Functional Trajectories After COVID-19 Hospitalization Among Older Adults

Little is known about functional trajectories among older adults who survive hospitalization for coronavirus disease 2019 (COVID-19). We characterized these trajectories over 6 months following discharge and evaluated the associations of potential risk factors with trajectory membership.

Participants were community-dwelling adults ≥ 60 years of age hospitalized for COVID-19 from June 2020 to June 2021. Interviews completed at 1, 3, and 6 months after discharge included assessments for disability in 15 functional activities. Functional trajectories were identified using latent class analysis. Factors associated with trajectory membership were evaluated using multinomial regression.

311 participants (mean age 71.3 years) were included. Four different functional trajectories were identified: no (43%), mild (16%), moderate (23%), and severe (18%) disability. The pre-admission count of disabilities was independently associated with membership in each non-reference trajectory. Additional factors independently associated with the moderate trajectory included in-hospital delirium (OR 4.12 [95% CI 1.11-15.4]), frailty (OR 1.67 [95% CI 1.12-2.50]) and number of comorbidities (OR 1.41 [95% CI 1.12-1.79]) and with the severe trajectory included in-hospital delirium (OR 12.4 [95% CI 1.93-79.4]), frailty (OR 2.01 [95% CI 1.11-3.62]), number of comorbidities (OR 1.59 [95% 1.11-2.28]), severity of illness (OR 1.46 [95% CI 1.09-1.95]), and age (OR 1.10 [95% CI 1.02-1.18]).

Older survivors of COVID-19 hospitalization experience distinct functional trajectories. Our findings may help inform shared medical decision-making during and after hospitalization and stimulate further research into modifiable risk factors.