Frailty as a mortality predictor in older adults with COVID-19: A systematic review and meta-analysis of cohort studies.
Ita Daryanti Saragih, Shailesh Advani, Ice Septriani Saragih and 3 others
PMID 34256158WHAT IT FOUND
Among older adults with confirmed COVID-19, frailty was linked to higher death rates: 44% of frail patients died versus 13% of non-frail patients.
Frailty assessment may help identify higher risk. This is not proof that frailty causes death.
Key findings
01Among older adults with confirmed COVID-19, the pooled prevalence of mortality was 44% in frail patients and 13% in non-frail patients.
02The pooled odds ratio for mortality in frail older adults compared with non-frail older adults was 5.76, with a 95% confidence interval of 3.85 to 8.61.
03The final analysis included 22 studies and 924,520 confirmed COVID-19-positive patients, with follow-up periods ranging from 30 to 105 days.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The evidence comes from observational cohort studies, so frailty may mark risk without proving it caused death. Only 7 studies were analyzed for the pooled mortality prevalence and the impact of frailty on overall mortality. The authors report missing data for some clinical outcomes and no single gold standard for measuring frailty. Frailty cutoffs were not uniform: some studies classified CFS 4 to 9 as frail, while others classified CFS 5 to 9 as frail. The search was limited to English, so relevant studies in other languages may have been missed. Funnel plots showed asymmetry for all outcomes. The authors say this indicates possible publication bias due to small sample size, although Egger's test found a small influence. All included studies lost points for not reporting strategies to address incomplete follow-up.
Declared interests
The research received no specific grant from public, commercial, or not-for-profit sectors, and the authors declared no competing interests.
The easy way to misread this
Do not read the odds ratio of 5.76 as proof that frailty causes death or that reducing frailty will lower mortality. The studies were observational cohorts, and the authors report missing outcome data, varied frailty cutoffs, and possible publication bias.