Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study

Abstract

Background The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. Methods Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. Results Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58–81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6–24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1–3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97–4.11); CFS 5, 3.77 (1.94–7.32); CFS 6, 4.04 (2.09–7.82); CFS 7, 2.16 (1.12–4.20); and CFS 8, 3.19 (1.06–9.56). Conclusions Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.

Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis

“…Over half of those previously working had not yet returned to work and did not feel ready to do so, concordant with the increasing care needs seen in a significant amount of patients after discharge in other reports. 20 These findings highlight the importance of holistic assessment and ongoing support following COVID-19 and have led to the inclusion of a clinical psychologist, physiotherapist and occupational therapist within our post-COVID clinic.…”

The degree of frailty as a translational measure of health in aging

“…The mortality data from COVID-19 reflect the known dose-response relationship between the degree of frailty and the risk of death 58 . Similarly, frailty is related to the risk of COVID-19 being severe 89 and to important complications, including incomplete recovery 90 and prolonged hospital stay 85,86 . Frailty can also be more common in people with COVID-19 who develop delirium; mortality is especially high in this setting 84,91 .…”

COVID-19 im Alter – Die geriatrische Perspektive

“…Mehrere Arbeiten belegen, dass es bei älteren Patienten im Rahmen einer COVID-19-Erkrankung in einem relevanten Prozentsatz zu einer Verschlechterung des funktionellen Status und der Fähigkeit zur Selbstversorgung kommt. So war in einer britischen Studie mit mehr als 800 Teilnehmern zum Zeitpunkt der Krankenhausentlassung bei 25 % der Patienten der verstärkte Einsatz ambulanter Hilfen erforderlich [ 69 ]. In diesem Kollektiv erwies sich die CFS als ein zuverlässiger Prädiktor einer zu erwartenden funktionellen Verschlechterung.…”