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Background and Objectives: Frailty leaves older adults vulnerable to adverse health outcomes. Frailty assessment is recommended by multiple COVID-19 guidelines to inform care and resource allocation. We aimed to identify, describe, and synthesize studies reporting the association of frailty with outcomes (informed by the Institute for Healthcare Improvement's Triple Aim [health, resource use, and experience]) in individuals with COVID-19.Design: Systematic review and meta-analysis. Setting: Studies reporting associations between frailty and outcomes in the setting of COVID-19 diagnosis. Participants: Adults with COVID-19.Measurements: Following review of titles, abstracts and full text, we included 52 studies that contained 118,373 participants with COVID-19. Risk of bias was assessed using the Quality in Prognostic studies tool. Our primary outcome was mortality, secondary outcomes included delirium, intensive care unit admission, need for ventilation and discharge location. Where appropriate, random-effects meta-analysis was used to pool adjusted and unadjusted effect measures by frailty instrument.Results: The Clinical Frailty Scale (CFS) was the most used frailty instrument. Mortality was reported in 37 studies. After confounder adjustment, frailty identified using the CFS was significantly associated with mortality in COVID-19 positive patients (odds ratio 1.79, 95% confidence interval [CI] 1.49-2.14; hazard ratio 1.87, 95% CI 1.33-2.61). On an unadjusted basis, frailty identified using the CFS was significantly associated with increased odds of delirium and reduced odds of intensive care unit admission. Results were generally consistent using other frailty instruments. Patient-reported, cost and experience outcomes were rarely reported. Conclusion:Frailty is associated with a substantial increase in mortality risk in COVID-19 patients, even after adjustment. Delirium risk is also increased. Frailty assessment may help to guide prognosis and individualized care

It is important to consider physical activity and movement in early life to ensure children establish and maintain healthy physical activity patterns. Recent evidence has highlighted the importance of outdoor play and the childcare environment. Active outdoor play, especially free play, supports independence, self-regulation and allows children to explore their world and make decisions. Loose parts or open-ended materials are natural or synthetic resources that can be used in more than one way, allowing children to experiment through play. Incorporating loose parts into play environments creates opportunity for new play experiences. Despite growing evidence supporting loose parts play, the perspectives of childcare providers on the benefits and challenges of this type of play have been overlooked. The purpose of this study was to identify the benefits and challenges of incorporating loose parts play into the outdoor environments of childcare centres, from the perspectives of educators who took part in the Physical Literacy in the Early Years (PLEY) project. PLEY is a larger, mixed methods intervention study with the goal of evaluating a loose parts intervention in early childcare settings. This portion of the project used qualitative description to explore educators' perspectives. Data were collected using focus groups (n = 15) with early childhood educators (n = 3–5 in each group). Thematic analysis was used to identify five themes relating to benefits, and four themes relating to challenges. Benefit themes included: loose parts enable children to take risks; loose parts spark creativity and imagination; loose parts contribute to problem-solving abilities; loose parts cultivate independence and confidence; and loose parts build relationships and leadership. Challenges included: apprehension of loose parts; loose parts as a novelty; sustainability of loose parts; and loose parts present challenges with storage. Overall, we found educators perceived outdoor loose parts play to have multiple social and cognitive benefits for preschool-aged children that are critical for optimal growth and development, and overall health and wellness.

<abstract> <p>Development of fundamental movement skills in early childhood supports lifelong health. The potential for outdoor play with loose parts to enhance fundamental movement skills has not been investigated. A multi-methods randomized controlled design was used to determine the efficacy of integrating outdoor loose parts play into Nova Scotia childcare centers (19 sites: 11 interventions, 8 control). Movement skills (n = 209, age 3–5 years) were assessed over a 6-month period to investigate changes in fundamental movement skills over time and between groups. Qualitative data was also collected on the educators' perceptions of outdoor loose parts play. Quantitative data (fundamental movement skills) revealed a non-intervention effect, however, educators spoke of outdoor loose parts play providing opportunities to combine/ repeat movements and take risks; supporting physical, cognitive and socio-emotional (holistic) development; and increasing awareness of children's physical development and how to support it. Our findings demonstrate value in outdoor loose parts play for the development of fundamental movement skills in childcare settings.</p> </abstract>