Abstract
BackgroundThis 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).MethodsWe 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.ResultsThe 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.ConclusionsOver 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.
Highlights
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)
Hospitalization due to pneumonia poses a high risk for hospitalization-associated disability, because prolonged inflammation and hypoxia in respiratory infections can cause delirium and cognitive impairment deterioration [7, 8], older patients who were hospitalized for the treatment of COVID-19 were considered to be at high risk for functional decline, but little is known about the changes in activities of daily living (ADL) dependency following the onset of COVID-19
From this retrospective cohort study, we showed that the majority of older patients who recovered from COVID19 developed functional decline during hospitalization, especially in their ability of walking on a level surface and moving from wheelchair to bed and return
Summary
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). Older age, cognitive impairment, delirium, and hypoalbuminemia are well-known risk factors for hospitalization-associated disability, which is defined as a decrease in independence with activities of daily living (ADL) due to functional decline [6]. We aimed to determine the frequency of functional decline at discharge from a hospital and to evaluate the factors associated with functional decline in hospitalized older patients with COVID-19 Hospitalization due to pneumonia poses a high risk for hospitalization-associated disability, because prolonged inflammation and hypoxia in respiratory infections can cause delirium and cognitive impairment deterioration [7, 8], older patients who were hospitalized for the treatment of COVID-19 were considered to be at high risk for functional decline, but little is known about the changes in ADL dependency following the onset of COVID-19.
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