Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19

Abstract

BackgroundWe report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Ser-ious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. MethodsPatients with laboratory-confirmed COVID-19 admitted to 11 sites in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020 were enrolled in this prospective observational cohort study. Measures included age, sex, demographics, housing, exposures, Clinical Frailty Scale, comorbidities; in addition, length of stay, intensive care unit (ICU) admission, mechanical ventilation, and survival were assessed. Descriptive analyses and multivariable logistic regressions were conducted. ResultsAmong 2,011 patients, mean age was 71.0 (range 19–105) years. 29.7% were admitted from assisted living or long-term care facilities. The full spectrum of frailty was represented in both younger and older age groups. 81.8% had at least one underlying comorbidity and 27.2% had obesity. Mortality was 14.3% without ICU admission, and 24.6% for those admitted to ICU. Older age and frailty were independent predictors of lower ICU use and higher mortality; accounting for frailty, obesity was not an independent predictor of mortality, and associations of comorbidities with mortality were weakened. ConclusionsFrailty is a critical clinical factor in predicting outcomes of COVID-19, which should be considered in research and clinical settings.

Multimorbidity and frailty are associated with poorer SARS-CoV-2-related outcomes: systematic review of population-based studies

“…They also consider earlier waves of the pandemic (study period between January 2020 and July 2021) and address short-term outcomes, notably in terms of infection, hospitalisation, ICU admission and mortality. The studies support our findings underlying the higher risk of poorer outcomes with the higher number of diseases or with a CCI score increment [ 55 , 56 , 58 , 59 , 61 , 62 ], with increasing frailty [ 63 – 65 ] and for certain disease patterns such as cardiometabolic or cardiovascular patterns, which presented a stronger association with infection or infection severity [ 57 , 60 ]. Regarding the risk of infection, however, the findings seem to be less conclusive, for e.g., Catalano et al [ 58 ] showed the lesser likelihood of infection for patients with multimorbidity, even though they were tested more often, which may potentially be explained by their better compliance with the restrictive measures; nevertheless, in the same study, the risk of hospitalisation, ICU admission or death was higher for patients with multimorbidity.…”

“…Our results present the state of the evidence in the early years of the COVID-19 pandemic. Since our review, several studies on population representative samples have been released for multimorbidity [ 55 – 62 ] and frailty [ 63 – 65 ]. They also consider earlier waves of the pandemic (study period between January 2020 and July 2021) and address short-term outcomes, notably in terms of infection, hospitalisation, ICU admission and mortality.…”

Antimicrobial resistance in intensive care patients hospitalized with SEPSIS: a comparison between the COVID-19 pandemic and pre-pandemic era

“…In this ICU population, age is a significant risk factor for mortality; data about this are widely available in the literature ( 33 , 34 ). Another risk factor highlighted in our study is the correlation between mortality and days of stay in the ICU.…”

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

“…1 ALF residents are particularly susceptible to the serious complications of SARS-CoV-2 infection due to the age of the population, immunosenescence, frailty, and comorbidities associated with aging. 2,3 Although there is substantial variation among ALFs with respect to admissions, resident care needs, and staffing, 4 in general, ALFs provide a level of medical assistance while allowing some autonomy and promoting socialization. Almost half (46%) of ALFs in the United States do not have a registered or licensed nurse on staff.…”

“…Assisted living facilities (ALFs) emerged 4 decades ago in response to a growing need for supportive, residential housing for the aging population 1. ALF residents are particularly susceptible to the serious complications of SARS-CoV-2 infection due to the age of the population, immunosenescence, frailty, and comorbidities associated with aging 2,3. Although there is substantial variation among ALFs with respect to admissions, resident care needs, and staffing,4 in general, ALFs provide a level of medical assistance while allowing some autonomy and promoting socialization.…”