Frailty as a mortality predictor in older adults with COVID-19: A systematic review and meta-analysis of cohort studies

•SARS-CoV-2 (COVID-19) pandemic continues to spread rapidly around the globe and is associated with high rates of mortality among older adults.•Frailty in older adults is generally accompanied by underlying physiological changes that increases the risk of hospitalization and overall mortality.•Frailty among older adults with COVID-19 is associated with higher rates of mortality. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the coronavirus diseases 2019 (COVID-19) pandemic, continues to spread rapidly worldwide and is associated with high rates of mortality among older adults, those with comorbidities, and those in poor physiological states. This paper aimed to systematically identify the impact of frailty on overall mortality among older adults with COVID-19. We conducted a systematic review of the literature indexed in 4 databases. A random-effects model with inverse variance-weighted meta-analysis using the odds ratio was used to study the association of frailty levels with clinical outcomes among older adults with COVID-19. Heterogeneity was measured using the I2 statistic and Egger's test. We identified 22 studies that met our inclusion criteria, including 924,520 total patients. Overall, frailty among older adults was associated with high rates of COVID-19-related mortality compared with non-frail older adults (OR [odds ratio]:5.76; 95% confidence interval [95% CI]: 3.85–8.61, I2: 40.5%). Our results show that physical limitations, such as those associated with frailty among older adults, are associated with higher rates of COVID-19-related mortality.