ABSTRACT
Background: COVID-19 infection in older adults may cause serious clinical complications requiring hospitalization. Frailty is a clinical syndrome characterized by a loss of physiologic reserve that increases the risk for poor health outcomes. Identification of frailty status during hospitalization my influence clinicians, patients and surrogates' resuscitation decisions. The study aim was to determine whether frailty changes resuscitation decisions (code) in hospitalized older veterans with COVID 19 infection. Methods: Retrospective case series of Veterans ≥65 years old, hospitalized with COVID-19 infection at 7 VA centers in Florida from March-August 2020. We used a 31-item VA Frailty index (VA-FI) to determine frailty status on admission based on clinical variables found in the medical records. The VA-FI categorized veterans in two groups: non- frail (FI<.21) and frail (FI≥.21). Information on changes in code status upon admission and during hospitalization were obtained from in-depth chart audits. After adjusting for age, gender, race, and ethnicity, we performed a binomial logistic regression by calculating Odds ratios (OR) with 95% confidence intervals (CI) with frailty status as the independent variable and change in code status from FC to DNR/DNI as the dependent variable. Results: 400 Older Veterans were hospitalized, mean age 76.30 (SD=8.26) years, 64.75% Caucasian (n=259), 85.25% non-Hispanic (n=341), and 97.25% (n=389) male. On hospital admission, 73.50% (n=294) were full code (FC), 25.50% (n=102) had do not resuscitate/ do not intubate (DNR/DNI) status and 1.00% (n=4) had DNR/OK to intubate order. During the course of the hospital stay, 18 Veterans changed code status from FC to DNR/DNI (Non-frail n=4, 13.33%, frail n=14, 46.67%) and 12 changed from DNR/DNI to FC (Non-frail n=5, 16.67%, frail n=7, 23.33%). Frailty status was not associated with the decision to change code status from FC to DNR (OR:1.65 95%CI .226-12.092, p=0.620). Conclusion: In older Veterans hospitalized with COVID-19 infection frailty status was not associated with changes in code status from full code to DNR/DNI. Future studies are needed to confirm these preliminary findings in larger and more diverse populations.