TY - JOUR
T1 - Increased care at discharge from COVID-19
T2 - The association between pre-admission frailty and increased care needs after hospital discharge; a multicentre European observational cohort study
AU - on behalf of the COPE Study
AU - Vilches-Moraga, A.
AU - Price, A.
AU - Braude, P.
AU - Pearce, L.
AU - Short, R.
AU - Verduri, A.
AU - Stechman, M.
AU - Collins, J. T.
AU - Mitchell, E.
AU - Einarsson, A. G.
AU - Moug, S. J.
AU - Quinn, T. J.
AU - Stubbs, B.
AU - McCarthy, K.
AU - Myint, P. K.
AU - Hewitt, J.
AU - Carter, B.
AU - Davey, Charlotte
AU - Jones, Sheila
AU - Lunstone, Kiah
AU - Cavenagh, Alice
AU - Evans, Louis
AU - Silver, Charlotte
AU - Telford, Thomas
AU - Simmons, Rebecca
AU - Mutasem, Tarik El Jichi
AU - Singh, Sandeep
AU - Paxton, Dolcie
AU - Harris, Will
AU - Galbraith, Norman
AU - Bhatti, Emma
AU - Edwards, Jenny
AU - Duffy, Siobhan
AU - Kelly, Joanna
AU - Murphy, Caroline
AU - Bisset, Carly
AU - Alexander, Ross
AU - Garcia, Madeline
AU - Sangani, Shefali
AU - Kneen, Thomas
AU - Lee, Thomas
AU - Kyriakopoulos, George
AU - Thomas, Michael
AU - Tan, Denise
AU - Clini, Enrico
AU - Bruce, Eilidh
AU - Rickard, Frances
AU - Balow-Pay, Fenella
AU - Hesford, James
AU - Holloway, Mark
PY - 2020/12
Y1 - 2020/12
N2 - Background: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. Methods: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. Results: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58–81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6–24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1–3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97–4.11); CFS 5, 3.77 (1.94–7.32); CFS 6, 4.04 (2.09–7.82); CFS 7, 2.16 (1.12–4.20); and CFS 8, 3.19 (1.06–9.56). Conclusions: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
AB - Background: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. Methods: Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. Results: Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58–81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6–24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1–3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97–4.11); CFS 5, 3.77 (1.94–7.32); CFS 6, 4.04 (2.09–7.82); CFS 7, 2.16 (1.12–4.20); and CFS 8, 3.19 (1.06–9.56). Conclusions: Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
KW - Care need
KW - Clinical frailty scale
KW - COVID-19
KW - Discharge destination
KW - Frailty
KW - Increased care need
KW - Older people
UR - http://www.scopus.com/inward/record.url?scp=85097752804&partnerID=8YFLogxK
U2 - 10.1186/s12916-020-01856-8
DO - 10.1186/s12916-020-01856-8
M3 - Article
AN - SCOPUS:85097752804
SN - 1741-7015
VL - 18
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 408
ER -