We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159]. There is no doubt that difficult decisions have been made and are continuing to be made across the UK. These decisions will become increasingly difficult with the continued narrowing of the clinical criteria for the escalation of treatment, as has been seen in other countries globally. Frailty has been placed at the forefront, with professional associations responding to the NICE NG159 by proposing a frailty score as part of the clinical assessment. There is no doubt that increasing frailty (irrespective of the scale or score applied) is associated with poorer outcomes in both medical and surgical patients, with increased ITU admissions, prolonged length of stay, increased care needs on discharge and mortality all reported. However, these studies were not performed during a viral pandemic and while we, like all clinicians, await published evidence on COVID-19, we would like to highlight some points to consider when making clinical decisions based on frailty.
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