Abstract

Frailty is a major prognostic factor for COVID-19 in older individuals, associated with an increased risk of in-hospital mortality. This study broadly explores the pathophysiology, epidemiology, and clinical features of COVID-19 in older patients, as well as the associations of frailty with the progression and management of COVID-19. During the COVID-19 pandemic, older individuals consistently manifested severe symptoms. Comprehensive geriatric assessments can help identify the risk factors for frailty. Physical limitations may increase the risk of COVID-19-related mortality in older individuals with frailty. Immunosenescence or inflammaging are potential mechanisms underlying older individuals' increased susceptibility to COVID-19 andmortality risks. Vaccine efficacy varies across older individuals with frailty. COVID-19 can be potentially treated using corticosteroids and antiviral agents such as remdesivir, nirmatrelvir/ritonavir, and molnupiravir, as well as immunomodulatory agents such as baricitinib and tocilizumab. However, most reports of clinical trials on corticosteroids and new antiviral agents did not specifically address older patients, further limiting the discussion on frailty. Thorough clinical assessments and effective communication with healthcare providers aid in timely detection of disease worsening. In conclusion, our study underscores the complex interplay between age, frailty, and COVID-19 outcomes, but we refrain from making speculative assertions due to insufficient evidence. Further studies are necessary to optimize the outcomes of COVID-19 in individuals with frailty.