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Cases L, Vela E, Santaeugènia Gonzàlez SJ, Contel JC, Carot-Sans G, Coca M, Pastor M, Carrasco I, Barbeta C, Vila A, Amil P, Plaza A, Pontes C, Piera-Jiménez J, Amblàs J. Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia. Front Public Health 2023; 11:1208184. [PMID: 37732085 PMCID: PMC10507684 DOI: 10.3389/fpubh.2023.1208184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain). Design Observational, retrospective analysis of population-based central healthcare registries. Setting and participants Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022. Methods Deaths reported during the pre-pandemic period (2015-2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable "mortality"), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020-2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths' number observed to the expected deaths' number over the same period. Results The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015-2019) and 105,186 within the COVID-19 period (2020-2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, -182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45-2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27-1.34), 1.03 (1.00-1.07), 0.93 (0.89-0.97), 1.13 (1.10-1.17), and 1.07 (1.04-1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to -182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs. Conclusion Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people.
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Affiliation(s)
- Laia Cases
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Sebastià J. Santaeugènia Gonzàlez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Joan Carles Contel
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Marc Coca
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Marta Pastor
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Ignasi Carrasco
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- Catalan Health Service, Barcelona, Spain
| | - Conxita Barbeta
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Department of Social Welfare, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Vila
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Department of Social Welfare, Generalitat de Catalunya, Barcelona, Spain
| | - Paloma Amil
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Aina Plaza
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jordi Amblàs
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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Pant DP, Acharya B, Kattel MR. Association of government effectiveness, logistics performance, IT systems and income with COVID-19 mortality. Heliyon 2023; 9:e15214. [PMID: 37035369 PMCID: PMC10072949 DOI: 10.1016/j.heliyon.2023.e15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023] Open
Abstract
The COVID-19 pandemic has unprecedentedly shaken the public health system worldwide. It has been one of the greatest humanitarian crises faced by all countries, regardless of their economic prosperity. However, some countries have been able to minimize the deaths caused by the coronavirus even in the face of a large number of cases, while others have failed to control the death rate even in a comparatively small number of cases. This study explores possible causes of this disparity using cross-sectional data from 126 countries associated with demography, governance, income level, the extent of ICT maturity and the geographical divide. The results of this study suggest that while government effectiveness is negatively associated with the COVID-19 death rate, the logistics performance of governments is positively linked to the COVID-19 mortality rate. The ICT maturity proxied through online service delivery did not confirm its association with the COVID-19 mortality rate. This study informs that poverty and the location of countries do not necessarily influence COVID-19 deaths. Hence, it behoves governments to focus on improving government effectiveness and putting in place more effective and efficient mobility systems, healthcare supply chains and digital administration to address the global health crisis posed by the COVID-19 pandemic and mitigate its harsh effects, including mortality.
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Affiliation(s)
| | - Bikram Acharya
- Policy Research Institute, Narayanhiti, Kathmandu, Nepal
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Del Toro R, Palmese F, Feletti F, Zani G, Minguzzi MT, Maddaloni E, Napoli N, Bedogni G, Domenicali M. Relationship between Muscle Mass, Bone Density and Vascular Calcifications in Elderly People with SARS-CoV-2 Pneumonia. J Clin Med 2023; 12:jcm12062372. [PMID: 36983372 PMCID: PMC10059976 DOI: 10.3390/jcm12062372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection. METHODS In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography. RESULTS At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (-0.02, 95%CI -0.04 to -0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (-0.03, -0.06 to -0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death. CONCLUSIONS Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying.
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Affiliation(s)
- Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Francesco Palmese
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesco Feletti
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Maria Teresa Minguzzi
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Giorgio Bedogni
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Domenicali
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan. Nutrients 2023; 15:nu15051145. [PMID: 36904144 PMCID: PMC10005648 DOI: 10.3390/nu15051145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic. METHODS Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence. RESULTS In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (β, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (β, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (β, -0.045; 95% CI, -0.078 to -0.012; p = 0.015). CONCLUSIONS A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.
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Mazzalai E, Giannini D, Tosti ME, D’Angelo F, Declich S, Jaljaa A, Caminada S, Turatto F, De Marchi C, Gatta A, Angelozzi A, Marchetti G, Pizzarelli S, Marceca M. Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-31. [PMID: 36647529 PMCID: PMC9833641 DOI: 10.1007/s12134-023-01007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information The online version contains supplementary material available at 10.1007/s12134-023-01007-x.
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Affiliation(s)
- Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Franca D’Angelo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Declich
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department for Organisational Development, Local Health Unit Roma 1, Rome, Italy
| | - Giulia Marchetti
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Scilla Pizzarelli
- Knowledge Unit, Documentation and Library, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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Lu D, Dhanoa S, Cheema H, Lewis K, Geeraert P, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Basmaji J, Agrawal A, Niven D, Fiest K, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM, Lau VI. Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:999225. [PMID: 36590965 PMCID: PMC9800609 DOI: 10.3389/fmed.2022.999225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background and aim With the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times. Methods We searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results Of 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons (n = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06-0.06% p < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38-1.70, p < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07-1.30, p < 0.00001). There was "very low" certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain. Interpretation The COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain. Systematic review registration [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256].
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Affiliation(s)
- David Lu
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Dipayan Chaudhuri
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - John Basmaji
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Arnav Agrawal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dan Niven
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Danny J. Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Oleksa G. Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vincent I. Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
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Nguyen-Michel VH, Houot M, Delorme C, Sangaré A, Gales A, Frazzini V, Hanin A, Aissani D, Trân T, Oquendo B, Ketz F, Lafuente-Lafuente C, Oasi C, Kinugawa K, Ouvrard G, Ursu R, Degos B, Rohaut B, Demeret S, Lambrecq V, Navarro V, Fournier E, Corvol JC, Borden A. Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality. Brain Behav 2022; 12:e2787. [PMID: 36355411 PMCID: PMC9759137 DOI: 10.1002/brb3.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/05/2022] [Accepted: 09/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions. METHODS We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19. RESULTS Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001). CONCLUSION Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.
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Affiliation(s)
- Vi-Huong Nguyen-Michel
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France
| | - Marion Houot
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Center of Excellence of Neurodegenerative Disease (CoEN), Paris, France
| | - Cécile Delorme
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Aude Sangaré
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Ana Gales
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Sleep Disorders Unit, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Djamal Aissani
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Department of Radiology, Paris, France
| | - Thanh Trân
- Pierre Bérégovoy Hospital, Neurological Unit, Nevers, France
| | - Bruno Oquendo
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Flora Ketz
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | | | - Christel Oasi
- Sorbonne Université, AP-HP, Charles-Foix Hospital, Geriatric Department, Paris, France
| | - Kiyoka Kinugawa
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, CNRS, UMR 8256 Biological Adaption and Aging, Paris, France
| | - Gaëlle Ouvrard
- Sorbonne Université, AP-HP, Rothschild Hospital, Neurological Rehabilitation Unit, Paris, France
| | - Renata Ursu
- Université de Paris, AP-HP Nord, Saint-Louis Hospital, Neurological Unit, Paris, France
| | - Bertrand Degos
- Sorbonne Université Paris Nord, AP-HP, Avicenne Hospital, Department of Neurology, Bobigny, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Sophie Demeret
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Neurological Intensive Care Unit, Paris, France
| | - Virginie Lambrecq
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Vincent Navarro
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Epileptology Unit, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Emmanuel Fournier
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France.,Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Alaina Borden
- Sorbonne Université, AP-HP, Pitié-Salpêtrière Charles-Foix Hospital Group, Clinical Neurophysiology Department, EEG-Epilepsy Unit, Functional Exploration Unit for the Older Patients, Paris, France
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9
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Jang JH, Kim T, Yeo HJ, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K. Impact of nutrition and physical activity on outcomes of hospital-acquired pneumonia. Sci Rep 2022; 12:15605. [PMID: 36114344 PMCID: PMC9481870 DOI: 10.1038/s41598-022-19793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty is an important risk factor for adverse health-related outcomes. It is classified into several phenotypes according to nutritional state and physical activity. In this context, we investigated whether frailty phenotypes were related to clinical outcome of hospital-acquired pneumonia (HAP). During the study period, a total of 526 patients were screened for HAP and 480 of whom were analyzed. The patients were divided into four groups according to physical inactivity and malnutrition: nutritional frailty (Geriatric Nutritional Risk Index [GNRI] < 82 and Clinical Frailty Scale [CFS] ≥ 4), malnutrition (GNRI < 82 and CFS < 4), physical frailty (GNRI ≥ 82 and CFS ≥ 4), and normal (GNRI ≥ 82 and CFS < 4). Among the phenotypes, physical frailty without malnutrition was the most common (39.4%), followed by nutritional frailty (30.2%), normal (20.6%), and malnutrition (9.8%). There was a significant difference in hospital survival and home discharge among the four phenotypes (p = 0.009), and the nutritional frailty group had the poorest in-hospital survival and home discharge (64.8% and 34.6%, respectively). In conclusion, there were differences in clinical outcomes according to the four phenotypes of HAP. Assessment of frailty phenotypes during hospitalization may improve outcomes through adequate nutrition and rehabilitation treatment of patients with HAP.
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10
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Prendki V, Tiseo G, Falcone M. Caring for older adults during the COVID-19 pandemic. Clin Microbiol Infect 2022; 28:785-791. [PMID: 35283306 PMCID: PMC8912971 DOI: 10.1016/j.cmi.2022.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist. OBJECTIVES To discuss unmet needs of COVID-19 in this special population. SOURCES A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide the literature search. The search was conducted in the MEDLINE database, combining specific search terms. Two reviewers independently conducted the search and selected the studies according to the prespecified clinical questions. CONTENT Elderly patients with COVID-19 have peculiar characteristics. They may have atypical clinical presentation, with no fever and with delirium or neurological manifestations as the most common signs, with potential delayed diagnosis and increased risk of death. The reported fatality rates among elderly patients with COVID-19 are extremely high. Several factors, including comorbidities, atypical presentation, and exclusion from intensive care unit care, contribute to this excess of mortality. Age alone is frequently used as a key factor to exclude the elderly from intensive care, but there is evidence that frailty rather than age better predicts the risk of poor outcome in this category. Durability of vaccine efficacy in the elderly remains debated, and the need for a third booster dose is becoming increasingly evident. Finally, efforts to care for elderly patients who have survived after acute COVID-19 should be implemented, considering the high rates of long COVID sequelae and the risk of longitudinal functional and cognitive decline. IMPLICATIONS We highlight peculiar aspects of COVID-19 in elderly patients and factors contributing to high risk of poor outcome in this category. We also illuminated gaps in current evidence, suggesting future research directions and underlining the need for further studies on the optimal management of elderly patients with COVID-19.
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Affiliation(s)
- Virginie Prendki
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
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11
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Seligman B, Charest B, Ho YL, Gerlovin H, Ward RE, Cho K, Driver JA, Gaziano JM, Gagnon DR, Orkaby AR. 30-day Mortality Following COVID-19 and Influenza Hospitalization Among US Veterans Aged 65 and Older. J Am Geriatr Soc 2022; 70:2542-2551. [PMID: 35474510 PMCID: PMC9115089 DOI: 10.1111/jgs.17828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Background COVID‐19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID‐19 and influenza among hospitalized older adults. Methods We conducted a retrospective study of 30‐day mortality among veterans aged 65+ hospitalized with COVID‐19 from March 1, 2020–December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID‐19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims‐based Veterans Affairs Frailty Index (VA‐FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders. Results A total of 15,474 veterans were admitted with COVID‐19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID‐19 and influenza cohorts respectively. Crude 30‐day mortality (95% CI) was 18.9% (18.3%–19.5%) for COVID‐19 and 4.3% (3.8%–4.7%) for influenza. Combining cohorts, the odds ratio for 30‐day mortality from COVID‐19 (versus influenza) was 6.61 (5.74–7.65). There was a statistically significant interaction between infection with COVID‐19 and frailty, but there was no significant interaction between COVID‐19 and age. Separating cohorts, greater 30‐day mortality was significantly associated with older age (p: COVID‐19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID‐19: <0.001, Influenza: <0.001). Conclusion Mortality from COVID‐19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID‐19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
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Affiliation(s)
- Benjamin Seligman
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Geriatrics Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, CA.,Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Hanna Gerlovin
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Rachel E Ward
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane A Driver
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ariela R Orkaby
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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12
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Falandry C, Bitker L, Abraham P, Subtil F, Collange V, Balança B, Haïne M, Guichon C, Leroy C, Simon M, Malapert A, Pialat JB, Jallades L, Lepape A, Friggeri A, Thiolliere F. Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19. Aging Dis 2022; 13:614-623. [PMID: 35371615 PMCID: PMC8947822 DOI: 10.14336/ad.2021.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
The SARS-COV2 pandemic induces tensions on health systems and ethical dilemmas. Practitioners need help tools to define patients not candidate for ICU admission. A multicentre observational study was performed to evaluate the impact of age and geriatric parameters on 30-day mortality in patients aged ≥60 years of age. Patients or next of kin were asked to answer a phone questionnaire assessing geriatric covariates 1 month before ICU admission. Among 290 screened patients, 231 were included between March 7 and May 7, 2020. In univariate, factors associated with lower 30-day survival were: age (per 10 years increase; OR 3.43, [95%CI: 2.13-5.53]), ≥3 CIRS-G grade ≥2 comorbidities (OR 2.49 [95%CI: 1.36-4.56]), impaired ADL, (OR 4.86 [95%CI: 2.44-9.72]), impaired IADL8 (OR 6.33 [95%CI: 3.31-12.10], p<0.001), frailty according to the Fried score (OR 4.33 [95%CI: 2.03-9.24]) or the CFS ≥5 (OR 3.79 [95%CI: 1.76-8.15]), 6-month fall history (OR 3.46 [95%CI: 1.58-7.63]). The final multivariate model included age (per 10 years increase; 2.94 [95%CI:1.78-5.04], p<0.001) and impaired IADL8 (OR 5.69 [95%CI: 2.90-11.47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85]. Age and IADL8 provide independent prognostic factors for 30-day mortality in the considered population. Considering a risk of death exceeding 80% (82.6% [95%CI: 61.2% - 95.0%]), patients aged over 80 years with at least 1 IADL impairment appear as poor candidates for ICU admission.
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Affiliation(s)
- Claire Falandry
- Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, Pierre-Bénite, France.,Correspondence should be addressed to: Dr. Claire Falandry, Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Laurent Bitker
- Hospices Civils de Lyon, Service de Réanimation Médicale, Hôpital de La Croix Rousse, Lyon, France.,Université de Lyon, CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
| | - Paul Abraham
- Hospices Civils de Lyon, Département d’anesthésie et reanimation médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Fabien Subtil
- Université de Lyon, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Université Claude Bernard Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.
| | - Vincent Collange
- Medipole Lyon-Villeurbanne, Département anesthésie réanimation, Villeurbanne, France.
| | - Baptiste Balança
- Hospices Civils de Lyon, Département of d’Anesthésie Réanimation Neurologique, Hôpital Wertheimer, Bron, France.,Hôpital Pierre Wertheimer; Université de Lyon, Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Bron, France.
| | - Max Haïne
- Hôpital Nord-Ouest, Service de Gériatrie, Gleizé, France.
| | - Céline Guichon
- Hospices Civils de Lyon, Service de réanimation, Centre hospitalier universitaire de la Croix Rousse, Lyon, France.,Université de Lyon, Lyon, France.
| | - Christophe Leroy
- Centre Hospitalier Emile Roux, Service de réanimation, Le Puy-en-Velay, France.
| | - Marie Simon
- Hospices Civils de Lyon, Service de Médecine Intensive-Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Amélie Malapert
- Hospices Civils de Lyon, Plateforme Transversale de Recherche de l'ICHCL, Pierre-Bénite, France.
| | - Jean-Baptiste Pialat
- Hospices Civils de Lyon, Service de radiologie, Groupement Hospitalier Sud; Pierre-Bénite, France.,Université de Lyon, CREATIS CNRS UMR 5220 INSERM U1206, Villeurbanne, France.
| | - Laurent Jallades
- Hospices Civils de Lyon, Service d'Hématologie biologique - Groupement Hospitalier Sud, Pierre-Bénite, France.
| | - Alain Lepape
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Centre International de Recherche en Infectiologie (CIRI), Lyon, France. On behalf of the Senior-COVID-Rea study group. ^Membership of the Senior-COVID-Rea study group is provided in the Acknowledgments section.;
| | - Arnaud Friggeri
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Fabrice Thiolliere
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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13
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Salini S, Russo A, De Matteis G, Piccioni A, Della Polla D, Carbone L, Barillaro C, Landi F, Franceschi F, Covino M. Frailty in Elderly Patients with Covid-19: A Narrative Review. Gerontol Geriatr Med 2022; 8:23337214221079956. [PMID: 35274027 PMCID: PMC8902186 DOI: 10.1177/23337214221079956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The SARS CoV-2 pandemic still generates a very high number of affected patients and a
significant mortality rate. It is essential to establish objective criteria to stratify
COVID-19 death risk. Frailty has been identified as a potential determinant of increased
vulnerability in older adults affected by COVID-19, because it may suggest alterations
of physical performance and functional autonomy. Methods We have conducted a narrative review of the literature on the evidences regarding
COVID-19 and the frailty condition. Thirteen observational studies were included. Conclusion Data emerging from the studies indicate that older COVID-19 patients with a frailty
condition have an increased risk of mortality compared with non-frail patients, and this
association is independent of other clinical and demographic factors. A frailty
evaluation is required to help clinicians to better stratify the overall risk of death
for older patients with COVID-19.
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Affiliation(s)
- Sara Salini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Russo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Davide Della Polla
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luigi Carbone
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Christian Barillaro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Landi
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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14
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15
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Subramaniam A, Shekar K, Afroz A, Ashwin S, Billah B, Brown H, Kundi H, Lim ZJ, Ponnapa Reddy M, Curtis JR. Frailty and mortality associations in patients with
COVID
‐19: A Systematic Review and Meta‐analysis. Intern Med J 2022; 52:724-739. [PMID: 35066970 PMCID: PMC9314619 DOI: 10.1111/imj.15698] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
Background Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. Aim To examine associations between frailty and short‐term mortality in patients hospitalised with coronavirus disease 2019 (COVID‐19). Methods In this systematic review and meta‐analysis, we searched PubMed, Embase and the COVID‐19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID‐19 (age ≥18 years) were included. Data on patient demographics, short‐term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle−Ottawa Scale. Results Twenty‐five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06–1.11) and had more comorbidities. Fifty‐eight percent of patients were frail. Adjusting for age, there was no difference in short‐term mortality between frail and non‐frail patients (RR = 1.04; 95% CI: 0.84–1.28). The non‐frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30–2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non‐frail (RR = 1.62; 95% CI 0.93–2.77). Conclusion This systematic review did not demonstrate an independent association between frailty status and short‐term mortality in patients with COVID‐19. Patients with frailty were less commonly admitted to ICU and non‐frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Monash University, Peninsula Clinical School Frankston Victoria Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital Brisbane Queensland Australia
- University of Queensland, Brisbane; Queensland University of Technology Brisbane and Bond University Gold Coast Queensland Australia
| | - Afsana Afroz
- Centre for Integrated Critical Care, Department of Medicine and Radiology Melbourne Medical School Melbourne Victoria Australia
| | - Sushma Ashwin
- Department of Health Economics School of Health and social development, Deakin University Melbourne Victoria Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Hamish Brown
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
| | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Zheng Jie Lim
- Department of Anaesthesiology, Austin Health Heidelberg Victoria Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Department of Intensive Care Medicine, Calvary Hospital Canberra Australian Capital Territory Australia
| | - J Randall Curtis
- Cambia Palliative Care Centre of Excellence University of Washington Seattle Washington United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University of Washington Seattle Washington United States of America
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16
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Di Bari M, Tonarelli F, Balzi D, Giordano A, Ungar A, Baldasseroni S, Onder G, Mechi MT, Carreras G. COVID-19, Vulnerability, and Long-Term Mortality in Hospitalized and Nonhospitalized Older Persons. J Am Med Dir Assoc 2021; 23:414-420.e1. [PMID: 34990587 PMCID: PMC8673732 DOI: 10.1016/j.jamda.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 02/09/2023]
Abstract
Objective Studies suggesting that vulnerability increased short-term mortality in older patients with COVID-19 enrolled hospitalized patients and lacked COVID-negative comparators. Aim of this study was to examine the relationship between frailty and 1-year mortality in older patients with and without COVID-19, hospitalized and nonhospitalized. Design Cohort study. Setting and Participants Patients over 75 years old accessing the emergency departments (ED) were identified from the ED archives in Florence, Italy. Methods Vulnerability status was estimated with the Dynamic Silver Code (DSC). COVID-19 hospital discharges (HC+) were compared with non-COVID-19 discharges (HC-). Linkage with a national COVID-19 registry identified nonhospitalized ED visitors with (NHC+) or without COVID-19 (NHC-). Results In 1 year, 48.4% and 33.9% of 1745 HC+ and 15,846 HC- participants died (P < .001). Mortality increased from 27.5% to 64.0% in HC+ and from 19.9% to 51.1% in HC- across DSC classes I to IV, with HC+ vs HC- hazard ratios between 1.6 and 2.2. Out of 1039 NHC+ and 18,722 NHC- participants, 18% and 8.7% died (P < .001). Mortality increased from 14.2% to 46.7% in NHC+ and from 2.9% to 26% in NHC- across DSC; NHC+ vs NHC- hazard ratios decreased from 5.3 in class I to 2.0 in class IV. Conclusions and Implications In hospitalized older patients, mortality increases with vulnerability similarly in the presence and in the absence of COVID-19. In nonhospitalized patients, vulnerability-associated excess mortality is milder in individuals with than in those without COVID-19. The disease reduces survival even when background risk is low. Thus, apparently uncomplicated patients deserve closer clinical monitoring than commonly applied.
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Affiliation(s)
- Mauro Di Bari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Tonarelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Balzi
- Department of Epidemiology, Azienda USL Toscana Centro, Florence, Italy
| | - Antonella Giordano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Samuele Baldasseroni
- Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Italy
| | - M Teresa Mechi
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Carreras
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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17
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Rebora P, Focà E, Salvatori A, Zucchelli A, Ceravolo I, Ornago AM, Finazzi A, Arsuffi S, Bonfanti P, Citerio G, Mazzola P, Ecarnot F, Valsecchi MG, Marengoni A, Bellelli G. The effect of frailty on in-hospital and medium-term mortality of patients with COronaVIrus Disease-19: the FRACOVID study. Panminerva Med 2021; 64:24-30. [PMID: 34761887 DOI: 10.23736/s0031-0808.21.04506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Older persons hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middleaged and older adults with COVID-19 during the first two pandemic waves. METHODS Observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry. RESULTS In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR= 1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50). CONCLUSIONS Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.
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Affiliation(s)
- Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Brescia Spedali Civili Hospital, Brescia, Italy
| | - Andrea Salvatori
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Isabella Ceravolo
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alice M Ornago
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Stefania Arsuffi
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, EA3920, University of Franche-Comté, Besançon, France
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy - .,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
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18
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Costa NA, Minicucci MF, Pereira AG, de Paiva SAR, Okoshi MP, Polegato BF, Zornoff LAM, Villas Boas PJF, Atherton PJ, Phillips BE, Banerjee J, Gordon AL, Azevedo PS. Current perspectives on defining and mitigating frailty in relation to critical illness. Clin Nutr 2021; 40:5430-5437. [PMID: 34653819 DOI: 10.1016/j.clnu.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 01/10/2023]
Abstract
Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.
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Affiliation(s)
- N A Costa
- Faculty of Nutrition, Univ Federal de Goiás (UFG), Goiânia, Brazil.
| | - M F Minicucci
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - A G Pereira
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - S A R de Paiva
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - M P Okoshi
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - B F Polegato
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - L A M Zornoff
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J F Villas Boas
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J Atherton
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - B E Phillips
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - J Banerjee
- Geriatric Emergency Medicine, University Hospitals of Leicester, School of Health Science, University of Leicester, Leicester, UK
| | - A L Gordon
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - P S Azevedo
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
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19
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Ramos‐Rincon J, Moreno‐Perez O, Pinargote‐Celorio H, Leon‐Ramirez J, Andres M, Reus S, Herrera‐García C, Martí‐Pastor A, Boix V, Gil J, Sanchez‐Martinez R, Merino E. Clinical Frailty Score vs Hospital Frailty Risk Score for predicting mortality and other adverse outcome in hospitalised patients with COVID-19: Spanish case series. Int J Clin Pract 2021; 75:e14599. [PMID: 34227196 PMCID: PMC8420333 DOI: 10.1111/ijcp.14599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID-19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID-19. MATERIAL AND METHODS This retrospective cohort study included adult (≥18 years) inpatients with COVID-19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in-hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. RESULTS Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4-23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8-27.7). Prevalence of frailty increased with age according to both measures: 50-64 years, CFS 1.9% vs HFRS 12.3%; 65-79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P < .001). CFS-defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49-9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08-0.93). HFRS-defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53-5.44), ICU admission (OR 4.18, 95% CI 1.84-9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33-15.10). CONCLUSION In the spring 2020 wave of the COVID-19 pandemic in Spain, CFS-defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation.
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Affiliation(s)
- Jose‐Manuel Ramos‐Rincon
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Oscar Moreno‐Perez
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Endocrinology and Nutrition DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Hector Pinargote‐Celorio
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Sergio Reus
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Cristian Herrera‐García
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Ana Martí‐Pastor
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rosario Sanchez‐Martinez
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Esperanza Merino
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
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20
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Dumitrascu F, Branje KE, Hladkowicz ES, Lalu M, McIsaac DI. Association of frailty with outcomes in individuals with COVID-19: A living review and meta-analysis. J Am Geriatr Soc 2021; 69:2419-2429. [PMID: 34048599 PMCID: PMC8242611 DOI: 10.1111/jgs.17299] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
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 planning, but data relating frailty status to patient-reported outcomes are urgently needed to provide a more comprehensive overview of outcomes relevant to older adults.
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Affiliation(s)
| | - Karina E. Branje
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - Emily S. Hladkowicz
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- School of Rehabilitation TherapyQueen's UniversityKingstonCanada
| | - Manoj Lalu
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
| | - Daniel I. McIsaac
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
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21
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Trends in emergency department use by older people during the COVID-19 pandemic. Eur Geriatr Med 2021; 12:1159-1167. [PMID: 34273092 PMCID: PMC8285692 DOI: 10.1007/s41999-021-00536-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023]
Abstract
Aim To examine changing trends in presentation of older people to the emergency department during the COVID-19 pandemic compared to 2018/2019. Findings On average 4 fewer people aged ≥70 years presented to the ED in the first 6 months of the COVID-19 pandemic (March-August 2020). There was a 20% reduction in presentations of stroke and cardiac complaints but a 25% increase in falls/injuries following easing of lockdown restrictions. Message It is imperative that we consider enabling strategies to ensure older people access unscheduled care in a timely manner when necessary. Purpose Reports suggest that many older people deferred seeking healthcare during the COVID-19 pandemic due to fear of contracting COVID-19. The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years. Methods The study site is a 1000-bed university teaching hospital with annual ED new-patient attendance of > 50,000. All ED presentations of patients aged ≥ 70 years from March to August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision. Results There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average, 4 fewer people aged ≥ 70 years presented to the ED per day in 2020. Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned. There was a 20% reduction in patients presenting with stroke and cardiac complaints. In the 3 months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019. Conclusion This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints. Given the possibility of further lockdowns, it is imperative that we consider enabling strategies to ensure older people access unscheduled care in a timely manner when necessary.
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22
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Falandry C, Malapert A, Roche M, Subtil F, Berthiller J, Boin C, Dubreuil J, Ravot C, Bitker L, Abraham P, Collange V, Balança B, Goutte S, Guichon C, Gadea E, Argaud L, Dayde D, Jallades L, Lepape A, Pialat JB, Friggeri A, Thiollière F. Risk factors associated with day-30 mortality in patients over 60 years old admitted in ICU for severe COVID-19: the Senior-COVID-Rea Multicentre Survey protocol. BMJ Open 2021; 11:e044449. [PMID: 34230013 PMCID: PMC8264162 DOI: 10.1136/bmjopen-2020-044449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION With the spread of COVID-19 epidemic, health plans must be adapted continuously. There is an urgent need to define the best care courses of patients with COVID-19, especially in intensive care units (ICUs), according to their individualised benefit/risk ratio. Since older age is associated with poorer short-term and long-term outcomes, prediction models are needed, that may assist clinicians in their ICU admission decision. Senior-COVID-Rea was designed to evaluate, in patients over 60 years old admitted in ICU for severe COVID-19 disease, the impact of age and geriatric and paraclinical parameters on their mortality 30 days after ICU admission. METHODS AND ANALYSIS This is a multicentre survey protocol to be conducted in seven hospitals of the Auvergne-Rhône-Alpes region, France. All patients over 60 years old admitted in ICU for severe COVID-19 infection (or their legally acceptable representative) will be proposed to enter the study and to fill in a questionnaire regarding their functional and nutritional parameters 1 month before COVID-19 infection. Paraclinical parameters at ICU admission will be collected: lymphocytes and neutrophils counts, high-fluorescent lymphoid cells and immature granulocytes percentages (Sysmex data), D-dimers, C-reactive protein, lactate dehydrogenase (LDH), creatinine, CT scan for lung extension rate as well as clinical resuscitation scores, and the delay between the first signs of infection and ICU admission. The primary outcome will be the overall survival at day 30 post-ICU admission. The analysis of factors predicting mortality at day 30 will be carried out using univariate and multivariate logistic regressions. Multivariate logistic regression will consider up to 15 factors.The ambition of this trial, which takes into account the different approaches of geriatric vulnerability, is to define the respective abilities of different operational criteria of frailty to predict patients' outcomes. ETHICS AND DISSEMINATION The study protocol was ethically approved. The results of the primary and secondary objectives will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04422340.
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Affiliation(s)
- Claire Falandry
- Service de Gériatrie, Centre Hospitaliser Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Faculté de Médecine et de Maïeutique Charles Mérieux, Université de Lyon, Oullins, France
| | - Amélie Malapert
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mélanie Roche
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Fabien Subtil
- CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Julien Berthiller
- Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- SREC - PSP - Cellule innovation, Hospices Civils de Lyon, Bron, France
| | | | - Justine Dubreuil
- Plateforme Transversale de Recherche de l'ICHCL - Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Ravot
- Service de Gériatrie, Centre Hospitaliser Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Bitker
- Service de Réanimation Médicale, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France
- CREATIS INSERM 1044 CNRS 5220, Université de Lyon, Lyon, France
| | - Paul Abraham
- Département d'anesthésie-réanimation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Vincent Collange
- Département Anesthésie-réanimation, Medipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Baptiste Balança
- Département d'anesthésie et réanimation neurologique, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, University of Lyon, Lyon, France
| | - Sylvie Goutte
- Service de gériatrie, Hôpital Nord-Ouest, Gleizé, France
| | - Céline Guichon
- Service d'anesthésie - réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Emilie Gadea
- Département de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Laurent Argaud
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service de Médecine Intensive-Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - David Dayde
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Jallades
- Service d'Hématologie biologique - Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alain Lepape
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France
| | - Jean-Baptiste Pialat
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- CREATIS CNRS UMR 5220 INSERM U1206, Université de Lyon, Lyon, France
| | - Arnaud Friggeri
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Thiollière
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Hussien H, Nastasa A, Apetrii M, Nistor I, Petrovic M, Covic A. Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones. BMC Geriatr 2021; 21:389. [PMID: 34176479 PMCID: PMC8236311 DOI: 10.1186/s12877-021-02316-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. CONCLUSION Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.
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Affiliation(s)
- Hani Hussien
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Andra Nastasa
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania.
| | - Mugurel Apetrii
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Ionut Nistor
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Adrian Covic
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
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24
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Simon NR, Jauslin AS, Rueegg M, Twerenbold R, Lampart M, Osswald S, Bassetti S, Tschudin-Sutter S, Siegemund M, Nickel CH, Bingisser R. Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection. J Clin Med 2021; 10:jcm10112472. [PMID: 34199572 PMCID: PMC8199640 DOI: 10.3390/jcm10112472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 12/17/2022] Open
Abstract
Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with suspected COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with suspected COVID-19 presenting to the Emergency Department during the first wave of the pandemic were consecutively enrolled. All patients underwent nasopharyngeal SARS-CoV-2 PCR swab tests. Patients with a Clinical Frailty Scale (CFS) > 4, were considered to be frail. Associations between age, gender, frailty, and COVID-19 status with the composite adverse outcome of 30-day-intensive-care-admission and/or 30-day-mortality were tested. In the 372 patients analysed, the median age was 77 years, 154 (41.4%) were women, 44 (11.8%) were COVID-19-positive, and 125 (33.6%) were frail. The worst outcome was seen in frail COVID-19-patients with six (66.7%) adverse outcomes. Frailty (CFS > 4) and COVID-19-positivity were associated with an adverse outcome after adjustment for age and gender (frailty: OR 5.01, CI 2.56–10.17, p < 0.001; COVID-19: OR 3.47, CI 1.48–7.89, p = 0.003). Frailty was strongly associated with adverse outcomes and outperformed age as a predictor in emergency patients with suspected COVID-19.
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Affiliation(s)
- Noemi R. Simon
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Andrea S. Jauslin
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Maurin Lampart
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Sarah Tschudin-Sutter
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland;
- Department of Clinical Research, University of Basel, C/O University Hospital Basel, 4031 Basel, Switzerland;
| | - Martin Siegemund
- Department of Clinical Research, University of Basel, C/O University Hospital Basel, 4031 Basel, Switzerland;
- Department of Intensive Care, University Hospital Basel, 4031 Basel, Switzerland
| | - Christian H. Nickel
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
- Correspondence: ; Tel.: +41-61-265-58-30
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25
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Kastora S, Kounidas G, Perrott S, Carter B, Hewitt J, Myint PK. Clinical frailty scale as a point of care prognostic indicator of mortality in COVID-19: a systematic review and meta-analysis. EClinicalMedicine 2021; 36:100896. [PMID: 34036252 PMCID: PMC8141355 DOI: 10.1016/j.eclinm.2021.100896] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 has resulted in the largest pandemic experienced since 1918, accounting for over 2 million deaths globally. Frail and older people are at the highest risk of mortality. The main objective of the present research was to quantify the impact of clinical frailty scale (CFS) by increasing severity of frailty and to identify other personal prognostic factors associated with increased mortality from COVID-19. METHODS This study offers a contemporary systematic review and meta-analysis to analyse the stratified mortality risk by increasing CFS sub-categories (1-3, 4-5 and 6-9). Databases searched included EMBASE, MEDLINE, CAB Abstracts, PsychInfo, and Web of Science with end-search restriction the 18th December 2020. Publications identified via MedRevix were followed up on the 23rd March 2021 in peer-reviewed database search, and citations were updated as published. Prospective and retrospective cohort studies which reported the association between CFS and COVID-19 mortality were included. Thirty-four studies were eligible for systematic review and seventeen for meta-analysis, with 81-87% (I2) heterogeneity. FINDINGS All studies [N: 34] included patients from a hospital setting, comprising a total of 18,042 patients with mean age 72.8 (Min: 56; Max: 86). The CFS 4-5 patient group had significantly increased mortality when compared to patients with CFS 1-3 [(RE) OR 1.95 (1.32 (95% CI), 2.87 (95% CI)); I2 81%; p = 0.0008]. Furthermore, CFS 6-9 patient group displayed an even more noticeable mortality increase when compared to patients with CFS 1-3 [(RE) OR 3.09 (2.03, 4.71); I2 87%; p<0.0001]. Generic inverse variance analysis of adjusted hazard ratio among included studies highlighted that CFS (p = 0.0001), male gender (p = 0.0009), National Early Warning Score (p = 0.0001), Ischaemic Heart Disease (IHD) (p = 0.07), Hypertension (HT) (p<0.0001), and Chronic Kidney Disease (CKD) (p = 0.0009) were associated with increased COVID-19 mortality. INTERPRETATION Our findings suggest a differential stratification of CFS scores in the context of COVID-19 infection, in which CFS 1-3 patients may be considered at lower risk, CFS 4-5 at moderate risk, and CFS 6-9 at high risk of mortality regardless of age. Overall, our study not only aims to alert clinicians of the value of CFS scores, but also highlight the multiple dimensions to consider such as age, gender and co-morbidities, even among moderately frail patients in relation to COVID-19 mortality. FUNDING None.
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Affiliation(s)
- Stavroula Kastora
- Medical Sciences & Nutrition, University of Aberdeen School of Medicine, Aberdeen, United Kingdom
| | - Georgios Kounidas
- Medical Sciences & Nutrition, University of Aberdeen School of Medicine, Aberdeen, United Kingdom
| | - Sarah Perrott
- Medical Sciences & Nutrition, University of Aberdeen School of Medicine, Aberdeen, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Phyo Kyaw Myint
- Medical Sciences & Nutrition, University of Aberdeen School of Medicine, Aberdeen, United Kingdom
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Blomaard LC, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Festen J, Barten DG, Borgers AJ, Bos JC, van den Bos F, de Brouwer EJM, van Deudekom FJA, van Dijk SC, Emmelot-Vonk MH, Geels RES, van de Glind EMM, de Groot B, Hempenius L, Kamper AM, Kampschreur LM, de Koning MMM, Labots G, Looman R, Lucke JA, Maas HAAM, Mattace-Raso FUS, el Moussaoui R, van Munster BC, van Nieuwkoop C, Oosterwijk L(BLE, Regtuijt M(EM, Robben SHM, Ruiter R, Salarbaks AM, Schouten HJ, Smit OM, Smits RAL, Spies PE, Vreeswijk R, de Vries OJ, Wijngaarden MA, Wyers CE, Mooijaart SP. Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study. Age Ageing 2021; 50:631-640. [PMID: 33951156 PMCID: PMC7929372 DOI: 10.1093/ageing/afab018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.
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Affiliation(s)
- Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands
| | - Harmke A Polinder-Bos
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Anke J Borgers
- Department of Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - Jeannet C Bos
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Raya E S Geels
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Liesbeth Hempenius
- Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ad M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marre M M de Koning
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Roy Looman
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Leanne (B L E) Oosterwijk
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aisha M Salarbaks
- Department of Geriatrics, Hospital Group Twente, Almelo, the Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Orla M Smit
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Petra E Spies
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Ralph Vreeswijk
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Oscar J de Vries
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Cosco TD, Best J, Davis D, Bryden D, Arkill S, van Oppen J, Riadi I, Wagner KR, Conroy S. What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review. Age Ageing 2021; 50:608-616. [PMID: 33951151 PMCID: PMC7929406 DOI: 10.1093/ageing/afab008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIM The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients. METHODS Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10 September 2020; the search was re-run in Medline up until the 9 December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively. RESULTS A total of 2,286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. In total, 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association. CONCLUSIONS Whilst the majority of studies have shown a positive association between COVID-19-related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness.
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Affiliation(s)
- Theodore D Cosco
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - John Best
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | | | | | | | - James van Oppen
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Indira Riadi
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | | | - Simon Conroy
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
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Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing 2021; 50:617-630. [PMID: 33543243 PMCID: PMC7929433 DOI: 10.1093/ageing/afab026] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. METHODS This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables. RESULTS Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18-49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54-5.02), frailty (CFS 8 versus 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1-3: odds ratio 7.00, CI 5.27-9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. CONCLUSION Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.
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Pei H, Wang Y, Zhang X, Luo W, Zhou C. Association of frailty status with adverse clinical outcomes in patients with COVID-19: protocol for a systematic review and dose-response meta-analysis. BMJ Open 2021; 11:e046980. [PMID: 33941633 PMCID: PMC8098297 DOI: 10.1136/bmjopen-2020-046980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Frailty status has been recognised as an important prognostic factor of adverse clinical outcomes in various clinical settings. Recently, the role of frailty status in adverse clinical outcomes for COVID-19-infected patients has received increasing attention with controversial results. Hence, we will conduct a comprehensive dose-response meta-analysis to quantitatively evaluate the association between frailty status and adverse clinical outcomes in patients with COVID-19. METHODS The researchers will systematically search PubMed, EMBase, Cochrane Library, ISI Knowledge via Web of Science and MedRxiv or BioRxiv databases (from inception until December 2020) to identify all retrospective and prospective cohort studies. All-cause mortality during hospitalisation will be set as the primary outcome. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the comparison between frail versus non-frail categories. Sensitivity analyses will be used to assess the robustness of our results by removing each included study one at a time to obtain and evaluate the remaining overall estimates of all-cause mortality. To conduct a dose-response meta-analysis for the potential linear or restricted cubic spline regression relationship between frailty status and all-cause mortality, studies with three or more categories will be included. ETHICS AND DISSEMINATION In accordance with the Institutional Review Board/Independent Ethics Committee of the First Affiliated Hospital of Baotou Medical College, ethical approval is not an essential element for the systematic review protocol. This meta-analysis will be disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020220226.
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Affiliation(s)
- Hanjun Pei
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Ying Wang
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Xinghui Zhang
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Wenlong Luo
- Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China
| | - Chenghui Zhou
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Andrés-Esteban EM, Quintana-Diaz M, Ramírez-Cervantes KL, Benayas-Peña I, Silva-Obregón A, Magallón-Botaya R, Santolalla-Arnedo I, Juárez-Vela R, Gea-Caballero V. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ 2021; 9:e11260. [PMID: 33954054 PMCID: PMC8051355 DOI: 10.7717/peerj.11260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background The complications from coronavirus disease 2019 (COVID-19) have been the subject of study in diverse scientific reports. However, many aspects that influence the prognosis of the disease are still unknown, such as frailty, which inherently reduces resistance to disease and makes people more vulnerable. This study aimed to explore the complications of COVID-19 in patients admitted to a third-level hospital and to evaluate the relationship between these complications and frailty. Methods An observational, descriptive, prospective study was performed in 2020. A sample of 254 patients from a database of 3,112 patients admitted to a high-level hospital in Madrid, Spain was analyzed. To assess frailty (independent variable) the Clinical Frailty Scale (CFS) was used. The outcome variables were sociodemographic and clinical, which included complications, length of stay, intensive care unit (ICU) admission and prognosis. Results A total of 13.39% of the patients were pre-frail and 17.32% were frail. Frail individuals had a shorter hospital stay, less ICU admission, higher mortality and delirium, with statistical significance. Conclusion Frailty assessment is a crucial approach in patients with COVID-19, given a higher mortality rate has been demonstrated amongst frail patients. The CFS could be a predictor of mortality in COVID-19.
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Affiliation(s)
- Eva María Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Madrid, Spain
| | - Manuel Quintana-Diaz
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Karen Lizzette Ramírez-Cervantes
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Departamento de Prevención, Asociación Española contra el Cáncer, Madrid, Madrid, Spain
| | | | - Alberto Silva-Obregón
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Guadalajara, Spain
| | - Rosa Magallón-Botaya
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zargoza, Aragón, Spain
| | - Ivan Santolalla-Arnedo
- Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Raúl Juárez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe., Adscript center of Universidad de Valencia., Valencia, Valencia, Spain.,Research Group GREIACC, Health Research Institute La Fe., Valencia, Valencia, Spain
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Zhang XM, Jiao J, Cao J, Huo XP, Zhu C, Wu XJ, Xie XH. Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis. BMC Geriatr 2021; 21:186. [PMID: 33731018 PMCID: PMC7968577 DOI: 10.1186/s12877-021-02138-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. Methods Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle–Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed. Results Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44–59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66–2.38) and 2.48 (95% CI: 1.78–3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68–4.07) and 2.09 (95% CI: 1.40–3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52–5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66–2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81–2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region. Conclusion Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02138-5.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China
| | - Xiao-Peng Huo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China
| | - Chen Zhu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China.
| | - Xiao-Hua Xie
- Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518000, China.
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Mak JKL, Kuja-Halkola R, Wang Y, Hägg S, Jylhävä J. Frailty and comorbidity in predicting community COVID-19 mortality in the U.K. Biobank: The effect of sampling. J Am Geriatr Soc 2021; 69:1128-1139. [PMID: 33619733 PMCID: PMC8013405 DOI: 10.1111/jgs.17089] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Frailty has been linked to increased risk of COVID-19 mortality, but evidence is mainly limited to hospitalized older individuals. This study aimed to assess and compare predictive abilities of different frailty and comorbidity measures for COVID-19 mortality in a community sample and COVID-19 inpatients. DESIGN Population-based cohort study. SETTING Community. PARTICIPANTS We analyzed (i) the full sample of 410,199 U.K. Biobank participants in England, aged 49-86 years, and (ii) a subsample of 2812 COVID-19 inpatients with COVID-19 data from March 1 to November 30, 2020. MEASUREMENTS Frailty was defined using the physical frailty phenotype (PFP), frailty index (FI), and Hospital Frailty Risk Score (HFRS), and comorbidity using the Charlson Comorbidity Index (CCI). PFP and FI were available at baseline, whereas HFRS and CCI were assessed both at baseline and concurrently with the start of the pandemic. Inpatient COVID-19 cases were confirmed by PCR and/or hospital records. COVID-19 mortality was ascertained from death registers. RESULTS Overall, 514 individuals died of COVID-19. In the full sample, all frailty and comorbidity measures were associated with higher COVID-19 mortality risk after adjusting for age and sex. However, the associations were stronger for the concurrent versus baseline HFRS and CCI, with odds ratios of 20.40 (95% confidence interval = 16.24-25.63) comparing high (>15) to low (<5) concurrent HFRS risk category and 1.53 (1.48-1.59) per point increase in concurrent CCI. Moreover, only the concurrent HFRS or CCI significantly improved predictive ability of a model including age and sex, yielding areas under the receiver operating characteristic curve (AUC) >0.8. When restricting analyses to COVID-19 inpatients, similar improvement in AUC was not observed. CONCLUSION HFRS and CCI constructed from medical records concurrent with the start of the pandemic can be used in COVID-19 mortality risk stratification at the population level, but they show limited added value in COVID-19 inpatients.
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Affiliation(s)
- Jonathan K L Mak
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yunzhang Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study. LANCET HEALTHY LONGEVITY 2021; 2:e163-e170. [PMID: 33655235 PMCID: PMC7906710 DOI: 10.1016/s2666-7568(21)00006-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background During the COVID-19 pandemic, the scarcity of resources has necessitated triage of critical care for patients with the disease. In patients aged 65 years and older, triage decisions are regularly based on degree of frailty measured by the Clinical Frailty Scale (CFS). However, the CFS could also be useful in patients younger than 65 years. We aimed to examine the association between CFS score and hospital mortality and between CFS score and admission to intensive care in adult patients of all ages with COVID-19 across Europe. Methods This analysis was part of the COVID Medication (COMET) study, an international, multicentre, retrospective observational cohort study in 63 hospitals in 11 countries in Europe. Eligible patients were aged 18 years and older, had been admitted to hospital, and either tested positive by PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or were judged to have a high clinical likelihood of having SARS-CoV-2 infection by the local COVID-19 expert team. CFS was used to assess level of frailty: fit (CFS1–3), mildly frail (CFS4–5), or frail (CFS6–9). The primary outcome was hospital mortality. The secondary outcome was admission to intensive care. Data were analysed using a multivariable binary logistic regression model adjusted for covariates (age, sex, number of drugs prescribed, and type of drug class as a proxy for comorbidities). Findings Between March 30 and July 15, 2020, 2434 patients (median age 68 years [IQR 55–77]; 1480 [61%] men, 954 [30%] women) had CFS scores available and were included in the analyses. In the total sample and in patients aged 65 years and older, frail patients and mildly frail patients had a significantly higher risk of hospital mortality than fit patients (total sample: CFS6–9vs CFS1–3 odds ratio [OR] 2·71 [95% CI 2·04–3·60], p<0·0001 and CFS4–5vs CFS1–3 OR 1·54 [1·16–2·06], p=0·0030; age ≥65 years: CFS6–9vs CFS1–3 OR 2·90 [2·12–3·97], p<0·0001 and CFS4–5vs CFS1–3 OR 1·64 [1·20–2·25], p=0·0020). In patients younger than 65 years, an increased hospital mortality risk was only observed in frail patients (CFS6–9vs CFS1–3 OR 2·22 [1·08–4·57], p=0·030; CFS4–5vs CFS1–3 OR 1·08 [0·48–2·39], p=0·86). Frail patients had a higher incidence of admission to intensive care than fit patients (CFS6–9vs CFS1–3 OR 1·54 [1·21–1·97], p=0·0010), whereas mildly frail patients had a lower incidence than fit patients (CFS4–5vs CFS1–3 OR 0·71 [0·55–0·92], p=0·0090). Among patients younger than 65 years, frail patients had an increased incidence of admission to intensive care (CFS6–9vs CFS1–3 OR 2·96 [1·98–4·43], p<0·0001), whereas mildly frail patients had no significant difference in incidence compared with fit patients (CFS4–5vs CFS1–3 OR 0·93 [0·63–1·38], p=0·72). Among patients aged 65 years and older, frail patients had no significant difference in the incidence of admission to intensive care compared with fit patients (CFS6–9vs CFS1–3 OR 1·27 [0·92–1·75], p=0·14), whereas mildly frail patients had a lower incidence than fit patients (CFS4–5vs CFS1–3 OR 0·66 [0·47–0·93], p=0·018). Interpretation The results of this study suggest that CFS score is a suitable risk marker for hospital mortality in adult patients with COVID-19. However, treatment decisions based on the CFS in patients younger than 65 years should be made with caution. Funding LOEY Foundation.
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Osuafor CN, Davidson C, Mackett AJ, Goujon M, Van Der Poel L, Taylor V, Preller J, Goudie RJB, Keevil VL. Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study. Geriatrics (Basel) 2021; 6:geriatrics6010011. [PMID: 33535520 PMCID: PMC7931067 DOI: 10.3390/geriatrics6010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio (HR), 95% Confidence Interval). Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to nonfrail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs. 20.8%, p < 0.001) and were more likely to die (66% vs. 16%, p = 0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose–response association between frailty and mortality was observed (CFS 1–4: reference; CFS 5–6: HR 1.78, 95% CI 0.90, 3.53; CFS 7–8: HR 2.57, 95% CI 1.26, 5.24). Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission, and diagnosis should prompt early advanced care planning.
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Affiliation(s)
- Christopher N. Osuafor
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-1223-274383
| | - Catriona Davidson
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
| | - Alistair J. Mackett
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
| | - Marie Goujon
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
| | - Lelane Van Der Poel
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
| | - Vince Taylor
- Cancer Research UK, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Jacobus Preller
- Department of Acute Internal Medicine and Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Robert J. B. Goudie
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK;
| | - Victoria L. Keevil
- Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (C.D.); (A.J.M.); (M.G.); (L.V.D.P.); (V.L.K.)
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
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Letter to the Editor: Premorbid Frailty is a better Prognostic Indicator than Age in Oldest-Old Hospitalized with COVID-19. J Am Med Dir Assoc 2021; 22:514-516. [PMID: 33484639 PMCID: PMC7816969 DOI: 10.1016/j.jamda.2021.01.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/14/2023]
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Zazzara MB, Penfold RS, Roberts AL, Lee KA, Dooley H, Sudre CH, Welch C, Bowyer RCE, Visconti A, Mangino M, Freidin MB, El-Sayed Moustafa JS, Small KS, Murray B, Modat M, Graham MS, Wolf J, Ourselin S, Martin FC, Steves CJ, Lochlainn MN. Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age Ageing 2021; 50:40-48. [PMID: 32986799 PMCID: PMC7543251 DOI: 10.1093/ageing/afaa223] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification. OBJECTIVE To assess how frailty affects presenting COVID-19 symptoms in older adults. DESIGN Observational cohort study of hospitalised older patients and self-report data for community-based older adults. SETTING Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application. SUBJECTS Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020. METHODS Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19. RESULTS Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath. CONCLUSIONS This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.
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Affiliation(s)
- Maria Beatrice Zazzara
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
- Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Amy L Roberts
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Karla A Lee
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Hannah Dooley
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King’s College London, SE17EH, London, UK
| | - Carly Welch
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT Birmingham, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Alessia Visconti
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, Guy's and St Thomas' NHS Foundation Trust and King's College London, London SE1 9RT, UK
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Julia S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Kerrin S Small
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King’s College London, SE17EH, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King’s College London, SE17EH, London, UK
| | - Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King’s College London, SE17EH, London, UK
| | | | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King’s College London, SE17EH, London, UK
| | - Finbarr C Martin
- Population Health Sciences, King’s College London, SE17EH London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
| | - Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH, UK
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Fox C, Kilvert A. Triple jeopardy: old age, frailty and diabetes in
COVID
‐19. PRACTICAL DIABETES 2021. [PMCID: PMC8014558 DOI: 10.1002/pdi.2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The COVID‐19 pandemic has turned the lives of people throughout the world upside down and the virus has hit the older population hardest of all. The term ‘triple jeopardy’ has been coined to identify that older people with frailty and diabetes are at particular risk from the virus. Government figures for non‐COVID deaths from March to May 2020 show a 20–50% increase in those >70 years but lack of testing capacity may have led to under‐reporting of the virus. There has undoubtedly been a catastrophe in care homes, with 40% of total COVID‐19 deaths occurring in this setting. Whether frailty poses a greater risk than age alone is uncertain, with observational studies producing conflicting results. NICE guidance to include assessment of frailty in clinical decision making may have introduced study bias. Diabetes adds additional risk, with 33% of all hospital deaths occurring in people with diabetes: hazard ratio 3.51 for type 1 diabetes and 2.03 for type 2. The majority of those who died were >70 years (60.9% type 1 and 79.2% type 2). Poor glycaemic control is associated with increased risk. A 19th century definition of triple jeopardy defined gender, race and poverty as the dominant factors and these remain just as relevant in the COVID‐19 era. The arrival of a second wave highlights the need to introduce measures to protect people with diabetes and those marginalised by society. This includes older people and their carers. Copyright © 2021 John Wiley & Sons.
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Yang Y, Luo K, Jiang Y, Yu Q, Huang X, Wang J, Liu N, Huang P. The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies. J Nutr Health Aging 2021; 25:702-709. [PMID: 33949641 PMCID: PMC7933604 DOI: 10.1007/s12603-021-1611-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. OBJECTIVE We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. DESIGN A systematic review and Meta-analysis of 16 cohort studies. PARTICIPANTS Patients with COVID-19. METHODS A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. RESULTS According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. CONCLUSIONS In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.
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Affiliation(s)
- Y Yang
- Nanhai Liu, Department of neurology, the first affiliated hospital of Gannan medical university,Ganzhou, Jiangxi province, China. ; Pan Huang, College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang province, China.
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Knopp P, Miles A, Webb TE, Mcloughlin BC, Mannan I, Raja N, Wan B, Davis D. Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality. Eur Geriatr Med 2020; 11:1089-1094. [PMID: 32734464 PMCID: PMC7391232 DOI: 10.1007/s41999-020-00373-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/20/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To describe the clinical features of COVID-19 in older adults, and relate these to outcomes. METHODS A cohort study of 217 individuals (median age 80, IQR 74-85 years; 62% men) hospitalised with COVID-19, followed up for all-cause mortality, was conducted. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil:lymphocyte ratio were used as measures of immune activity. RESULTS Cardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge. CONCLUSIONS COVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality.
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Affiliation(s)
- Paul Knopp
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Amy Miles
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Thomas E Webb
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Benjamin C Mcloughlin
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Imran Mannan
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Nadia Raja
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Bettina Wan
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daniel Davis
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, 1-19 Torrington Place, London, WC1E 7HB, UK.
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
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Rawle MJ, Bertfield DL, Brill SE. Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study. Aging Med (Milton) 2020; 3:237-244. [PMID: 33392429 PMCID: PMC7771562 DOI: 10.1002/agm2.12126] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care. METHODS A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. RESULTS Care home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status. CONCLUSION COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.
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Affiliation(s)
- Mark James Rawle
- Department of Geriatric MedicineBarnet HospitalRoyal Free London NHS Foundation TrustLondonUK
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Deborah Lee Bertfield
- Department of Geriatric MedicineBarnet HospitalRoyal Free London NHS Foundation TrustLondonUK
| | - Simon Edward Brill
- Department of Respiratory MedicineBarnet HospitalRoyal Free London NHS Foundation TrustLondonUK
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41
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Sze S, Pan D, Nevill CR, Gray LJ, Martin CA, Nazareth J, Minhas JS, Divall P, Khunti K, Abrams KR, Nellums LB, Pareek M. Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2020; 29:100630. [PMID: 33200120 PMCID: PMC7658622 DOI: 10.1016/j.eclinm.2020.100630] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. METHODS Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654. FINDINGS 18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67-2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24-1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46-2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22-1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34-2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99-1.50]). INTERPRETATION Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.
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Affiliation(s)
- Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Clareece R Nevill
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, United Kingdom
| | - Keith R Abrams
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
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Petermann-Rocha F, Hanlon P, Gray SR, Welsh P, Gill JMR, Foster H, Katikireddi SV, Lyall D, Mackay DF, O'Donnell CA, Sattar N, Nicholl BI, Pell JP, Jani BD, Ho FK, Mair FS, Celis-Morales C. Comparison of two different frailty measurements and risk of hospitalisation or death from COVID-19: findings from UK Biobank. BMC Med 2020; 18:355. [PMID: 33167965 PMCID: PMC7652674 DOI: 10.1186/s12916-020-01822-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frailty has been associated with worse prognosis following COVID-19 infection. While several studies have reported the association between frailty and COVID-19 mortality or length of hospital stay, there have been no community-based studies on the association between frailty and risk of severe infection. Considering that different definitions have been identified to assess frailty, this study aimed to compare the association between frailty and severe COVID-19 infection in UK Biobank using two frailty classifications: the frailty phenotype and the frailty index. METHODS A total of 383,845 UK Biobank participants recruited 2006-2010 in England (211,310 [55.1%] women, baseline age 37-73 years) were included. COVID-19 test data were provided by Public Health England (available up to 28 June 2020). An adapted version of the frailty phenotype derived by Fried et al. was used to define frailty phenotype (robust, pre-frail, or frail). A previously validated frailty index was derived from 49 self-reported questionnaire items related to health, disease and disability, and mental wellbeing (robust, mild frailty, and moderate/severe frailty). Both classifications were derived from baseline data (2006-2010). Poisson regression models with robust standard errors were used to analyse the associations between both frailty classifications and severe COVID-19 infection (resulting in hospital admission or death), adjusted for sociodemographic and lifestyle factors. RESULTS Of UK Biobank participants included, 802 were admitted to hospital with and/or died from COVID19 (323 deaths and 479 hospitalisations). After analyses were adjusted for sociodemographic and lifestyle factors, a higher risk of COVID-19 was observed for pre-frail (risk ratio (RR) 1.47 [95% CI 1.26; 1.71]) and frail (RR 2.66 [95% CI 2.04; 3.47]) individuals compared to those classified as robust using the frailty phenotype. Similar results were observed when the frailty index was used (RR mildly frail 1.46 [95% CI 1.26; 1.71] and RR moderate/severe frailty 2.43 [95% CI 1.91; 3.10]). CONCLUSIONS Frailty was associated with a higher risk of severe COVID-19 infection resulting in hospital admission or death, irrespective of how it was measured and independent of sociodemographic and lifestyle factors. Public health strategies need to consider the additional risk that COVID-19 poses in individuals with frailty, including which additional preventive measures might be required.
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Affiliation(s)
- Fanny Petermann-Rocha
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Jason M R Gill
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hamish Foster
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Donald Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Barbara I Nicholl
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
- Centre of Exercise Physiology Research (CIFE), Universidad Mayor, Santiago, Chile.
- Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile.
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Chong E, Chan M, Tan HN, Lim WS. Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale. Eur Geriatr Med 2020; 12:275-284. [PMID: 33095431 PMCID: PMC7582023 DOI: 10.1007/s41999-020-00418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/08/2020] [Indexed: 12/01/2022]
Abstract
Aims To establish if dependency in basic activities of daily living (bADL) amongst moderately frail older adults predict poorer health outcomes including mortality and institutionalisation. We also examined the utility of subgrouping category 6 of the Clinical Frailty Scale (CFS) by level of functional dependency to improve predictive performance. Findings We observed a wider range in functional dependency among CFS 6 patients when compared to other frail categories. Incorporating CFS 6 subcategories based on bADL functional status increased predictive performance for longitudinal adverse outcomes compared with the original CFS scoring. Message This study corroborates the heterogeneity of bADL functional status in CFS 6 individuals and validates the use of a modified approach to subgrouping the CFS via bADL dependency for improved predictive performance. Electronic supplementary material The online version of this article (10.1007/s41999-020-00418-8) contains supplementary material, which is available to authorized users. Purpose Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined the utility of subgrouping the CFS in predicting mortality and institutionalisation. Methods We prospectively studied 201 hospitalised frail patients (89.5 ± 4.7 years, female 70.1%). We examined Katz Index (KI) against adverse outcomes in CFS6 (n = 106). We then compared predictive performances of a modified CFS version 1 (mCFS-1; category 6A: CFS6 and KI ≥ 2; 6B: CFS6 and KI ≤ 1) and modified CFS version 2 (mCFS-2; category 6A: CFS6 and KI ≥ 2; 6B1: CFS6, KI ≤ 1 and feeding independent; 6B2: CFS6, KI ≤ 1 and feeding dependent) against the CFS. Multivariate analysis was used to compare each tool against mortality and institutionalisation. Receiver operator characteristic analysis was performed to determine area under curve and optimal cut-points for each tool. Results KI ≤ 1 in CFS6 was associated with higher 12-month mortality (39.3% vs. 15.6%, p = 0.01); amongst KI items, feeding dependent predicted 12-month mortality (p < 0.05). Using mCFS-1, category 6A did not increase 12-month mortality compared with category 5 (OR 1.83, 95% CI 0.52–6.47), unlike category 6B (OR 6.33, 95% CI 2.07–19.33). mCFS-2 produced higher mortality in category 6B1 (OR 5.19, 95% CI 1.30–20.69) and 6B2 (OR 6.92, 95% CI 2.14–22.35). Similar observations were seen for institutionalisation. Optimal cut-point for 12-month mortality was category 6 for CFS, and 6B and 6B1 for mCFS-1 and mCFS-2, respectively. Conclusion This study corroborates the heterogeneity of functional status in moderately frail individuals and validates the use of a modified approach to subgrouping the CFS6 via bADL functional status for improved predictive performance. Electronic supplementary material The online version of this article (10.1007/s41999-020-00418-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward Chong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Mark Chan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Huei Nuo Tan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
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de Oliveira RP, Achcar JA, Nunes AA. Modeling the incidence and death rates of COVID-19 pandemic in different regions of the world. ACTA ACUST UNITED AC 2020. [DOI: 10.1515/em-2020-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
This paper reports a broad study using epidemic-related counting data of COVID-19 disease caused by the novel coronavirus (SARS-CoV-2). The considered dataset refers to 119 countries’ daily counts of reported cases and deaths in a fixed period. For the data analysis, it has been adopted a beta regression model assuming different regions of the world where it was possible to discover important economic, health and social factors affecting the behavior of the pandemic in different countries. The Bayesian method was applied to fit the proposed model. Some interesting conclusions were obtained in this study, which could be of great interest to epidemiologists, health authorities, and the general public in the face of the forthcoming hard times of the global pandemic.
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Affiliation(s)
- Ricardo Puziol de Oliveira
- Universidade Estadual de Maringá , Av. Ângelo Moreira da Fonseca, 1800 - Parque Danielle , Umuarama , 87506-370 , Brazil
| | - Jorge Alberto Achcar
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto , Ribeirao Preto , São Paulo , Brazil
| | - Altacílio Aparecido Nunes
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto , Ribeirao Preto , São Paulo , Brazil
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Maltese G, Corsonello A, Di Rosa M, Soraci L, Vitale C, Corica F, Lattanzio F. Frailty and COVID-19: A Systematic Scoping Review. J Clin Med 2020; 9:E2106. [PMID: 32635468 PMCID: PMC7408623 DOI: 10.3390/jcm9072106] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022] Open
Abstract
Older people have paid a huge toll in terms of mortality during the coronavirus disease-19 (COVID-19) pandemic. Frailty may have contributed to the vulnerability of older people to more severe clinical presentation. We aimed at reviewing available evidence about frailty and COVID-19. We searched PUBMED, Web of Science, and EMBASE from 1 December 2019 to 29 May 2020. Study selection and data extraction were performed by three independent reviewers. Qualitative synthesis was conducted and quantitative data extracted when available. Forty papers were included: 13 editorials, 15 recommendations/guidelines, 3 reviews, 1 clinical trial, 6 observational studies, 2 case reports. Editorials and reviews underlined the potential clinical relevance of assessing frailty among older patients with COVID-19. However, frailty was only investigated in regards to its association with overall mortality, hospital contagion, intensive care unit admission rates, and disease phenotypes in the few observational studies retrieved. Specific interventions in relation to frailty or its impact on COVID-19 treatments have not been evaluated yet. Even with such limited evidence, clinical recommendations on the use of frailty tools have been proposed to support decision making about escalation plan. Ongoing initiatives are expected to improve knowledge of COVID-19 interaction with frailty and to promote patient-centered approaches.
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Affiliation(s)
- Giuseppe Maltese
- Department of Diabetes and Endocrinology, Epsom & St Helier University Hospitals, Surrey SM5 1AA, UK;
- Unit for Metabolic Medicine, Cardiovascular Division, Faculty of Life Sciences & Medicine, King’s College, London WC2R 2LS, UK
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics and Unit of Geriatric Medicine, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (L.S.)
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics and Unit of Geriatric Medicine, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (L.S.)
| | - Luca Soraci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics and Unit of Geriatric Medicine, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (L.S.)
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
| | - Cristiana Vitale
- Department of Medical Science, IRCCS San Raffaele Pisana, 00163 Rome, Italy;
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
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