The authors of this paper discuss a framework to consider the multiple reasons that residents of long term care facilities have been especially vulnerable to COVID-19. They specifically highlight frailty as a construct, which is already systematically measured in most nursing facilities, to predict severity and how to approach treatment of COVID-19 among residents in Long Term Care Facilities (LTCFs).

Frailty can be a measure of health and functional problems for older adults and makes them more vulnerable to poor health outcomes. The authors discuss the relationship of the individual to families and caregivers, institution, communities and contextual government policies in the vulnerability of older adults during COVID-19. Examples of this vulnerability include:

• On the family and caregiver level, visitor restrictions have decreased advocacy opportunities
• On the institutional level, residents living in close quarters and limited staffing recourses contribute to vulnerability of the residents
• On the community level, staff interaction with the community, especially in terms of transport, can put residents at a higher risk for contracting COVID-19
• On a contextual level, funding for resources and barriers to testing exists, i.e., barriers to testing can result in limitation in cases and deaths due to COVID-19 being reported

Previous studies have shown that clinical frailty scale (CFS) can be used to determine differences in health status and outcomes, potential vaccine effectiveness (as seen in influenza), atypical illness presentation in underrecognized cases as see with flu cases in LTCF residents.

The article discusses the use of biomarkers in predicting disease severity of COVID-19 older adults. However, there are few studies exploring frailty and biomarkers with severity of illness in older adults. In identifying these high risk individuals, biomarkers may be helpful to organize patients into treatment groups and lend more information on the mechanisms of severe disease.

Understanding frailty helps identify the medical and social factors that contribute to illness in older people. The authors call for widespread assessment of frailty using tools such as CFS and being more consistent and precise in reporting morbidity and mortality in LTCFs. Surveillance and further research on frail residents will also provide insight on how COVID-19 effects high risk and vulnerable individuals to create better prevention and treatment strategies against COVID-19.

Andrew M, Searle SD, McElhaney JE, et al. COVID-19, frailty and long-term care: Implications for policy and practice. The Journal of Infection in Developing Countries. 2020;14(05):428-432. doi:10.3855/jidc.13003