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Increased care at discharge from COVID-19: The association between pre-admission frailty and increased care needs after hospital discharge; a multi-centre, European observational cohort study.

Research output: Contribution to journalArticlepeer-review

A Vilches, Angeline Price, Philip Braude, Roxanna Short, Alessia Verduri, Michael Stechman, Jemima T. Collins, Emma Mitchell, Alice Einarsson, Susan J Moug, Terry J. Quinn, Brendon Stubbs, Kathryn McCarthy, Phyo K Myint, Jonathan Hewitt, Ben Carter

Original languageEnglish
JournalBMC Medicine
Accepted/In press17 Nov 2020

King's Authors

Abstract

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 preadmission 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 27th February and 10th 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, comorbidities, and admission CRP as a marker of severity of disease.

Results:
Thirteen hospitals included patients, 1671 patients were screened, 840 were excluded including 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, 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%) 19 had frailty (≥CFS 5), 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 CFS 4: 22 1.99 (0.97-4.11), CFS 5: 3.77 (1.94-4.11), CFS 6: 4.04 (2.09-7.82), CFS 7: 2.16 (1.12-4.20), 23 and CFS 8: 3.19 (1.06-9.56).

Conclusions:
Many 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 needs at discharge. Our results have implications for service planning and public health policy suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.

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