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      Assessment of Functional Mobility After COVID-19 in Adults Aged 50 Years or Older in the Canadian Longitudinal Study on Aging

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          Key Points

          Question

          What is the association of a COVID-19 diagnosis and mobility and physical function among community-living middle-aged and older Canadians during the initial pandemic lockdown in 2020?

          Findings

          This cohort study of 24 114 participants found that community-living middle-aged and older adults with confirmed, probable, or suspected COVID-19 had nearly 2-fold higher odds of worsening mobility and physical function compared with adults without COVID-19, although most participants with COVID-19 had mild to moderate disease and were not hospitalized.

          Meaning

          These findings suggest that individuals with mild and moderate COVID-19 who were predominantly not hospitalized experienced deficits in functional mobility compared with those without COVID-19.

          Abstract

          This cohort study evaluates the association of mild to moderate COVID-19 with change in mobility and physical function in a population-based sample of adults aged 50 years or older in Canada.

          Abstract

          Importance

          The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated.

          Objective

          To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown.

          Design, Setting, and Participants

          This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021.

          Exposures

          The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non–COVID-19.

          Main Outcomes and Measures

          Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined.

          Results

          Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 2748 individuals with confirmed or probable or suspected COVID-19, 113 (94.2%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41).

          Conclusions and Relevance

          This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.

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          6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

          Chaolin Huang, Lixue Huang, Yeming Wang … (2021)
          Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
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            Persistent Symptoms in Patients After Acute COVID-19

            Angelo Carfì, Roberto Bernabei, Francesco Landi (2020)
            This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.
            Article 0 comments Cited 1929 times – based on 0 reviews     Review now
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              Post-acute COVID-19 syndrome

              Ani Nalbandian, Kartik Sehgal, Aakriti Gupta … (2021)
              Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
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                Author and article information

                Journal
                Journal ID (nlm-ta): JAMA Netw Open
                Journal ID (iso-abbrev): JAMA Netw Open
                Title: JAMA Network Open
                Publisher: American Medical Association
                ISSN (Electronic): 2574-3805
                Publication date (Electronic): 12 January 2022
                Publication date Collection: January 2022
                Publication date PMC-release: 12 January 2022
                Volume: 5
                Issue: 1
                Electronic Location Identifier: e2146168
                Affiliations
                [1 ]School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
                [2 ]Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
                [3 ]McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
                [4 ]Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
                [5 ]Department of Medicine, Section of Geriatric Medicine, University of Calgary, Calgary, Canada
                [6 ]O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
                [7 ]Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
                [8 ]Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
                [9 ]Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
                [10 ]Department of Medicine, McGill University, Montreal, Canada
                [11 ]Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
                [12 ]Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
                Author notes
                Article Information
                Accepted for Publication: December 6, 2021.
                Published: January 12, 2022. doi:10.1001/jamanetworkopen.2021.46168
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Beauchamp MK et al. JAMA Network Open.
                Corresponding Author: Parminder Raina, PhD, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 309A McMaster Innovation Park (MIP), 1280 Main St. W. Hamilton, ON L8S 4K1, Canada ( praina@ 123456mcmaster.ca ).
                Author Contributions: Dr Raina had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Beauchamp and Joshi contributed equally as co–first authors.
                Concept and design: Beauchamp, McMillan, Basta, Kirkland, Raina.
                Acquisition, analysis, or interpretation of data: Beauchamp, Joshi, Erbas Oz, Griffith, Kirkland, Wolfson, Raina.
                Drafting of the manuscript: Beauchamp, Joshi, McMillan, Raina.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Beauchamp, Erbas Oz, Raina.
                Obtained funding: Kirkland, Wolfson, Raina.
                Administrative, technical, or material support: Basta, Kirkland, Raina.
                Supervision: Raina.
                Conflict of Interest Disclosures: None reported.
                Funding/Support: Funding for the support of the CLSA COVID-19 Questionnaire-based study was provided by Juravinski Research Institute, Faculty of Health Sciences, McMaster University, Provost Fund from McMaster University, McMaster Institute for Research on Aging, Public Health Agency of Canada and Government of Nova Scotia. Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant No. LSA 94473 and the Canada Foundation for Innovation.
                Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                The Canadian Longitudinal Study on Aging Team: The Members of the Canadian Longitudinal Study on Aging Team are listed in Supplement 2.
                Disclaimer: The opinions expressed in this manuscript are the authors’ own and do not reflect the views of the Canadian Longitudinal Study on Aging.
                Additional Contributions: This research was conducted using the CLSA Baseline Tracking Dataset version 3.7, Baseline Comprehensive Dataset version 5.1, Follow-up 1 Tracking Dataset version 2.2, Follow-up 1 Comprehensive Dataset version 3.0, CLSA Sample Weights Version 1.2, and COVID-19 questionnaire data under Application ID No. 21CON001. The CLSA is led by Drs. Raina, Wolfson, and Kirkland. Dr Raina holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, is the Director of the McMaster Institute for Research on Aging and the Labarge Centre for Mobility in Aging, and holds a Tier 1 Canada Research Chair in Geroscience. Dr Beauchamp holds a Tier 2 Canada Research Chair in Mobility, Aging, and Chronic Disease. Lauren Griffith is supported by the McLaughlin Foundation Professorship in Population and Public Health.
                Article
                Publisher ID: zoi211274
                DOI: 10.1001/jamanetworkopen.2021.46168
                PMC ID: 8756318
                PubMed ID: 35019980
                SO-VID: 5f97caf0-a1bc-411a-a589-666484d29242
                Copyright © Copyright 2022 Beauchamp MK et al. JAMA Network Open.
                License:

                This is an open access article distributed under the terms of the CC-BY License.

                History
                Date received : 30 August 2021
                Date accepted : 6 December 2021
                Categories
                Subject: Research
                Subject: Original Investigation
                Subject: Featured
                Subject: Online Only
                Subject: Geriatrics

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