Association of Frailty With Mortality in Older Inpatients With Covid-19

A Cohort Study

Darren Aw; Lauren Woodrow; Giulia Ogliari; Rowan Harwood


Age Ageing. 2020;49(6):915-922. 

In This Article

Abstract and Introduction


Background: COVID-19 has disproportionately affected older people.

Objective: The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19.

Design: Cohort study.

Setting: Secondary care acute hospital.

Participants: Participants included are 677 consecutive inpatients aged 65 years and over.

Methods: Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity.

Results: Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1–3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34–3.38) and those with CFS 7–9 had a 1.79-fold (95% CI 1.12–2.88) increased mortality risk, compared to those with CFS 1–3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk.

Conclusions: Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.


Older age, underlying co-morbidities (such as chronic lung disease, hypertension, diabetes, ischaemic heart disease and obesity), social deprivation and ethnicity have been associated with worse outcomes from COVID-19.[1–8]

Frailty is defined as the propensity to deteriorate in the face of a stressor. It reflects homeostatic reserve and physiological resilience or 'biological age'. It is increasingly used to stratify clinical populations to reflect differing prognosis and clinical needs, in particular the need for an approach based on comprehensive geriatric assessment.

A specific, specialist, pathway for the assessment and management of frail older patients has been established in our Emergency Department since 2016, including routinely electronically recording the Clinical Frailty Scale (CFS) score for patients over 65 year old.[9] From March 2020, electronic records included COVID-19 status.

The aim of our observational study was to explore the association between frailty and mortality in a cohort of adults aged 65 years and older, who were admitted to hospital and diagnosed with COVID-19.