Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study
Authors:   Geriatric Medicine Research Collaborative, Alsahab Mustafa , Beishon Lucy , Brown Bryony , Burn Elinor , Burton Jenni K , Cox Natalie , Dani Melanie , Elhadi Muhammed , Freshwater Sarah , Gaunt Victoria , Gordon Adam , Goujon Marie , Hale Matthew , Hughes Terry , Jackson Thomas A , Jelley Benjamin , Khan Asma , Khiroya Heena , Lal Rajni , Madden Katy , Magill Laura , Masoli Jane , Masud Tahir , McCluskey Lauren , McNeela Natalie , Mohammedseid-Nurhussien Awolkhier , Moorey Hannah , Lochlainn Mary Ni , Nirantharakumar Krishnarajah , Okoth Kelvin , Osuafor Christopher N , Patterson Katherine , Pearson Grace M E , Perry Rita , Pettitt Michala , Pigott Jennifer , Pinkney Thomas , Quinn Terence , Reynolds Abigail , Richardson Sarah , Sanyal Nik , Seed Adam , Sleeman Isobel , Soo Chee , Steves Claire , Strain W David , Taylor Joanne , Torsney Kelli , Welch Carly , Wilson Daisy , Witham Miles ,   Covid Collaborative, Elazeem Hossam Aldein S Abd , Abdelhafez Mohammed H , Abdelmalak Amir , Abdelwahab Omar A , Abdulhadi Osama M A S , Adewole Olubayode , Ahmad Mohammed , Ahmed Eltayeb A , Ahmed Hazem , Ahmed Islam A , Akcay Mertcan , Akdeniz Yeşim , Akın Emrah , Akladious Carolyn , Alessandri Francesco , Ali Ali , Aljafari Abdulmalek , Aljafari Abdulmoiz , Al-Sadawi Mohammed , Al-Sodani Lobna , Altintoprak Fatih , Amaratungaz Gitanjali , Amer Jocelyn , Amini Sylvia , Amir Taha , Anandarajah Cheran , Anders Rachael , Ansari Muhammed H , Appiah Kingsley , Atia Jolene , Atkin Catherine , Aujayeb Avinash , Awad Elsayed M , Azab Mohammed A , Azam Mohammad T , Aziz Sally , Azzam Ahmed Y , Babar Laxmi , Babb Laura , Badh Manpreet , Baguneid Clare , Bailey Emily , Baili Efstratia , Baldwin Sarah , Baloyiannis Ioannis , Bannerjee Moulinath , Barnard Anna , Barra Fabio , Bashir Hannah , Bawor Monica , Bayhan Zülfü , Beishon Lucy , Belcher James , Belgamwar Ravindra , Bentley Corrina , Birchenough Amy , Bo Yen Nee J , Boden Hayley R , Bouhuwaish Ahmad , Brachini Gioia , Bremner Laura , Bridgwater Hannah , Bryant Catherine , Budd Gabrielle , Budd Sharon , Budzikoski Adam , Bulla Reem , Buondonno Antonio , Buondonno Antonio , Burden Nicole , Burn Elinor , Butt Hejab , Capoglu Recayi , Caracostea Andra , Cardoso Rifa , Carr Alexis , Carrasco-Prats Milagros , Cattel Caterina , Ceccarelli Giancarlo , Cecere Giuseppe , Charalabopoulos Alexandros , Charsley Evelyn , Cheney-Lowe Hannah , Chevallier Theodore , Choudhry Asad J , Ciccarone Flavia , Cicerchia Pierfranco M , Cirillo Bruno , Collins Fatma D , Comerford Victoria , Cordie Ahmed , Coulter Siobhan , Coulthard Nick , Cox Catrin , Cox Victoria , Crowe Andrew , Cullen Jack , Cummings Jean , Cunningham Niamh , Curley Daniel , Currie Hannah , Daly Madeleine , Darley Jay , Dattani Nikhita , Davakis Spyridon , Davies Rowan , De Paola Gilda , De Toma Giorgio , Del Valle-Ruiz Sergio , Deldar Benyamin , Demir Hakan , Desai Arjun , Desai Nirali , Devaney Alice , Dew Lindsey , Dhesi Jugdeep , Dias Maria , Dick Gordon , Doddamani Parveen , Dogra Gurinder , Doll Tina , Dooley Hannah C , Dost Samiullah , Dotchin Catherine , Dowell Hannah , Draghita Ioan M , Dundas James M , Duranti Giulia , Dusara Hiren , Dwivedi Rajesh , Dyer Adam H , Eastaugh Alison , Edwards Elinor , Elghazaly Shrouk M , Elmehrath Ahmed O , Elrick Hope , El-Shazly Mostafa , Emery Alexander , Etchill Eric W , Evans Sarah , Evison Felicity , Fairhead Cassandra , Faulkner Margherita , Felska Agnieszka , Fernandez Antia , Fernández-Fernández Pedro V , Ferraiolo Antonella , Ferrero Simone , Fiori Enrico , Firat Necattin , Fisk Gracie , Fleck Anna , Fonsi Giovanni B , Gabre-Kidan Alodia , Gallo Gaetano , Gandhi Ratnam , Garner Madeleine , Georgiou Nikolaos , Gerretsen Hannah , Ghannam Nourhan A A , Ghobrial Andrew , Ghobrial Hedra , Ghufoor Zaynub , Gibbon Jake , Gilbert Georgia F , Giles Marie , Giménez-Francés Clara , Gonullu Emre , Gray Amy , Gray Joshua H , Green Deirdre , Greene Charlotte , Griffin Ellanna , Griffith Karla , Grubb Anthony , Guan Yue , Guerero Daniel N , Gupta Ayushi , Gustavino Claudio , Guzman Laurenny , Hadreiez Ahmed K M , Hajiioannou Jiannis , Hanji Deevia , Madhavan Deepthy Hari , Harmantepe Tarık , Harrison Patrick , Hart Barbara , Haslam Aidan , Haunton Victoria , Haut Elliott R , Heinsohn Torben , Hennah Lindsay , Hetta Helal F , Hickman Alexander , Hobill Abigail , Hogan Patrick C P , Hogan Vesna , Holmes Elizabeth , Honney Katie , Hood Katharine , Hopkinson Katherine , Howells Lara , Hrouda Nicole , Hunsley Danielle , Hurst William , Hussein Rand A , Ibrahim Mohamed Eltaher A A , Ibtida Ishmam , Ibukunoluwakitan Aina , Ishlek Irem , Iyer Rishi , Jackson Karl , Jackson Rosie , James Ellen , Jarvis Hayley , Jeffs Sophie , Jenko Nathan , Jeyakumar Sasha , Kabir Shahriar , Kainth Harjinder , Kalloo Jason , Kanzaria Akhil , Karapanou Amalia , Kardaman Nuha , Karthikeyan Sandeep , Karunatilleke Anne , Kelly Mairead , Kelly Nicola I , Khalid Hesham , Khan Haris , Khan Muhammad S , King Matthew , Kneen Thomas , Kok Li , Kratochwila Chiara , Kuzeva Aneliya , Lapolla Pierfrancesco , Lau Rebecca , Law Kar Yee , Leadbetter Aimee , Lee Gabriel , Lee Helena , Lee Helena , Levinson Gavriella , Lewis Grace , Liakakos Theodore , Lim Stephen , Lis Danielle , Livesey Emma , López-Morales Pedro , Lowes Lily , Lunt Eleanor , Lyon Emily , Madan Suvira , Majid Zeinab , Malapati Harsha , Man Jade , Mandane Baguiasri , Manning Sarah H , Mantoglu Baris , Martínez-Sanz Nuria , Marx William , Masood Almontacer E B , Maughan Tom , Mawhinney Jamie , Maxfield Dominic , Mayer Jordan , Maynard Henry , McDonald Claire , McGovern Aine , Mclachlan Sophie , Medina-Manuel Esther , Meneghini Simona , Metcalf Michelle , Millwood-Hargrave John , Mingoli Andrea , Miu Kelvin , Mohamed Fawsiya , Mohamed Soha M , Hussein Aliae A R Mohamed , Mohammad Abdulkader , Mohammed Aaliya , Momen Ahmed A , Moomo Farhana , Mora-Guzmán Ismael , Moriarty Lizzie , Morrin Hamilton , Morris Claire , Moss Nicholas , Moustafa Mohamed M , Mpoura Maria , Mubin Mohammed , Muhtaroglu Ali , Muir Georgina , Mulhern Stephanie , Muller Daniel , Murphy Declan C , Muzammil Bushra , Nadkarni Varun , Nageh Mariam Albatoul , NasrEldin Yasmin K , Nawaz Wasim , Nguyen Hanna , Cheallaigh Cliona Ni , Noar Alexander , North Samuel , Nwolu Favour , O’Docherty Alice , Odutola Omoteniola , O’Dwyer Sinead , Ogochukwu Olebu , O’Mahony Catherine , Orlando Lia , Osterdahl Marc , Page Christina , Panayotidis Ismini , Pancholi Shivam , Parkin Jessica , Passby Lauren C , Pastor-Pérez Patricia , Patel Harnish , Patel Shefali , Penfold Rose , Perinpanathan Rupini , Perivoliotis Konstantinos , Perra Teresa , Pinkney Martha , Pinotti Enrico , Porcu Alberto , Price Angeline , Pugliese Francesco , Puri Prabhleen , Pytraczyk Sylvia , Qaiser Yusra , Qurashi Maria , Radenkovic Dina , Rajeswaran Thurkka , Rapaport Sarah F , Razzak Tahmina , Reilly Lara , Reynolds Paul , Richardson Alexandra , Roberts Amelia , Roberts Amelia , Roberts-Rhodes Charlotte , Robinson Tanya , Rocca Aldo , Ross-Skinner Emily , Ruiz-Marín Miguel , Ryall Rebecca , Saad Alshaimaa M , Saad Mahmoud M , Sadiq Ambreen , Sammarco Giuseppe , Sampanis Michail A , Sanghvi Hazel , Sapienza Paolo , Sayers Ross , Scott Luca , Sen Michael , Shaban Mosab A A , Shakespeare Kathleen T , Shaw Ellie , Shaw Hannah , Sheldrake Jonathan , Sim Sing Yang , Simonelli Luigi , Sipsas Nikolaos V , Sivam Jarita , Sivarajan Sri , Smith Jennifer , Speranza Fabio , Spice Claire , Stafford Amanda , Stambollouian Katharine , Stevens Kent A , Stewart Jack , Stratton Emma , Street Hannah , Surtees Michael , Swinnerton Emma , Taher Ahmed S A , Tait Caroline , Taylor Amybel , Thake Miriam , Thin Katie , Thould Hannah , Thyn Thyn , To Benjaman , Tobiss Hannah , Toppley Kathryn , Townsend Liam , Tullo Ellen , Tzovaras George , Umeadi Anthony , Vaidya Hrisheekesh , Valero-Soriano María , Varden Rosanna , Vergani Vittoria , Vervoort Dominique , Vescio Giuseppina , Vettasseri Mark , Virk Madiha , Vyas Vaishali , Wagland Joanne , Wallis Stephanie , Warner Chloe , Watkins Eleanor , Watson Hannah , Webb Rachael , Welsh Sarah H , West Ruth , Whelan Elisha , Whitney Julie , Whitsey Mark , Wilcock Catherine , Wilkinson Iain , Williams David , Williamson Megan , Willott Ruth H , Wimalasundera Mettha , Win Yu Lelt , Winter Laura , Worrall Stephanie , Wright Rebecca , Yeo Natalie , Yeung Eirene , Yigit Merve , Yildiz Yasin A , Yusuf Humza , Zambon Martina , Zaw Hein , Elabedeen Omar Zein , Welch Carly 
Published: January 2021

Abstract

Introduction
Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (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, interquartile range [IQR] 54–83; 55.2% male). The risk of death increased independently with increasing age (&gt;80 versus 18–49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54–5.02), frailty (CFS 8 versus 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1–3: odds ratio 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.

Conclusion
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.