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Multicenter Study
. 2024 Aug;15(4):951-959.
doi: 10.1007/s41999-024-01001-1. Epub 2024 Jun 7.

Preparing for future pandemics: frailty associates with mortality in hospitalised older people during the entire COVID-19 pandemic, a Dutch multicentre cohort study

Bas F M van Raaij  1   2 , Raymond Noordam  3 , Rosalinde A L Smits  3   4 , Veerle M G T H van der Klei  3   4 , Steffy W M Jansen  5 , Carolien M J van der Linden  5 , Harmke A Polinder-Bos  6 , Julia Minnema  6 , Lisanne Tap  6 , Jessica M van der Bol  7 , Esther M M van de Glind  8 , Hanna C Willems  9 , Floor J A van Deudekom  10 , Rikje Ruiter  11 , Barbara C van Munster  12 , Sarah H M Robben  13 , Henrike J Schouten  14 , Dennis G Barten  15 , Jacinta A Lucke  16 , Geeske Peeters  17 , Stella Trompet  3   4 , Yvonne M Drewes  3   4 , Frederiek van den Bos  3   4 , Jacobijn Gussekloo  3   4   18 , Simon P Mooijaart  3   4 ; COOP study group
Collaborators, Affiliations
Multicenter Study

Preparing for future pandemics: frailty associates with mortality in hospitalised older people during the entire COVID-19 pandemic, a Dutch multicentre cohort study

Bas F M van Raaij et al. Eur Geriatr Med. 2024 Aug.

Abstract

Purpose: Viral mutations and improved prevention or treatment options may have changed the association of frailty with mortality throughout the COVID-19 pandemic. We investigated how associations of frailty with in-hospital mortality changed throughout the pandemic in older people hospitalised for COVID-19.

Methods: The COVID-OLD study included COVID-19 patients aged ≥ 70 years hospitalised during the first (early 2020), second (late 2020), third (late 2021) or fourth wave (early 2022). Based on the clinical frailty scale, patients were categorised as fit (1-3), pre-frail (4-5) or frail (6-9). Associations of frailty with in-hospital mortality were assessed with pairwise comparisons with fit as reference category and modelled using binary logistic regression adjusted for age and sex.

Results: This study included 2362 patients (mean age 79.7 years, 60% men). In the first wave, in-hospital mortality was 46% in patients with frailty and 27% in fit patients. In-hospital mortality decreased in each subsequent wave to 25% in patients with frailty and 11% in fit patients in the fourth wave. After adjustments, an overall higher risk of in-hospital mortality was found in frail (OR 2.26, 95% CI: 1.66-3.07) and pre-frail (OR 1.73, 95% CI: 1.27-2.35) patients compared to fit patients, which did not change over time (p for interaction = 0.74).

Conclusions: Frailty remained associated with a higher risk of in-hospital mortality throughout the entire COVID-19 pandemic, although overall in-hospital mortality rates decreased. Frailty therefore remains a relevant risk factor in all stages of a pandemic and is important to consider in prevention and treatment guidelines for future pandemics.

Keywords: COVID-19; Frailty; In-hospital mortality.

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Conflict of interest statement

The authors have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of hospital admissions for COVID-19 of older people (70 years and older) in the Netherlands in relation to inclusions of the COVID-OLD study and important events
Fig. 2
Fig. 2
Flowchart of the COVID-OLD study. Number of participating hospitals in the different waves: 19 first wave, 10 second wave, 5 third wave and 4 fourth wave
Fig. 3
Fig. 3
The association of frailty with in-hospital mortality stratified by COVID-19 wave. Comparisons with fit patients: *p value < 0.05, **p value < 0.001
Fig. 4
Fig. 4
Multivariable adjusted associations of frailty with in-hospital mortality and discharge location. 95% CI = 95% confidence interval. Variables included in both models were: age, sex, clinical frailty scale, wave and clinical frailty scale*wave (interaction term)
See this image and copyright information in PMC

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