Frailty assessment for COVID-19 follow-up: a prospective cohort study

Abstract

BackgroundThe Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19.ObjectivesTo investigate frailty and the CFS for post-COVID-19 follow-up.MethodsThis prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively.ResultsOf the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2–3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=−0.48, p<0.001) (criterion validity) and with the St George’s Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=−0.25, p<0.001), 6 min walk distance (r=−0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02).ConclusionsThe CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.

Understanding the Post COVID-19 Condition (Long COVID) in Adults and the Expected Burden for Ontario

“…A separate prospective cohort study included 288 COVID-19 survivors aged 50 years or older (71% were hospitalized for acute COVID-19) who presented for follow-up 3 or more months after acute COVID-19. 61 Prior to the development of COVID-19, 6% (n=17) of the cohort were considered frail using a CFS score of ≥4; after COVID-19, 21% (n=60) developed frailty. Additionally, there is a proposed role of "inflammaging" and immunosenescence in the immunopathogenesis of the post COVID-19 condition, and these processes may also increase one's risk of frailty.…”

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

“…Frailty was also associated with poor mental health [ 165 ], poor exercise capacity [ 166 ], reduced quality of life [ 167 ], and sustained symptom of COVID-19 [ 168 ]. Conversely, COVID-19 is reported to increase the risk of frailty [ 169 – 172 ]. In patients with COVID-19 who received treatment in ICU, 74% reported physical symptoms, 26% mental symptoms, and 16% cognitive symptoms in the 1-year follow-up questionnaires [ 170 ].…”

“…In patients with COVID-19 who received treatment in ICU, 74% reported physical symptoms, 26% mental symptoms, and 16% cognitive symptoms in the 1-year follow-up questionnaires [ 170 ]. The CFS significantly increased from baseline at a follow-up period after discharge in patients with COVID-19 [ 169 , 171 ]. In nursing home residents, COVID-19-infected residents had a greater decline in handgrip, walking speed, and a greater increase in Frail-NH scores compared with uninfected control [ 172 ].…”

Functional decline, long term symptoms and course of frailty at 3-months follow-up in COVID-19 older survivors, a prospective observational cohort study

“…In this context, we could therefore infer that severe COVID-19 disease may theoretically index worse functional decline in frail older patients. Furthermore, if older survivors experienced functional decline or developed long-COVID symptoms, they may also be at high risk for increasing frailty [ 23 ]. Indeed, frailty is common among survivors of critical illness, either newly acquired or worsened frailty [ 24 ].…”