COVID-19, frailty and long-term care: Implications for policy and practice

  • Melissa Andrew Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
  • Samuel D Searle Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
  • Janet E McElhaney Health Sciences North Research Institute, Sudbury, Canada
  • Shelly A McNeil Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Canada
  • Barry Clarke Department of Family Medicine, Dalhousie University, Halifax, Canada
  • Kenneth Rockwood Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
  • David J Kelvin Department of Microbiology and Immunology, Dalhousie, Halifax, Canada
Keywords: COVID-19, frailty, older adult, Long-Term Care, biomarker


Older adults have been disproportionately affected by the COVID-19 pandemic, with many outbreaks occurring in Long Term Care Facilities (LTCFs). We discuss this vulnerability among LTCF residents using an ecological framework, on levels spanning from the individual to families and caregivers, institutions, health services and systems, communities, and contextual government policies. Challenges abound for fully understanding the burden of COVID-19 in LTCF, including differences in nomenclature, data collection systems, cultural differences, varied social welfare models, and (often) under-resourcing of the LTC sector. Registration of cases and deaths may be limited by testing capacity and policy, record-keeping and reporting procedures. Hospitalization and death rates may be inaccurate depending on atypical presentations and whether or not residents’ goals of care include escalation of care and transfer to hospital. Given the important contribution of frailty, use of the Clinical Frailty Scale (CFS) is discussed as a readily implementable measure, as are lessons learned from the study of frailty in relation to influenza. Biomarkers hold emerging promise in helping to predict disease severity and address the puzzle of why some frail LTCF residents are resilient to COVID-19, either remaining test-negative despite exposure or having asymptomatic infection, while others experience the full range of illness severity including critical illness and death. Strong and coordinated surveillance and research focused on LTCFs and their frail residents is required. These efforts should include widespread assessment of frailty using feasible and readily implementable tools such as the CFS, and rigorous reporting of morbidity and mortality in LTCFs.


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How to Cite
Andrew M, Searle SD, McElhaney JE, McNeil SA, Clarke B, Rockwood K, Kelvin DJ (2020) COVID-19, frailty and long-term care: Implications for policy and practice. J Infect Dev Ctries 14:428-432. doi: 10.3855/jidc.13003
Coronavirus Pandemic