Older patients with Covid-19 who are frail have a higher risk of dying during hospitalization than less frail patients. This is shown by international research by Erasmus MC and Amphia Hospital, published in The Lancet Healthy Longevity.
The survey was conducted among nearly 2,500 hospitalized adults in 11 European countries. The vulnerability of these patients was investigated using the Clinical Frailty Scale (CFS) known in the medical world. Vulnerability in the elderly is a process of accumulating physical, psychological and / or social deficits in functioning that increases the likelihood of negative health outcomes. The CFS measures how the patient functioned up to two weeks prior to hospitalization and is given a score that can range from fit, through frail to terminally ill. To determine the score, physical, functional and psychological problems are considered, among other things. The researchers found that the higher Covid patients scored on the Clinical Frailty Scale, the less likely they were to survive hospitalization. Patients with high vulnerability also ended up in IC more often. “We saw that in all age groups in our research. However, the CFS scale has only been validated as a measuring instrument for people over 65 years of age. Therefore, it is only for this group that we can now say with certainty that their vulnerability determines their chances of survival”, says Jorie Versmissen, internist-clinical pharmacologist at Erasmus MC. The research results are relevant in the context of the discussion about the scenario for "Code Black". Code Black takes effect when there are too few IC beds available for the number of patients who need a bed. Then choices have to be made as to who is or is not eligible for IC care. “Age triage in combination with frailty can help caregivers to make a careful and meaningful decision about IC admission. This study thus substantiates the guidelines set out in the national script for "Code black", says Miriam Faes, clinical geriatrician at Amphia Hospital.
Info: 'Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study', 9 February 2021. Authors: Roos S G Sablerolles, Melvin Lafeber, Janneke A L van Kempen, Bob P A van de Loo, Eric Boersma, Wim J R Rietdijk, Harmke A Polinder-Bos, Simon P Mooijaart, Hugo van der Kuy, Jorie Versmissen, Miriam C Faes.