A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults

Aliberti, Márlon Juliano Romero; Covinsky, Kenneth E.; Garcez, Flávia Barreto; Smith, Alexander K.; Curiati, Pedro Kallas; Lee, Sei J.; Dias, Murilo Bacchini; Melo, Victor José Dornelas; Rego-Júnior, Otávio Fortes do; Richinho, Valéria de Paula; Jacob‐Filho, Wilson; Avelino‐Silva, Thiago Junqueira

doi:10.1093/ageing/afaa240

Cited by 30 publications

(39 citation statements)

References 30 publications

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“…34,47 Although our results indicate the relevance of the early recognition of frailty in the prognostication of COVID-19 patients, no measure should be used in isolated manner to determine the allocation of medical resources. 21 On the contrary, our study highlights the importance of sociodemographic factors, multimorbidity, and, particularly, acute disease morbidity to stratify risks in hospitalized middle-aged and older adults with COVID-19. These routinely assessed measures are essential to help health providers delineate a fuller picture of F I G U R E 1 Kaplan-Meier survival curves over 6 months, according to age group and frailty status.…”

Section: Discussionmentioning

confidence: 57%

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Aliberti

Szlejf

Avelino‐Silva

et al. 2021

J American Geriatrics Society

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105

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Background: Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID-19) prognosis remains unclear.Objectives: To investigate the association between frailty and mortality over 6 months in middle-aged and older patients hospitalized with COVID-19 and the association between acute morbidity severity and mortality across frailty strata.Design: Observational cohort study. Setting: Large academic medical center in Brazil.Participants: A total of 1830 patients aged ≥50 years hospitalized with COVID-19 (March-July 2020).Measurements: We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7)(8)(9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox A complete list of investigators in the COVID HCFMUSP Study Group is provided in Data S1.

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Section: Discussionmentioning

confidence: 57%

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Aliberti

Szlejf

Avelino‐Silva

et al. 2021

J American Geriatrics Society

Self Cite

105

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“…Older people, and those with comorbidities, are at greater risk of requiring hospitalization or dying if they are diagnosed with COVID-19( Wu & McGoogan, 2020 ; Becerra-Muñoz et al 2020 ). Indeed, in older patients with COVID-19 emerged that not only the severity of COVID-19-related pneumonia or impairment of respiratory function, but also frailty and vulnerability are crucial determinant of poor prognosis ( Aliberti et al 2021 ; Hwang et al 2020 ). Consequently, mainly due to age-related vulnerability and to the several complications, the older patients are facing a more severe COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

Covino

Matteis

Polla

et al. 2021

Archives of Gerontology and Geriatrics

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Introduction : To date, mainly due to age-related vulnerability and to coexisting comorbidities, older patients often face a more severe COVID-19. This study aimed to identify at Emergency Department (ED) admission the predictors of in-hospital mortality and suitable scores for death risk stratification among COVID-19 patients ≥ 80 years old. Methods : Single-centre prospective study conducted in the ED of an university hospital, referral center for COVID-19 in central Italy. We included 239 consecutive patients ≥ 80 years old with laboratory-confirmed COVID-19. The primary study endpoint was all-cause in-hospital mortality. Multivariable Cox regression analysis was performed on significant variables at univariate analysis to identify independent risk factor for death. Overall performance in predicting mortality of WHO severity scale, APACHE II score, NEWS score, and CURB-65 was calculated. Results : Median age was 85 [82-89] and 112 were males (46.9%). Globally, 77 patients (32.2%) deceased. The presence of consolidations at chest x-ray and the hypoxemic respiratory failure were significant predictors of poor prognosis. Moreover, age ≥ 85 years, dependency in activities of daily living (ADL), and dementia were risk factors for death, even after adjusting for clinical covariates and disease severity. All the evaluated scores showed a fairly good predictive value in identifying patients who could experience a worse outcome. Conclusions : Among patients ≥ 80 years old hospitalized with COVID-19, not only a worse clinical and radiological presentation of the disease, but also the increasing age, dementia, and impairment in ADL were strong risk factors for in-hospital death, regardless of disease severity.

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“…M.D. SARAIVA 1,* , D. APOLINARIO 1,2,* , T.J. AVELINO-SILVA¹, C. DE ASSIS MOURA TAVARES 3 , I.F. GATTÁS-VERNAGLIA 4 , C. MARQUES FERNANDES 3 , L.M.…”

Section: The Impact Of Frailty On the Relationship Between Life-spaceunclassified

“…SARAIVA 1,* , D. APOLINARIO 1,2,* , T.J. AVELINO-SILVA¹, C. DE ASSIS MOURA TAVARES 3 , I.F. GATTÁS-VERNAGLIA 4 , C. MARQUES FERNANDES 3 , L.M. RABELO 3 , S. TAVARES FERNANDES YAMAGUTI 2 , T. KARNAKIS 4 , R. KALIL-FILHO 3 , W. JACOB-FILHO¹, M.J. ROMERO ALIBERTI 1,5 proposed, consolidating the concept of life-space mobility (13,14).…”

Section: The Impact Of Frailty On the Relationship Between Life-spacementioning

confidence: 99%

“…GATTÁS-VERNAGLIA 4 , C. MARQUES FERNANDES 3 , L.M. RABELO 3 , S. TAVARES FERNANDES YAMAGUTI 2 , T. KARNAKIS 4 , R. KALIL-FILHO 3 , W. JACOB-FILHO¹, M.J. ROMERO ALIBERTI 1,5 proposed, consolidating the concept of life-space mobility (13,14). Life-space is characterized by the movement that extends from within one's home to beyond their town or region, and it can be evaluated by instruments like the Life-Space Assessment (LSA) (15).…”

Section: The Impact Of Frailty On the Relationship Between Life-spacementioning

confidence: 99%

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The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

Saraiva

Apolinário

Avelino‐Silva

et al. 2021

The Journal of nutrition, health and aging

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Background: The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective: To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design: Multicenter prospective cohort study based on structured telephone interviews. Setting: Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants: 557 community-dwelling adults aged 60 years and older. Measurements: The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results: Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion: Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.

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A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults

Cited by 30 publications

References 30 publications

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Predictors of in-hospital mortality AND death RISK STRATIFICATION among COVID-19 PATIENTS aged ≥ 80 YEARs OLD

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

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