Factors Associated with Disability Over the 6 Months After a COVID Hospitalization Among Older Adults: The VALIANT (COVID-19 in Older Adults: A Longitudinal Assessment) Study

Rationale: Although mortality from COVID-19 increases with advanced age, most older adults survive a COVID hospitalization. Disability, or dependence in functional activities, is known to increase after a serious illness among older adults, with adverse consequences for patients, families, and society. Little is known about disability, and the factors associated with disability, after a COVID hospitalization among older adults. Methods: We enrolled 341 older (≥60 years) adults during their index COVID-19 hospitalization between 7/6/2020-6/24/2021 from five hospitals in the Yale-New Haven Health System. Upon enrollment, participants underwent an assessment of baseline (prehospitalization) disability, frailty, general health, social support, hearing, vision, mental health, and assessments of current (in-hospital) symptom burden and cognitive function. These assessments were linked to EMR data including demographics, SOFA score, comorbidities, biomarkers, respiratory support, pressors, length of stay, and COVIDspecific treatments. Disability was assessed at baseline and 1, 3, and 6 months by asking about dependence in 15 basic, instrumental, and mobility activities. The primary outcome was the disability count (0-15) over the 6 months after the COVID hospitalization. The analytic sample included 304 participants who survived their hospitalization and had at least one post-discharge follow-up. We determined the mean (SD) number of disabilities over the 6 months after discharge and evaluated 27 factors for their association with the 6-month disability count using backwards selection based on minimization of the Bayesian Information Criterion with a zero-inflated negative binomial distribution and adjustment for baseline disability count and months of follow-up. Results: The mean age was 71.2 years (SD 8.5), 158 (51.8%) were women, and 108 (35.5%) were of nonwhite race or Hispanic ethnicity (Table). The mean prehospitalization disability count was 2.2 (SD 3.4), and the mean disability count over the 6 months after the COVID hospitalization was 2.9 (SD 3.7). In the multivariable model, greater baseline disability, older age, higher BMI, higher comorbidity count, cognitive dysfunction, greater symptom burden during the hospitalization, and the need for advanced respiratory support were all associated with greater disability over the 6 months after a COVID hospitalization. Conclusions: Other than the need for advanced respiratory support, factors associated with disability after a COVID hospitalization among older adults reflect vulnerability at baseline (comorbidities, baseline disability, age, BMI) or during the hospitalization (symptom burden, cognitive dysfunction), rather than biomarkers or severity of illness. These factors may identify older adults for referral to Post-COVID clinic programs to improve the likelihood of functional recovery after discharge. (Table Presented).