Associations of frailty and COVID-19 severity with long-term health outcomes of COVID-19 among older people

To investigate whether frailty and COVID-19 severity are associated with long-term health outcomes of COVID-19 in older people. In this cohort study, older people aged ≥ 70 years with COVID-19 between January 2020 and December 2021 were invited for follow-up. Participants were recruited from two multicentre hospital cohorts and 14 primary care practices. Frailty pre-COVID-19 was assessed with the clinical frailty scale. COVID-19 was categorised as severe for hospitalised patients and as mild in non-hospitalised patients. At follow-up, we evaluated long-term health outcomes, including self-reported post-COVID symptoms and self-perceived decline in six dimensions of health. 944 participants were included (median age 74 years, 58% men). Compared to fit participants (73%), frail participants (27%) more frequently had at least two post-COVID symptoms (OR 1.8, 1.3–2.3) and decline in all six dimensions of health (OR ranged between 1.6 for decline in participation to 2.5 for decline in daily functioning). Compared to participants with mild COVID-19 (55%), participants with severe COVID-19 (45%) more frequently had at least two post-COVID symptoms (OR 8.3, 6.1–11.2) and decline in all six dimensions of health (OR ranged between 3.0 for decline in meaningfulness to 5.9 for decline in bodily functions). Since severe COVID-19 (hospitalisation) is a more pronounced risk factor for post-COVID symptoms and decline on all aspects of health two years after onset of COVID-19 compared to frailty, older people in need of hospitalisation for COVID-19 should be considered susceptible for long-term COVID-19 health outcomes regardless of their frailty status.