Frailty Linked to Healthcare Challenges During Pandemic

Frailty may help identify patients who would benefit from interventions to reduce the effects of the COVID-19 pandemic on health and social outcomes, new data suggest.

In an analysis of cross-sectional data for about 24,000 Canadians, community-dwelling adults in the highest quartile of frailty were 15% more likely to report challenges accessing healthcare than adults in the lowest quartile of frailty.

“In many ways, the findings are what we expected,” study author Lauren Griffith, PhD, associate professor of clinical epidemiology and biostatistics at McMaster University in Hamilton, Ontario, told Medscape Medical News. “We found that as the level of frailty increased, so did the number of people suffering negative health, social, and healthcare access impacts during the pandemic, which could not be explained by other factors such as sex, age, or health behaviors such as smoking.”

The study was published online December 19 in the journal Age and Ageing.

Effects by Age

Previous studies have examined frailty in the context of COVID-19, but most focused on healthcare utilization and worse outcomes following COVID-19 infection. “We used the frailty lens to examine health, resource (such as loss of income and inability to access necessary supplies), and relationship impacts, including healthcare access, in people living in the community,” said Griffith.

The researchers analyzed cross-sectional data on 23,974 participants in the Canadian Longitudinal Study on Aging (CLSA). The latter study began recruiting participants between 2011 and 2015. Participants were seen at 3-year intervals for as long as 20 years. About 95% of participants completed their first follow-up, which included a frailty assessment, between 2015 and 2018.

Just after the onset of the COVID-19 pandemic (in April 2020), the researchers began administering weekly or monthly questionnaires, which were completed on the phone or online. The current researchers included in their analysis participants who completed a COVID-19 interview between September and December 2020.

Participants were aged 50-90 years, about 53% female, 65% age 65 years or older, and 26% had a household income of less than $50,000. Increased frailty level was associated with older age, lower income, unmarried status, and living alone.

The researchers sorted participants by frailty quartile. All COVID-19 effects except loss of income were more common in participants in quartiles of higher frailty. Approximately 48% of participants in the least frail quartile reported family separation. The prevalence of this outcome increased to 52.7% in the frailest quartile.

Compared with the least frail quartile, the frailest quartile had a greater likelihood of reporting having been ill with COVID-19 (23.1% vs 9.8%), experiencing an increase in verbal or physical conflict (11% versus 3.7%), being unable to access needed supplies (10.6% vs 3.6%), and reporting challenges to accessing healthcare (38.1% vs 18.2%).

The most common healthcare access challenges were accessing primary care (25.9% frailest vs 11.6% least frail) and accessing specialist care (17.7% vs 6.1%).

Age and frailty were not necessarily linked closely. “Frailty and age, while related, are often separate, with many people enjoying good health into their eighties and nineties,” said Griffith. “Across all levels of frailty, we kept seeing people in the youngest age category as being the ones experiencing the most challenges, especially with accessing healthcare. This was particularly true for with those with the highest levels of frailty.”

Older populations were well cared for in the context of the pandemic, as highlighted by the study’s finding that older populations had the fewest challenges with respect to healthcare access. “But focusing on frailty, especially in the ‘younger old,’ may help identify individuals whose healthcare needs may not be as effectively addressed,” said Griffith.

In the group with the highest level of frailty, nearly 30% of people aged 50-55 years reported challenges in accessing specialist care, compared with 12.7% of those aged 75 years and older. “Understanding challenges in accessing healthcare, however, are complex, and more research is needed to determine what drives these findings,” said Griffith.

The researchers acknowledged that the study is limited by the predominance of White, well-educated, and economically advantaged participants. The findings therefore may not apply to economically marginalized groups.

More Assistance Needed

Commenting on the findings for Medscape, Jennifer Watt, MD, PhD, a geriatrician at St. Michael’s Hospital and an assistant professor of medicine at the University of Toronto, said, “This paper is really interesting because it’s describing older adults’ social frailty during the COVID-19 pandemic.” Frailer participants had worse physical health and sustained greater effects on their relationships and resources. “This finding is important because it describes the association between frailty and a decreased ability to fulfill social needs,” said Watt.

“People living with frailty may require more assistance in accessing services and resources that they need to stay living independently in the community. Researchers, patients, clinicians, and policymakers should consider the potential impact of both [age and frailty] when trying to support older adults’ health and social care needs,” she concluded.

The study was funded by Juravinski Research Institute, Faculty of Health Sciences, McMaster University, Provost Fund from McMaster University, McMaster Institute for Research on Aging, Public Health Agency of Canada, and the Nova Scotia COVID-19 Health Research Coalition. Griffith and Watt report no relevant financial disclosures.

Age Ageing. Published online December 19, 2022. Full text

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