Background: During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective: The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods: This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results: A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions: The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.

As the coronavirus disease of 2019 (COVID-19) pandemic progressed diagnostics and treatment changed. to investigate differences in characteristics, disease presentation and outcomes of older hospitalised COVID-19 patients between the first and second pandemic wave in The Netherlands. this was a multicentre retrospective cohort study in 16 hospitals in The Netherlands including patients aged ≥ 70 years, hospitalised for COVID-19 in Spring 2020 (first wave) and Autumn 2020 (second wave). Data included Charlson comorbidity index (CCI), disease severity and Clinical Frailty Scale (CFS). Main outcome was in-hospital mortality. a total of 1,376 patients in the first wave (median age 78 years, 60% male) and 946 patients in the second wave (median age 79 years, 61% male) were included. There was no relevant difference in presence of comorbidity (median CCI 2) or frailty (median CFS 4). Patients in the second wave were admitted earlier in the disease course (median 6 versus 7 symptomatic days; P < 0.001). In-hospital mortality was lower in the second wave (38.1% first wave versus 27.0% second wave; P < 0.001). Mortality risk was 40% lower in the second wave compared with the first wave (95% confidence interval: 28–51%) after adjustment for differences in patient characteristics, comorbidity, symptomatic days until admission, disease severity and frailty. compared with older patients hospitalised in the first COVID-19 wave, patients in the second wave had lower in-hospital mortality, independent of risk factors for mortality. The better prognosis likely reflects earlier diagnosis, the effect of improvement in treatment and is relevant for future guidelines and treatment decisions.

Objectives: An increasing number of older adults, including those with mild cognitive impairment, are undergoing cardiac surgery. Despite strong recommendations for preoperative cognitive screening and peri-operative monitoring, routine implementation faces challenges, such as limited time in busy outpatient clinics and lack of patient motivation. To address this issue, gamification and self-administration of cognitive screening using BAMCOG were explored in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: A multi-methods prospective repeated-measures within-subject cohort study was conducted between January 2021 and December 2022 to assess usability and concurrent validity. The initial part after game development focused on qualitatively examining the usability of BAMCOG in eight patients, using the System Usability Scale (SUS). The second part, with 40 patients, evaluated concurrent validity by comparing BAMCOG with the widely used Montreal Cognitive Assessment (MoCA). Results: The average SUS score was 79.7, indicating good usability. In the preoperative period, the correlation between BAMCOG and MoCA scores was r = 0.33 (p < 0.05), which increased to r = 0.59 (p < 0.001) on the first postoperative day. Conclusions: In conclusion, peri-operative self-monitoring of cognition around a TAVR procedure is feasible, but the concurrent validity of the BAMCOG and the MoCA scores is moderate to low. This warrants further research on gamified cognitive screeners to optimize their use in perioperative cognitive monitoring.