Functional Trajectories After COVID-19 Hospitalization Among Older Adults

Background: 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. Methods: 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. Results: 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]). Conclusions: 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.