The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

Ma, Yao; Hou, Lisha; Yang, Xiaobin; Huang, Zhixin; Yang, Xue; Zhao, Na; He, Min; Shi, Yixin; Kang, Yan; Yue, Jirong; Wu, Chenkai

doi:10.1186/s12916-020-01761-0

Cited by 74 publications

(73 citation statements)

References 42 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We observed no deaths in patients under 56 years of age, although overall numbers in this group were relatively small (56 out of 316 (18%)). Furthermore, the association between death and frailty observed in our cohort has also been consistently reported in other studies across a range of international healthcare systems [22][23][24]. We also examined the influence of ethnicity, finding no evidence of an association.…”

Section: Discussionsupporting

confidence: 84%

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

et al. 2021

View full text Add to dashboard Cite

Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is limited granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on management and outcome. We performed a retrospective single-centre analysis of clinical management and 28-day outcomes of consecutive adult inpatients with SARS-CoV-2 PCR-confirmed COVID-19 from 31 January to 16 April 2020 inclusive. In total, 316 cases were identified. Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Mortality was 84 out of 316 (26.6%). Most deaths occurred in patients in whom a ceiling of inpatient treatment had been determined and for whom end of life care and specialist palliative care input was provided where appropriate. No deaths occurred in patients aged under 56 years. Decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities. In total, 59 (18%) patients were admitted to intensive care, of which 31 (10% overall cohort) required intubation. Multiple logistic regression identified associations between death and age, frailty, and disease severity, with age as the most significant factor (odds ratio 1.07 [95% CI 1.03–1.10] per year increase, p < 0.001). These findings provide important clinical context to outcome data. Mortality was associated with increasing age. Most deaths were anticipated and occurred in patients with advance decisions on ceilings of treatment.

show abstract

Section: Discussionsupporting

confidence: 84%

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…First, substantial uncertainties remain regarding epidemiological characteristics of COVID-19. It is well established that various COVID-19 outcomes vary with age, comorbidity, and frailty [76][77][78], but quantitative descriptions of these associations are incomplete, and it was not possible to reliably integrate such individual-level variation into our model. For instance, owing to individual-level risk factors, higher rates of symptomatic infection may be expected among LTCF residents than staff.…”

Section: Discussionmentioning

confidence: 99%

Optimizing COVID-19 surveillance in long-term care facilities: a modelling study

Duval

Pouwels

et al. 2020

BMC Med

View full text Add to dashboard Cite

Background Long-term care facilities (LTCFs) are vulnerable to outbreaks of coronavirus disease 2019 (COVID-19). Timely epidemiological surveillance is essential for outbreak response, but is complicated by a high proportion of silent (non-symptomatic) infections and limited testing resources. Methods We used a stochastic, individual-based model to simulate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along detailed inter-individual contact networks describing patient-staff interactions in a real LTCF setting. We simulated distribution of nasopharyngeal swabs and reverse transcriptase polymerase chain reaction (RT-PCR) tests using clinical and demographic indications and evaluated the efficacy and resource-efficiency of a range of surveillance strategies, including group testing (sample pooling) and testing cascades, which couple (i) testing for multiple indications (symptoms, admission) with (ii) random daily testing. Results In the baseline scenario, randomly introducing a silent SARS-CoV-2 infection into a 170-bed LTCF led to large outbreaks, with a cumulative 86 (95% uncertainty interval 6–224) infections after 3 weeks of unmitigated transmission. Efficacy of symptom-based screening was limited by lags to symptom onset and silent asymptomatic and pre-symptomatic transmission. Across scenarios, testing upon admission detected just 34–66% of patients infected upon LTCF entry, and also missed potential introductions from staff. Random daily testing was more effective when targeting patients than staff, but was overall an inefficient use of limited resources. At high testing capacity (> 10 tests/100 beds/day), cascades were most effective, with a 19–36% probability of detecting outbreaks prior to any nosocomial transmission, and 26–46% prior to first onset of COVID-19 symptoms. Conversely, at low capacity (< 2 tests/100 beds/day), group testing strategies detected outbreaks earliest. Pooling randomly selected patients in a daily group test was most likely to detect outbreaks prior to first symptom onset (16–27%), while pooling patients and staff expressing any COVID-like symptoms was the most efficient means to improve surveillance given resource limitations, compared to the reference requiring only 6–9 additional tests and 11–28 additional swabs to detect outbreaks 1–6 days earlier, prior to an additional 11–22 infections. Conclusions COVID-19 surveillance is challenged by delayed or absent clinical symptoms and imperfect diagnostic sensitivity of standard RT-PCR tests. In our analysis, group testing was the most effective and efficient COVID-19 surveillance strategy for resource-limited LTCFs. Testing cascades were even more effective given ample testing resources. Increasing testing capacity and updating surveillance protocols accordingly could facilitate earlier detection of emerging outbreaks, informing a need for urgent intervention in settings with ongoing nosocomial transmission.

show abstract

“…The Long Term Effects of Older persons who underwent lockdown with the COVID-19 pandemic are likely to have decreased their exercise and developed sarcopenia. During this period health professionals and public health professionals failed to increase public awareness to reduce the development of sarcopenia and frailty (11)(12)(13). The marked increase in inflammatory cytokines in COVID-19 leads to an acceleration of muscle destruction and cachexia (14).…”

Section: Figurementioning

confidence: 99%

COVID-19 — The Long Road to Recovery

Morley

2020

J Nutr Health Aging

View full text Add to dashboard Cite

Seems like it's been a long journey in the past two months of recovery. I'm making progress and starting to walk independently with a cane. A little at a time but getting there."-Carol Todecheene COVID-19 is a pandemic viral disease that has spread throughout the world in 2020 (1, 2). Nearly half of the persons with COVID-19 are asymptomatic. Older persons, persons with comorbidity and diabetes mellitus are particularly at risk of developing COVID-19. Severe cases of COVID-19 cause a viral pneumonia. In addition, COVID-19 can affect almost any organ in the body, as it enters cells through the angiotensin converting enzyme (ACE) 2 receptor (3). A subset of persons with COVID-19 appear to have a prolonged recovery period. This has been termed "long Covid" (4). The concept of a viral disease leading to a post viral syndrome usually with chronic fatigue, is well recognized (5). In one study where patients were followed after having one of three viral diseases (Epstein Barr virus, Coxiella burnetti or Ross fever virus), 12% were found to have a specific syndrome for 6 or more months. Acute recurrences of the illness occurred in the first 3 months and chronic fluctuating symptoms included fatigue, cognitive disturbances, dysphoria, anxiety and pains in the muscles. This syndrome has also been termed myalgic encephalomyelitis (6). After having had COVID-19, the Boston Red Sox pitcher, Eduardo Rodriguez was fatigued when throwing the ball and an MRI showed that he had myocarditis that will prevent him from pitching this year. There is now good evidence that the corona virus can invade myocardial cells and cause destruction of heart muscle (7). As is shown in Figure 1, myocarditis is not the only long-term side effect of COVID-19. These symptoms of "long Covid" include: fatigue, cough, dyspnea, loss of taste and smell, muscle weakness, muscle and joint pain, headache, confusion, conjunctivitis, chest pain, decreased mobility and falls (8, 9). It is important to recognize that persons who have severe pneumonia due to COVID-19 might take 6 months or longer to return their breathing to normal and that this is associated with decreased mobility. Elevated D-dimer levels are prognostic of poor lung function at 3 months (10).

show abstract

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

Cited by 74 publications

References 42 publications

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis

Optimizing COVID-19 surveillance in long-term care facilities: a modelling study

COVID-19 — The Long Road to Recovery

Contact Info

Product

Resources

About