Being a frail older person at the time of the COVID-19 pandemic

Abstract

Background: During the COVID-19 pandemic, frail older individuals have been identified as a particularly vulnerable group for poor health outcomes, including cognitive decline and dementia. We aimed to reflect on the interaction between frailty and COVID-19 with regards to health consequences.

Method: Using a rapid literature review approach, we aimed to identify what it means to be a frail older individual in the COVID-19 pandemic from the perspective of three different settings: community, hospitals, and nursing homes. Four researchers from 4 countries (Ireland, France, Germany, and Brazil) reviewed articles from the MEDLINE database and grey literature including public policy briefs from their countries.

Results: In the community, some governments advised to practice "cocooning", i.e. stay-at-home-orders for older individuals. This brought unprecedented restrictions to lifestyles, leading to a potential frailty cascade among older adults. Social frailty likely caused mental ill-health, cognitive and functional decline, increasing the risk for dementia. In hospitals, frailty affected from disease onset to survivorship. The clinical presentation was rather atypical, and the biological findings were more heterogenous. Some resource allocation strategies based on the Clinical Frailty Scale remained questionable and should take into account patients' and carers' needs. A quarter of patients had increased care needs at discharge. However, availability of rehabilitation and support services in the community has been reduced. Frail older adults living in nursing homes were the most vulnerable group. Isolating residents and limiting the spread of COVID-19 was a key difficulty. Reduced visits from relatives, cancelled physical activities, and lack of social engagement worsened cognitive, behavioral, and physical conditions of the residents. There were also positive aspects such as the boom of digital literacy and telemedicine and a renewed debate on age and ageing.

Conclusions: The COVID-19 pandemic spotlights the ageing population that is rapidly growing worldwide. Prolonged lifestyle restrictions during the pandemic led to poor health outcomes in frail older individuals, including cognitive decline and dementia. Lessons learned from how frail older individuals are getting through the pandemic provide a unique chance to improve health outcomes, community and health services and how we want to live as ageing societies.