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05 February 2021

Frail people with COVID-19 are three times more likely to die, study finds

New research has found very severely frail individuals with COVID-19 are three times more likely to die than those who were not frail, even considering their age.

Old person hands Parkinsons

The clinical observational study, published today in Age and Ageing and supported by the National Institute for Health Research, is the largest international study of its kind to date. Involving 5,711 patients with COVID-19 at 55 hospitals across 12 countries, the study also found that those with severe frailty who survived the virus were seven times more likely to go on to need increased care at home or in care homes.

The Geriatric Medicine Research Collaborative (GeMRC) – the group of experts behind the study - are now calling for improved global public health policy after their research showed that frailty, independently of older age, increases the risk of death from COVID-19.

Frailty is a state where the body becomes more vulnerable to the effects of illness. It is identified by clinicians using a holistic assessment that considers how much support the person needs from others in their daily living before becoming unwell - not just their medical problems, but the person as a whole. The risk of frailty increases as we get older, but it can develop at different ages.

Senior author Dr Carly Welch, clinical research fellow in geriatric medicine at the University of Birmingham’s Institute of Inflammation & Ageing, and Chair and Co-Founder of GeMRC, said: “It was identified very early in the pandemic that older age was a significant risk factor for a higher chance of death with Covid-19. However, not all older people are the same, we all age differently - some people can live well into their 90s without developing frailty, and it can develop even without the presence of other long-term conditions.

GeMRC hopes the research findings will influence public health policy, including advice on shielding and recommendations for prioritisation on vaccination for those with frailty.

We hope that this research will help to enable increased understanding of frailty as occurring separately to age and that frailty can be considered alongside age in policies both in and outside of hospital.

Dr Mary Ni Lochlainn, from the School of Life Course Sciences

She added: “Increased understanding of frailty within the general public will enable improved communication between clinicians, patients, and their relatives or carers, and can be used in thinking about how we ensure that the right treatment is given for all patients in line with their wishes.”

The results also showed that delirium - a state of clouding of the mind and extremely prevalent in patients with COVID-19 – is not itself independently associated with increased risk of mortality.

Meanwhile, the findings also showed an increased likelihood of transition to a higher level of care on discharge from hospital for those COVID-19 patients with increasing age, frailty, delirium, dementia, and mental health problems.

Further research is encouraged to understand what factors affect recovery of physical function and quality of life with COVID-19, and the inclusion of older adults with frailty in such research is paramount.