Factors Associated With Disability Over 6 Months After COVID Hospitalization Among Older Adults: the VALIANT Study

ABSTRACT

Background: Mortality from COVID increases with age, but most older adults survive. Little is known about disability after COVID hospitalization. Methods: We enrolled 341 adults ≥60 years during their index COVID hospitalization between 7/2020-6/2021 from 5 hospitals. Participants underwent assessment of baseline (pre-hospital) disability, frailty, general health, social support, hearing, vision, mental health, & in-hospital symptom burden and cognitive function. Assessments were linked to health record data, including comorbidities, SOFA score, biomarkers, respiratory support, & COVID-specific treatments. Disability in 15 functional activities was assessed again at 1, 3, and 6 months. The primary outcome was mean disability count over 6 months after discharge. The analytic sample included 304 participants with ≥1 post-discharge follow-up. We evaluated 27 factors for their association with the primary outcome using backward selection with a zero-inflated negative binomial distribution & adjustment for baseline disability & months of follow-up. Results: Mean age was 71.2 yrs (SD 8.5);52% were women and 36% of nonwhite race or Hispanic ethnicity. Mean baseline disability count was 2.2 (SD 3.4). Mean disability count over the 6 months after discharge was 2.9 (SD 3.7). Greater baseline disability, older age, higher BMI, higher comorbidity count, cognitive dysfunction, greater symptom burden, and need for advanced respiratory support were associated with greater post-hospitalization disability (Table). Conclusions: Baseline vulnerability factors as well as in-hospital symptom burden, cognitive dysfunction, and advanced respiratory support were associated with increased disability after a COVID hospitalization. There was no association with COVIDspecific treatments or biomarkers. These factors may identify older adults with the most potential to benefit from efforts to improve functional recovery.