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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

Viches-Moraga, A., Price, A., Braude, P., Pearche, L., Short, R., Verduri, A., Stechman, M., Collins, J. T., Mitchelle, E., Einarsson, A. G., Moug, S. J., Quinn, T. J., Stubbs, B., McCarthy, K., Myint, P. K., Hewitt, J. and Carter, B. 2020. 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. BMC Medicine 18 , 408. 10.1186/s12916-020-01856-8

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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 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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License
Publisher: BioMed Central
ISSN: 1741-7015
Date of First Compliant Deposit: 9 December 2020
Date of Acceptance: 17 November 2020
Last Modified: 16 Feb 2021 14:22
URI: http://orca.cf.ac.uk/id/eprint/136915

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