Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study

Abstract

Objectives Among patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia. Design and Setting This case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls. Results 132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039); prior fall (OR=2.08, p=0.012); malnutrition (OR=1.97, p=0.018); length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049). Conclusion COVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s12603-022-1845-1.

Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia

“…In our study, half of the patients experienced a functional decrease of at least 5 Barthel Index (BI) points, a third showed a clinically relevant decrease of at least 10 points, and one in ten had a catastrophic decrease of 30 or more points. The functional decline in our patients was higher than the one in five at 30 days previously reported in similar pre-COVID-19 studies [21,22], but it is in line with the results of the study by Le Gentil et al, who reported a 3-month persistent functional decline of 42% in older adults admitted for pneumonia in 2020 [23]. Moreover, consistent with these observations and those of other authors, we did not find that COVID-19 etiology was a statistically significant independent factor for functional decline, while age [23], previous institutionalization and a better score in BI [24], Charlson Index (CCI) [24], and length of stay [23,24] were risk factors.…”

“…The functional decline in our patients was higher than the one in five at 30 days previously reported in similar pre-COVID-19 studies [21,22], but it is in line with the results of the study by Le Gentil et al, who reported a 3-month persistent functional decline of 42% in older adults admitted for pneumonia in 2020 [23]. Moreover, consistent with these observations and those of other authors, we did not find that COVID-19 etiology was a statistically significant independent factor for functional decline, while age [23], previous institutionalization and a better score in BI [24], Charlson Index (CCI) [24], and length of stay [23,24] were risk factors. We consider that restrictions due to pandemic lockdowns-such as isolation, limited mobility, and little physical therapy-contributed to greater functional decline even in patients with a higher BI.…”

Factors associated with functional decline in COVID-19 elderly survivors hospitalized in a tertiary care center

“…Another cause of variation could be due to modifications in the scales for functional status measurement, which in some studies has been evaluated with the Katz BADL scale, 29 and in others, with a simplified IADL scale, such as the modified Lawton Index. [15][16][17]30 As for the burden of comorbidity, another analysis found that stroke and depression were predictors of functional decline. 15 Furthermore, it has been documented that various diseases significantly increased mortality during COVID-19, including CKD (RR = 3.9), dementia (RR = 3.6), cardiovascular diseases (OR = 2.4) and diabetes mellitus (OR = 1.7).…”

“…Although there are few investigations on the subject, older people have been shown to suffer complications, functional decline and quality of life decrease. [14][15][16][17][18] The cause of this functional decline is multifactorial. Inflammation has been proposed to play an important role, and a positive correlation has been identified between elevated levels of inflammatory markers such as C-reactive protein, IL-6 and D-dimer and loss of muscle strength, 19 functional limitation 20 and disability.…”

Factores asociados al deterioro funcional en adultos mayores sobrevivientes de COVID-19 hospitalizados en un centro de tercer nivel

“…Aunque existen pocas investigaciones al respecto, se ha demostrado que las personas mayores sufren complicaciones, deterioro funcional y disminución de la calidad de vida. [14][15][16][17][18] La causa de este deterioro funcional es multifactorial. Se ha propuesto que la inflamación desempeña un papel importante y se ha identificado una correlación positiva entre niveles elevados de marcadores inflamatorios como la proteína C reactiva, IL-6 y el dímero D con pérdida de fuerza muscular, 19 limitación funcional 20 y discapacidad.…”