Introduction Increased mortality has been demonstrated in older adults with 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, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 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. Conclusions 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.

there was widespread failure to address attitudes on delirium within teaching, to evaluate the impact of sessions, to involve patients and the public in teaching and to guarantee exposure to delirium. Future teaching interventions should be directed at attitudinal outcomes, using a synthesis of clinical experience with multidisciplinary interaction and supportive technologies.

BackgroundDementia is an increasingly common condition and all doctors, in both primary and secondary care environments, must be prepared to competently manage patients with this condition. It is unclear whether medical education about dementia is currently fit for purpose. This project surveys and evaluates the nature of teaching and learning about dementia for medical students in the UK.MethodsElectronic questionnaire sent to UK medical schools.Results23/31 medical schools responded. All provided some dementia-specific teaching but this focussed more on knowledge and skills than behaviours and attitudes. Only 80% of schools described formal assessment of dementia-specific learning outcomes. There was a widespread failure to adequately engage the multidisciplinary team, patients and carers in teaching, presenting students with a narrow view of the condition. However, some innovative approaches were also highlighted.ConclusionsAlthough all schools taught about dementia, the deficiencies identified represent a failure to sufficiently equip medical students to care for patients with dementia which, given the prevalence of the condition, does not adequately prepare them for work as doctors. Recommendations for improving undergraduate medical education about dementia are outlined.

Dementia and dementia care present huge and growing challenges, both to individuals and to societies worldwide. In the United Kingdom, the context for the study reported here, recent key policy initiatives have highlighted problems in care provision, noting a lack of appropriate carer guidance, and an overemphasis on strictly biomedical interventions. Communication practices which support agency and empowerment have been identified as areas for particular improvement. A number of communication training and guidance packages are currently available, but these exhibit shortcomings, including a lack of user input and cross-referencing to other communications theory or to relevant empirical evidence ; a lack of individualisation ; and high context-specificity. In general, their uptake and level of application to care is very low. As a response, the study described here developed a new communications intervention characterised by the direct involvement of a broad spectrum of lay and professional stakeholders. This inter-group dialogue produced an agreed free-to-users, user-informed and user-relevant dementia communications toolkit (DEMTEC), which is empirically supported and adaptable to different socio-cultural and care environments. We detail the conceptual background to the toolkit, the inclusive and iterative methodology for its formulation, and how it can be used to help support 'personhood ' and quality of life and to challenge the socially-constructed ' othering ' of people with dementia.