Associations of length of stay with frailty status and COVID-19 disease severity among older adults at a community treatment facility in Singapore

Background.Hospitalised older patients with coronavirus disease 2019 (COVID-19) have an increased risk of poor health outcomes.We aimed to determine the associations of length of stay (LOS) with frailty status and disease severity among older patients admitted to a community treatment facility (CTF) in Singapore.Methods.Medical records of consecutive patients admitted to the CTF were retrospectively reviewed.Data retrieved included demographics, frailty, LOS, 30-day readmission, disease severity, and functional statuses on admission and at discharge. Results.In total, 96 older patients (mean age, 80.3 years) were included.According to the Clinical Frailty Scale (CFS), 26.0% were robust (CFS 1-3), 27.1% were mildly frail (CFS 4-5), and 46.9% were moderately/ severely frail (CFS 6-9).Compared with the robust and mildly frail groups, the moderately/severely frail group had more severe COVID-19 cases (p=0.033),longer LOS at the CTF (p=0.005), and fewer patients discharged home (p=0.01).Greater disease severity was associated with poorer frailty status (p=0.033),worsening of functional status at discharge (p=0.02),higher International Severe Acute Respiratory and emerging Infection Consortium score (p=0.031), and receipt of <2 doses of COVID-19 vaccine (p=0.005).Risk factors for longer LOS at the CTF and overall LOS were basic ADL-assisted status on admission (p=0.09 and p=0.017, respectively), fully dependent status on admission (p=0.043 and p=0.002, respectively), presence of infective changes on chest X-ray (p=0.027 and p=0.003, respectively), and receipt of <2 doses of COVID-19 vaccine (p=0.007 and p=0.005, respectively). Conclusions.Risk factors for longer LOS in older patients with COVID-19 were basic ADL-assisted status and fully dependent status on admission, presence of infective changes on chest X-ray, and receipt of <2 doses of COVID-19 vaccine.High-risk patients should be identified through assessments of these characteristics.Identification of risk factors for longer LOS can help guide medical decisions and optimise healthcare resource utilisation.