This is a summary, written by members of the CITF Secretariat, of:
Andrew MK, Godin J, LeBlanc J, Boivin G, Valiquette L, McGeer A, McElhaney JE, Hatchette TF, ElSherif M, MacKinnon-Cameron D, Wilson K, Ambrose A, Trottier S, Loeb M, Smith SW, Katz K, McCarthy A, McNeil SA. Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19. Can Geriatr J [Internet]. 2022 Jun. 1 [cited 2022 Jun. 17]; 25(2):183-96. doi: https://doi.org/10.5770/cgj.25.546.
The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.
A recent CITF-funded study published in the Canadian Geriatrics Journal concluded that frailty The paper used the well-validated Clinical Frailty Scale (CFS), which categorizes frailty as follows: 1=very fit, 2=well, 3=managing well, 4=vulnerable/pre-frail, 5=mildly frail, 6=moderately frail, 7=severely frail, 8=very severely frail, 9=end of life. is a critical clinical factor in predicting outcomes of COVID-19 among a group of COVID-19 patients with a median age of 71. Both frailty and older age correlated with higher rates of mortality in this population. The research, conducted by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance Network, and led by Dr. Shelly A. McNeil (Canadian Center for Vaccinology, Halifax) found that older age and frailty were independent predictors of lower ICU use and higher mortality.
- Mortality was generally high for the frail elderly who were hospitalized. Of those not admitted to ICU, 14.3% (226/1,583) died. Of those admitted to ICU, 24.6% (110/448) died. 29.6% (73/247) of those who received mechanical ventilation died.
- The length of hospital stay generally increased with age and frailty.
- Mortality showed a strong correlation with age: 4.5% of those who died were under 65, compared with 28.2% aged 85 or older. The odds of dying increased by 5% with each year of age.
- ICU admission and mechanical ventilation rates were similar in those aged under 65 and those aged 65–74. However, fewer people aged 75 or older were admitted to the ICU or put on mechanical ventilation. Notably, the more frail, the less chance of being admitted to the ICU or put on a mechanical ventilator.
- Individuals with underlying comorbidities experienced more severe outcomes and death than those without. Most patients had at least one underlying comorbidity:
- 8% had a cardiovascular issue
- 2% had a respiratory comorbidity
- 6% were either immunosuppressed or immunocompromised
- 2% were obese.
- The death rates for cardiovascular, respiratory, immunosuppressed, and immunocompromised were 19.8%, 20.1%, 17.4%, and 21.4%, respectively. The mortality rate was 6.5% for those with none of these comorbidities. The mortality rate for obese participants was 15%.
The study involved 2,011 patients with laboratory-confirmed COVID-19, admitted to 11 facilities in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020. Most of the patients were not frail (57.1%), 12.8% were mildly frail, 15.6% moderately frail, and 14.6% were severely frail. The majority (66.7%) were admitted from private dwellings; 21.5% were from assisted living facilities, 8.2% were admitted from long-term care homes, and 2.1% were from homeless shelters. 6.4% had a documented travel history, and 51.2% had a known COVID-19 exposure.