Frailty in the context of COVID-19 pandemic: A life-threatening condition

Abstract

The pandemic outbreak of coronavirus disease 2019 (COVID-19) has caused emerging challenges for healthcare systems regarding the assistance to the older adult population which, added to the increased life expectancy, may be exposing frail older adults to an increased risk of unfavorable health outcomes. Frailty has a pathogenesis of multifactorial etiology and is defined as a condition characterized by progressive decline in physiological function, weakness, decreased strength, and reduced resilience to stressors, leading to vulnerability and an increased risk of fractures, falls, institutionalization, and death. In the context of COVID-19, frail older adults accounted for approximately 51% of hospitalized patients with confirmed cases and elevated risk of mortality in-hospital. In addition, frailty may be associated with recent “excess mortality” reported by the World Health Organization (WHO) in terms of the full death toll associated directly (due to the disease) or indirectly (due to the pandemic's impact on health systems and society) to COVID-19. Therefore, this mini review aimed to provide a summarized discussion from meta-analyses data regarding the impact of frailty in community-dwelling older adults hospitalized with COVID-19 on short-term mortality risk.

Association between multidimensional prognostic index (MPI) and infections in a population of older people affected by COVID-19

“…It Italy, a particularly critical resistance rates are observed for Klebsiella pneumoniae to amoxicillin-clavulanic acid (57.2%) and piperacillin-tazobactam (45.8%), to third generation cephalosporins (> 50%) and to carbapenems (28.7% for meropenem) [ 14 ]. A recent review showed that in the context of COVID-19, frail older adults accounted for approximately 51% of hospitalized patients with confirmed cases and elevated risk of in-hospital mortality [ 5 ]. An American survey based on 50,419 respiratory samples demonstrates how even though the overall median age of the SARS-CoV-2-positive patients was 45 years, the bacterial co-infections were significantly higher in the older age group (60 + years) when compared to any other age group [ 15 ].…”

“…This highlights how it is necessary to carry out a comprehensive geriatric assessment (CGA) to evaluate the real state of frailty in older persons affected by infectious diseases and for clinical-decision making in frail older people often affected by MDR. For example, a recent meta-analysis highlights the impact of frailty in older adults hospitalized with COVID-19, showing that frail COVID-19 patients have an increased risk of short-term mortality compared to non-frail patients affected by COVID-19 [ 5 ]. A large meta-analysis indicated that 7% of hospitalized COVID-19 patients had a bacterial co-infection that increases to 14% in studies that only included ICU (intensive care unit) patients [ 6 ].…”

Serial SOFA‐score trends in ICU‐admitted COVID‐19 patients as predictor of 28‐day mortality: A prospective cohort study

“…In fact, some large prospective cohorts have discussed that such data, that is, frailty, daily‐life activities, could plausibly influence mortality rate of COVID‐19, particularly in elderly patients. 34 , 35 Since the data of our study lacks such information regarding activity of daily life or frailty, we could have overlooked its potential role in impacting the 28‐day mortality in patients; so future studies are needed to shed light on the matter.…”

Effect of the implementation of clinical guidelines on management of candidemia in elderly patients

“…It is possible that the COVID-19 pandemic has influenced this fact. 13,27 Likewise, it should be noted that the death can also be related to advanced age, exacerbations of the underlying pathology or other complications that reduce the effect of antifungal treatment on mortality.…”

“…It must also be clarified that we have not found the reason that justifies younger age and less comorbidity during the second period. It is possible that the COVID‐19 pandemic has influenced this fact 13,27 . Likewise, it should be noted that the death can also be related to advanced age, exacerbations of the underlying pathology or other complications that reduce the effect of antifungal treatment on mortality.…”