https://doi.org/10.4081/gc.2021.9635
Frailty and risk of mortality and hospitalization in nursing home residents affected by COVID-19
Submitted: 24 January 2021
Accepted: 17 February 2021
Published: 23 February 2021
Accepted: 17 February 2021
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Coronavirus disease 2019 (COVID-19) is a widespread condition in nursing homes (NHs). However, no research was made regarding frailty in NH residents during COVID-19 pandemic. The aim of this study was to assess whether frailty, assessed by the multidimensional prognostic index (MPI), can predict mortality/hospitalization in COVID-19 NH residents. A Cox’s regression analysis was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). 1146 NH residents affected by COVID-19 were included (mean age: 86 years; 75.4% females). During the followup period, we observed 286 deaths and 239 hospitalizations. Taking those with MPI <0.41 as reference, an MPI ≥0.50 was associated with a higher risk of death (HR=1.41; 95%CI: 1.07-1.85). Similar results were obtained using the MPI score increase in 0.10 points (HR=1.12; 95%CI: 1.03-1.23). Using hospitalization as outcome, only MPI score as continuous variable was associated with this outcome (HR=1.08; 95%CI: 1.002-1.17). In conclusion, frailty, as assessed by the MPI, was associated with a significant higher risk of mortality and hospitalization in NH residents affected by COVID-19 further indicating the necessity of assessing frailty in NH.
World Health Organization (WHO). Coronavirus disease 2019 (COVID-19): situation report, 45; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Last accessed: 24 January 2021
Lloyd-Sherlock PG, Kalache A, McKee M, et al. WHO must prioritise the needs of older people in its response to the covid-19 pandemic. BMJ 2020;368.
DOI: https://doi.org/10.1136/bmj.m1164
McMichael TM, Currie DW, Clark S, et al. Epidemiology of covid-19 in a long-term care facility in King County, Washington. N Engl J Med 2020 [Epub ahead of print].
Burton JK, Bayne G, Evans C, et al. Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK. Lancet Healt Longev 2020;1:e21-e31.
DOI: https://doi.org/10.1016/S2666-7568(20)30012-X
Trabucchi M, De Leo D. Nursing homes or besieged castles: COVID-19 in northern Italy. Lancet Psychiat 2020;7:387-8.
DOI: https://doi.org/10.1016/S2215-0366(20)30149-8
Pitkälä KH. COVID-19 has hit nursing homes hard. Berlin: Springer; 2020.
DOI: https://doi.org/10.1007/s41999-020-00411-1
Tjia J, Rothman MR, Kiely DK, et al. Daily medication use in nursing home residents with advanced dementia. J Am Geriatr Soc 2010;58:880-8.
DOI: https://doi.org/10.1111/j.1532-5415.2010.02819.x
Weinberger DM, Chen J, Cohen T, et al. Estimation of excess deaths associated with the COVID-19 pandemic in the United States, March to May 2020. JAMA Int Med 2020;180:1336-44.
DOI: https://doi.org/10.1001/jamainternmed.2020.3391
Team EE. Updated rapid risk assessment from ECDC on the novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK. Eurosurveill 2020;25(10).
DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.10.2003121
Pilotto A, Veronese N, Daragjati J, et al. Using the multidimensional prognostic index to predict clinical outcomes of hospitalized older persons: a prospective, multicenter, international study. J Gerontol Ser A Biol Sci Med Sci 2019;74:1643-9.
DOI: https://doi.org/10.1093/gerona/gly239
Pilotto A, Custodero C, Maggi S, et al. A multidimensional approach to frailty in older people. Ageing Res Rev 2020;60:101047.
DOI: https://doi.org/10.1016/j.arr.2020.101047
Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuv Res 2008;11:151-61.
DOI: https://doi.org/10.1089/rej.2007.0569
Pilotto A, Gallina P, Fontana A, et al. Development and validation of a multidimensional prognostic index for mortality based on a standardized multidimensional assessment schedule (MPI-SVaMA) in community-dwelling older subjects. J Am Med Direct Assoc 2013;14:287-92.
DOI: https://doi.org/10.1016/j.jamda.2013.01.005
Hewitt J, Carter B, Vilches-Moraga A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre. European, observational cohort study. Lancet Publ Health 2020 [Epub ahead of print].
Bellelli G, Rebora P, Valsecchi MG, et al. Frailty index predicts poor outcome in COVID-19 patients. Intens Care Med 2020:1 [Epub ahead of print].
DOI: https://doi.org/10.1007/s00134-020-06087-2
De Smet R, Mellaerts B, Vandewinckele H, et al. Frailty and mortality in hospitalized older adults with COVID-19: retrospective observational study. J Am Med Direct Assoc 2020 [Epub ahead of print].
DOI: https://doi.org/10.1016/j.jamda.2020.06.008
Gregersen M, Hansen TK, Jørgensen BB, Damsgaard EM. Frailty is associated with hospital readmission in geriatric patients: a prognostic study. Eur Geriatr Med 2020;11:783-92.
DOI: https://doi.org/10.1007/s41999-020-00335-w
Barnett ML, Grabowski DC, eds. Nursing homes are ground zero for COVID-19 pandemic. JAMA Health Forum - American Medical Association; 2020.
DOI: https://doi.org/10.1001/jamahealthforum.2020.0369
Veronese N, Sbrogiò LG, Valle R, et al. Prognostic value of lung ultrasound in older nursing home residents affected by COVID-19. J Am Med Direct Assoc 2020 [Epub ahead of print].
DOI: https://doi.org/10.1016/j.jamda.2020.07.034
Gallina P, Saugo M, Antoniazzi M, et al. Validazione della scheda per la valutazione multidimensionale dell'anziano (SVAMA). Tendenze Nuove 2006;6:229-64.
Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Ame Geriatr Soc 1975;23:433-41.
DOI: https://doi.org/10.1111/j.1532-5415.1975.tb00927.x
Bliss MR, McLaren R, Exton-Smith AN. Mattresses for preventing pressure sores in geriatric patients. Monthly Bull Ministry Health Public Health Lab Serv 1966;25:238.
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland State Med J 1965;14: 61-65.
Ciampi A. Constructing prediction trees from data: the RECPAM approach. Computational aspects of model choice. Berlin: Springer; 1993. pp 105-52.
DOI: https://doi.org/10.1007/978-3-642-99766-2_5
McMichael TM, Currie DW, Clark S, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med 2020;382:2005-11.
DOI: https://doi.org/10.1056/NEJMoa2005412
Chase J. Caring for frail older adults during COVID‐19: integrating public health ethics into clinical practice. J Am Geriatr Soc 2020 [Epub ahead of print].
DOI: https://doi.org/10.1111/jgs.16666
Werner RM, Hoffman AK, Coe NB. Long-term care policy after Covid-19 - Solving the nursing home crisis. N Engl J Med 2020 [Epub ahead of print].
DOI: https://doi.org/10.1056/NEJMp2014811
Ouslander JG, Weinberg AD, Phillips V. Inappropriate hospitalization of nursing facility residents: a symptom of a sick system of care for frail older people. New York, NY: Wiley Online Library; 2000.
DOI: https://doi.org/10.1111/j.1532-5415.2000.tb03919.x
Cenderello G, Dini S, Ziliani S, et al. COVID-19 treatment in the older people: a brief clinical review. Geriatric Care 2020;6:9330.
DOI: https://doi.org/10.4081/gc.2020.9330
How to Cite
Veronese, N., Stangherlin, V., Mantoan, P., Chiavalin, M., Tudor, F., & Pozzobon, G. (2021). Frailty and risk of mortality and hospitalization in nursing home residents affected by COVID-19. Geriatric Care, 7(1). https://doi.org/10.4081/gc.2021.9635
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