Frailty trajectories in community‐dwelling older adults during COVID‐19 pandemic: The PRESTIGE study

Abstract

Background Frailty has been recognized as potential surrogate of biological age and relevant risk factor for COVID‐19 severity. Thus, it is important to explore the frailty trajectories during COVID‐19 pandemic and understand how COVID‐19 directly and indirectly impacts on frailty condition. Methods We enrolled 217 community‐dwelling older adults with available information on frailty condition as assessed by multidimensional frailty model both at baseline and at one‐year follow‐up using Multidimensional Prognostic Index (MPI) tools. Pre‐frail/frail subjects were identified at baseline as those with MPI score >0.33 (MPI grades 2–3). Frailty worsening was defined by MPI difference between 12 months follow‐up and baseline ≥0.1. Multivariable logistic regression was modelled to identify predictors of worsening of frailty condition. Results Frailer subjects at baseline (MPI grades 2–3 = 48.4%) were older, more frequently female and had higher rates of hospitalization and Sars‐CoV‐2 infection compared to robust ones (MPI grade 1). Having MPI grades 2–3 at baseline was associated with higher risk of further worsening of frailty condition (adjusted odd ratio (aOR): 13.60, 95% confidence interval (CI): 4.01–46.09), independently by age, gender and Sars‐CoV‐2 infection. Specifically, frail subjects without COVID‐19 (aOR: 14.84, 95% CI: 4.26–51.74) as well as those with COVID‐19 (aOR: 12.77, 95% CI: 2.66–61.40, p = 0.001) had significantly higher risk of worsening of frailty condition. Conclusions Effects of COVID‐19 pandemic among community‐dwelling frailer individuals are far beyond the mere infection and disease, determining a significant deterioration of frailty status both in infected and non‐infected subjects.

A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS)

“…Recent findings confirmed that MPI is a reliable prognostic indicator also in older adults with COVID-19 disease [40][41][42][43][44]. Frailer subjects hospitalized for COVID-19 disease reported more atypical presentation (e.g., delirium), and had longer hospitalization, greater functional decline, and a sixtime higher risk of in-hospital mortality [40,42].…”

“…Also among 3946 older adults residents in long-term facilities incidence rate of death in people with positive COVID-19 swab was more than doubled than in those negative and was progressively higher by MPI category (from 2.57 per 1000 persons-days in the MPI-1 class to 3.11 in the MPI-2 class and 3.33 in the MPI-3 class) [41]. Finally, data from community-dwelling older population showed that subjects with multidimensional prefrailty/frailty (MPI-2 and 3 classes) before the COVID-19 pandemic, had higher rates of hospitalization and SARS-CoV-2 infection compared to robust ones (MPI-1 class) [44]. Frailer subjects affected by COVID-19, during 12 months of follow-up, had more than the four-time higher risk of experiencing further worsening of frailty condition compared to robust and non-infected subjects [44].…”

“…Finally, data from community-dwelling older population showed that subjects with multidimensional prefrailty/frailty (MPI-2 and 3 classes) before the COVID-19 pandemic, had higher rates of hospitalization and SARS-CoV-2 infection compared to robust ones (MPI-1 class) [44]. Frailer subjects affected by COVID-19, during 12 months of follow-up, had more than the four-time higher risk of experiencing further worsening of frailty condition compared to robust and non-infected subjects [44].…”

Older People Hospitalized for COVID-19: Prognostic Role of Multidimensional Prognostic Index and Other Prognostic Scores

“…Unfortunately, most prediction model studies were poorly reported and of low quality, as they often reported limited predictive performances [ 32 ]. At the same time, there is still a paucity of prognostic tools based on CGA that evaluate the impact of COVID-19 in older subjects, even if some recent reports suggested that the impact of the COVID-19 pandemic on frailty condition is largely independent of the direct effect of the virus [ 33 ]. Consistently, growing evidence brings attention to the burden of the indirect effects of COVID-19 (i.e., psychological distress, cognitive impairment, malnutrition and physical inactivity), which are reflected in multidimensional well-being [ 34 ].…”

The Intergenerational Representation of Old Age in the Transition to Frailty: An Empirical Analysis in Italy

“…The recent Covid-19 pandemic has brought the focus back on the elderly, who are the most vulnerable to the negative outcomes of the virus (Pilotto et al, 2022). An Italian study conducted by Diversity Lab and the University of Pavia showed that, between January and April 2020, media coverage of the five areas of diversity (generations, gender, disability, ethnicity, LGBT+) decreased dramatically, except for people over 60.…”