Journal
AGE AND AGEING
Volume 50, Issue 3, Pages 608-616Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ageing/afab008
Keywords
COVID-19; frailty; hospital-related mortality; systematic review; older people
Categories
Funding
- Wellcome Intermediate Clinical Fellowship [WT107467]
- Michael Smith Foundation for Health Research Scholar Award [SCH-2020-0490]
- National Institute for Health Research Doctoral Research Fellowship [NIHR300901]
- National Institutes of Health Research (NIHR) [NIHR300901] Funding Source: National Institutes of Health Research (NIHR)
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This systematic review aimed to investigate the association between frailty and COVID-19 mortality in hospitalized patients. Most studies found a positive association between increasing frailty and higher risk of death, but some studies suggested a need for a more nuanced understanding of the relationship between frailty and outcomes in COVID-19.
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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