Abstract
Frailty assessed using Clinical Frailty Scale (CFS) is a good predictor of adverse clinical events including mortality in older people. CFS is also an essential criterion for determining ceilings of care in people with COVID-19. Our aims were to assess the prevalence of frailty in older patients hospitalised with COVID-19, their sex and age distribution, and the completion rate of the CFS tool in evaluating frailty. Methods: Data were collected from thirteen sites. CFS was assessed routinely at the time of admission to hospital and ranged from 1 (very fit) to 9 (terminally ill). The completion rate of the CFS was assessed. The presence of major comorbidities such as diabetes and cardiovascular disease was noted. Results: A total of 1277 older patients with COVID-19, aged ≥ 65 (79.9 ± 8.1) years were included in the study, with 98.5% having fully completed CFS. The total prevalence of frailty (CFS ≥ 5) was 66.9%, being higher in women than men (75.2% vs. 59.4%, p < 0.001). Frailty was found in 161 (44%) patients aged 65–74 years, 352 (69%) in 75–84 years, and 341 (85%) in ≥85 years groups, and increased across the age groups (<0.0001, test for trend). Conclusion: Frailty was prevalent in our cohort of older people admitted to hospital with COVID-19. This indicates that older people who are also frail, who go on to contract COVID-19 may have disease severity significant enough to warrant hospitalization. These data may help inform health care planners and targeted interventions and appropriate management for the frail older person.
Highlights
Frailty is a pivotal factor in determining risk of poor health-related outcomes
The COPE study primary aims are to evaluate the association of frailty with clinical outcomes and mortality in patients admitted to hospital with COVID-19; a full study protocol can be found elsewhere [7]
Our results show that the prevalence of frailty is high (66.9%), when assessed using the Clinical Frailty Scale (CFS) in a population aged 65 years and above hospitalised with COVID-19
Summary
It confers an increased vulnerability to non-restoration of homeostasis after a stressor event [1]. Put, it means that even a minor insult may result in hospitalisation and death. New approaches to assessing risk may be required, distinct from a blanket policy to shield all people over a certain age. This may include the assessment of frailty, in order to better allocate care resources to people at greater risk of negative outcomes and identify potential targets for preventative interventions. Muscle strength training and protein supplementation may delay or even reverse the progression of frailty in older people [5,6]
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