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HSR&D Research Sheds Further Light on COVID-19, Influenza, and Frailty

June 22, 2022

A pair of recent studies, partially funded by HSR&D and led by Benjamin Seligman, MD, PhD, part of VA Boston Health Care, were published in the Journal of the American Geriatrics Society (JAGS).

In the first study, researchers reviewed 30-day mortality among Veterans aged 65 and older who were admitted to any VA hospital with COVID-19 (n=15,474) or influenza (n=7,867). Findings confirmed that while influenza was an important source of morbidity and mortality among older adults, mortality from COVID-19 exceeded that from influenza even after adjusting for an array of confounders. In addition, odds of mortality were highest in older adults who were frail and hospitalized with COVID-19 or flu, indicating that frailty should be incorporated in COVID-19 and influenza prevention and care strategies for older adults. The study’s authors suggest that with the potential for a season with both COVID-19 and influenza cases, healthcare providers should seek to differentiate these viral infections for infection control purposes and to guide prognostication and shared decision-making with patients.

The second study examined whether frailty is associated with altered vaccine effectiveness against hospitalization among individuals with COVID-19. Using VA data, investigators identified all Veterans aged 50 or older who had a positive COVID-19 test at the VA Greater Los Angeles Health Care System from December 2021 through January 2022 (n=1,091; 61% non-frail, 31% frail, and 9% severely frail). The odds of hospitalization were greater for partially and unvaccinated patients relative to fully vaccinated patients, and greater for frail and severely frail patients relative to non-frail patients. These findings provide early evidence that although frail Veterans face a higher risk of hospitalization following infection, vaccination against COVID-19 protects infected individuals against hospitalization regardless of frailty status. This suggests the vaccines are protective even among the most vulnerable older adults.

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