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

doi:10.1093/ageing/afab026

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

Inflammation and Ageing

Research output: Contribution to journal › Article › peer-review

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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 language	English
Pages (from-to)	617-630
Number of pages	14
Journal	Age and Ageing
Volume	50
Issue number	3
Early online date	5 Feb 2021
DOIs	https://doi.org/10.1093/ageing/afab026
Publication status	Published - 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ageing/afab026Licence: Creative Commons: Attribution (CC BY)

WelchC2021AgeFinal published version, 386 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

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

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.",

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author = "{Geriatric Medicine Research Collaborative} and {Covid Collaborative} and Carly Welch and Thomas Jackson and Daisy Wilson",

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: {\textcopyright} 2021 Oxford University Press. All rights reserved.",

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language = "English",

volume = "50",

pages = "617--630",

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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 ; Jackson, Thomas et al.
In: Age and Ageing, Vol. 50, No. 3, 05.05.2021, p. 617-630.

Research output: Contribution to journal › Article › peer-review

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T1 - Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors

T2 - results of an international multi-centre study

AU - Geriatric Medicine Research Collaborative

AU - Covid Collaborative

AU - Welch, Carly

AU - Jackson, Thomas

AU - Wilson, Daisy

N1 - 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.

PY - 2021/5/5

Y1 - 2021/5/5

N2 - 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.

AB - 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.

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KW - Cohort Studies

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KW - Frail Elderly

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KW - Humans

KW - Male

KW - SARS-CoV-2

KW - Survivors

KW - transitions of care

KW - frailty,COVID-19

KW - mortality

KW - delirium

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DO - 10.1093/ageing/afab026

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C2 - 33543243

SN - 0002-0729

VL - 50

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ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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