Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the Dutch Lifelines COVID-19 Cohort study

Yinjie Zhu; Martine J Sealy; Harriët Jager-Wittenaar; Jochen O Mierau; Stephan J L Bakker; Gerjan J Navis; Lifelines Corona Research Initiative

doi:10.1007/s40520-022-02268-9

Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the Dutch Lifelines COVID-19 Cohort study

Aging Clin Exp Res. 2022 Nov;34(11):2693-2702. doi: 10.1007/s40520-022-02268-9. Epub 2022 Oct 16.

Authors

Yinjie Zhu¹, Martine J Sealy^{2

3}, Harriët Jager-Wittenaar^{2

3

4}, Jochen O Mierau^{5

6

7}, Stephan J L Bakker⁸, Gerjan J Navis⁸; Lifelines Corona Research Initiative

Collaborators

Lifelines Corona Research Initiative:
H Marike Boezen, Jochen O Mierau, H Lude Franke, Jackie Dekens, Patrick Deelen, Pauline Lanting, Judith M Vonk, Ilja Nolte, Anil P S Ori, Annique Claringbould, Floranne Boulogne, Marjolein X L Dijkema, Henry H Wiersma, Robert Warmerdam, Soesma A Jankipersadsing, Irene van Blokland, Geertruida H de Bock, Judith G M Rosmalen, Cisca Wijmenga

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. y.zhu@umcg.nl.
² Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CA, Groningen, The Netherlands.
³ FAITH Research, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands.
⁴ Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
⁵ Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, University complex, 9747 AJ, Groningen, The Netherlands.
⁶ Lifelines Cohort Study and Biobank, Groningen, The Netherlands.
⁷ Team Strategy and External Relations, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
⁸ Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.

Abstract

Background: Frailty is associated with COVID-19 severity in clinical settings. No general population-based studies on the association between actual frailty status and COVID-19 hospitalization are available.

Aims: To investigate the association between frailty and the risk of COVID-19 hospitalization once infected.

Methods: 440 older adults who participated in the Lifelines COVID-19 Cohort study in the Northern Netherlands and reported positive COVID-19 testing results (54.2% women, age 70 ± 4 years in 2021) were included in the analyses. COVID-19 hospitalization status was self-reported. The Groningen Frailty Indicator (GFI) was derived from 15 self-reported questionnaire items related to daily activities, health problems, and psychosocial functioning, with a score ≥ 4 indicating frailty. Both frailty and COVID-19 hospitalization were assessed in the same period. Poisson regression models with robust standard errors were used to analyze the associations between frailty and COVID-19 hospitalization.

Results: Of 440 older adults included, 42 were hospitalized because of COVID-19 infection. After adjusting for sociodemographic and lifestyle factors, a higher risk of COVID-19 hospitalization was observed for frail individuals (risk ratio (RR) [95% CI] 1.97 [1.06-3.67]) compared to those classified as non-frail.

Discussion: Frailty was positively associated with COVID-19 hospitalization once infected, independent of sociodemographic and lifestyle factors. Future research on frailty and COVID-19 should consider biomarkers of aging and frailty to understand the pathophysiological mechanisms and manifestations between frailty and COVID-19 outcomes.

Conclusions: Frailty was positively associated with the risk of hospitalization among older adults that were infected with COVID-19. Public health strategies for frailty prevention in older adults need to be advocated, as it is helpful to reduce the burden of the healthcare system, particularly during a pandemic like COVID-19.

Keywords: COVID-19; Coronavirus; Frailty; Groningen Frailty Indicator.

MeSH terms

Aged
COVID-19 Testing
COVID-19* / epidemiology
Cohort Studies
Female
Frail Elderly
Frailty* / epidemiology
Geriatric Assessment
Hospitalization
Humans
Male