outcomes in a Multi-Hospital Health System

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy. MethodsThis retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS). ResultsWe identified 5384 older adults admitted with COVID-19 of whom 173 (3.21%) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p=0.007). Older adults with epilepsy were more likely to be ventilated (35.84% vs. 16.18%, p<0.001), less likely to be discharged home (21.39% vs. 43.12%, p<0.001), had longer median LOS (13 days vs. 8 days, p<0.001), and had higher in-hospital death (35.84% vs. 28.29%, p=0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95% CI 1.12-2.14, p=0.032), non-routine discharge disposition (aOR, 3.34; 95% CI 2.21-5.03, p<0.001), and longer LOS (46.46% 95% CI 34%-59%, p<0.001). ConclusionsIn models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.