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Triple jeopardy: old age, frailty and diabetes in COVID ‐19
Author(s) -
Fox Charles,
Kilvert Anne
Publication year - 2021
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.2317
Subject(s) - medicine , type 2 diabetes , diabetes mellitus , gerontology , observational study , population , pandemic , covid-19 , government (linguistics) , demography , disease , environmental health , linguistics , philosophy , sociology , infectious disease (medical specialty) , endocrinology
The COVID‐19 pandemic has turned the lives of people throughout the world upside down and the virus has hit the older population hardest of all. The term ‘triple jeopardy’ has been coined to identify that older people with frailty and diabetes are at particular risk from the virus. Government figures for non‐COVID deaths from March to May 2020 show a 20–50% increase in those >70 years but lack of testing capacity may have led to under‐reporting of the virus. There has undoubtedly been a catastrophe in care homes, with 40% of total COVID‐19 deaths occurring in this setting. Whether frailty poses a greater risk than age alone is uncertain, with observational studies producing conflicting results. NICE guidance to include assessment of frailty in clinical decision making may have introduced study bias. Diabetes adds additional risk, with 33% of all hospital deaths occurring in people with diabetes: hazard ratio 3.51 for type 1 diabetes and 2.03 for type 2. The majority of those who died were >70 years (60.9% type 1 and 79.2% type 2). Poor glycaemic control is associated with increased risk. A 19th century definition of triple jeopardy defined gender, race and poverty as the dominant factors and these remain just as relevant in the COVID‐19 era. The arrival of a second wave highlights the need to introduce measures to protect people with diabetes and those marginalised by society. This includes older people and their carers. Copyright © 2021 John Wiley & Sons.