Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Geriatric Medicine Research Collaborative, Covid Collaborative, Thomas Jackson, Daisy Wilson

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Abstract

INTRODUCTION: Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear.

METHODS: This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables.

RESULTS: Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18-49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54-5.02), frailty (CFS 8 versus 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1-3: odds ratio 7.00, CI 5.27-9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.

CONCLUSION: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

Original languageEnglish
Pages (from-to)617-630
Number of pages14
JournalAge and Ageing
Volume50
Issue number3
Early online date5 Feb 2021
DOIs
Publication statusPublished - 5 May 2021

Bibliographical note

Funding Information:
Declaration of Sources of Funding: The Geriatric Medicine Research Collaborative has previously received funding from the British Geriatrics Society for administrative and running costs. No project specific funding was obtained for this research. MW and SR acknowledge support from the NIHR Newcastle Biomedical Research Centre. The views expressed in this manuscript are those of the authors and not those of the NIHR, the NHS or the Department of Health.

Publisher Copyright:
© 2021 Oxford University Press. All rights reserved.

Keywords

  • Aged
  • COVID-19
  • Cohort Studies
  • Female
  • Frail Elderly
  • Frailty/diagnosis
  • Humans
  • Male
  • SARS-CoV-2
  • Survivors
  • transitions of care
  • frailty,COVID-19
  • mortality
  • delirium

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Ageing

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