Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study

Abstract

Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline.

Functional decline, long term symptoms and course of frailty at 3-months follow-up in COVID-19 older survivors, a prospective observational cohort study

“…In our study, 36% of patients lost at least 1 point on Katz ADL, which is consistent with published studies. Indeed, functional decline after COVID-19 was estimated between 27 and 54% in older patients [ 13 , 14 ]. This occurrence varies greatly among studies populations and according time to assessment.…”

“…As detailed in the methods part, the sample size calculation (SSC) was not possible when we started the study. The SSC varies between to 317 patients to include (considering a 80% target power, a 2-sided alpha of 0.05, a 30% COVID-19 mortality rate in acute geriatric ward and pejorative 10% follow-up withdrawal) as new data details post-COVID functional decline between 30 to 50% depending on the time of assessment and the settings of recent published studies [ 13 , 14 ]. Third, there is an important missing data for long-terms symptoms and frailty transition.…”

“…For example community acquired pneumonia or severe infection lead to an increased limitation in activities of daily living, and impact on the health-related quality-of-life in the post-discharge period [ 10 – 12 ]. After COVID-19, 27 to 54% of patients described functional decline [ 13 , 14 ]. Specific factors associated with this functional decline in older adults are unknown.…”

Predictors of Basic Activity in Daily Living and Length of Hospitalization in Patients with COVID-19

“…The Barthel index has been used as an important indicator of hospital outcome [ 25 ] and could be used as a predictor of mortality [ 26 ]. On the other hand, there have been studies on patients with COVID-19 that aimed to identify predictive factors of functional prognosis [ 18 , 27 , 28 ]. Similar to our study, Hosoda et al also discovered that baseline activities of daily living impairment was associated with a greater risk of functional decline at discharge [ 18 ].…”

“…Therefore, the purpose of this study is to find out whether a COVID-19 patient’s physical performance along with other laboratory data upon admission are associated with both functional prognosis and hospitalization stay duration. Based on a past study [ 18 ], which showed impaired baseline activities of daily living being associated with functional decline at discharge, we hypothesize that COVID-19 patients with a poor physical performance upon admission shall have longer hospital stays and worse functional outcomes.…”