COVID-19 disproportionately affects older adults, partly due to increased prevalence of frailty. Frail adults in residential settings may be at particular risk of transmission of respiratory illness. Understanding the differences in COVID-19 presentation resulting from frailty is imperative to prompt rapid diagnosis, isolation and contact-tracing and to guide assessment and treatment.

Early identification of frailty facilitates a differential, targeted clinical approach, focusing not only on “typical” COVID-19 symptoms (i.e., fever and cough) but also on symptoms, such as delirium, demonstrated to e more common in frail older adults. Rapid NICE guidance produced in response to the COVID-19 pandemic outlines the importance of identifying those at increased risk of poor outcomes and less likely to benefit from critical care admission.

Delirium is a frequent complication of hospitalization for older adults and for patients admitted to critical care of all ages. Although the pathophysiology is not fully understood, neuroinflammation has been hypothesized to play a key role. In a recent study, the prevalence of delirium in hospitalized COVID-19 patients was similar to that reported in a study from another London hospital (27%); notably, this study estimated actual delirium prevalence at 42% following specialist re-assessment.

What does this mean to you, the provider, the caregiver? The results of this study stresses the importance of a thorough, comprehensive assessment including identifying “frailty” in your residents as this increases their risk of significant illness.

Remember, assess your residents now, before they become ill, focus on the predictors of frailty and flag those residents affected as highest risk.

Stay well, stay safe and stay tuned!