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Publication Briefs

Older Veterans with COVID-19 Have Increased Frailty Over 12 Months


BACKGROUND:
Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health. In this study, researchers used the VA medical records of 91,338 Veterans infected with COVID-19 from March 1, 2020 to April 30, 2021 and an equal number of matched uninfected controls to investigate whether COVID-19 was associated with a change in frailty. Veterans <50 years at index or who did not survive 12 months after index were excluded. Participants' median age was 69 years (5% female, 71% White). Frailty was assessed at index and 12 months using the VA Frailty Index. Analysis was adjusted for age, gender, race, ethnicity, and BMI.

FINDINGS:

  • Older Veterans with COVID-19 experienced a greater increase in frailty, particularly functional impairment, compared to uninfected controls.
  • An increase in frailty was associated with baseline frailty and COVID-19 infection severity, particularly hospitalization.
  • After adjustment, those with COVID-19 accrued 1.5 times more deficits than those who were uninfected.
  • The five most common new deficits were fatigue (10%), anemia (7%), muscle atrophy (7%), gait abnormality (6%), and arthritis (6%).

IMPLICATIONS:

  • The association of COVID-19 severity and hospitalization with accelerated frailty related to function and mobility suggests that clinicians caring for older adults with COVID-19 should seek to prevent hospitalization and help maintain and recover mobility during and after infection.

LIMITATIONS:

  • Researchers were limited by assessing frailty through usual medical care; deficits may have been missed and time of onset was difficult to determine.
  • There may have been closer follow-up of those who had COVID-19, leading to differences in ascertainment of frailty.
  • Researchers were unable to consider COVID-19 variants and vaccination during the study period.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR (C19 21-279). Drs. Seligman and Goetz are with HSR’s Center for Healthcare Innovation, Implementation, and Policy (CSHIIP). Dr. Orkaby is with HSR’s Center for Health Optimization and Implementation Research (CHOIR). Drs. Smith and Maciejewski are with HSR’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Dr. Hynes is with HSR’s Center to Improve Veteran Involvement in Care (CIVIC). Dr. Ioannou is with HSR’s Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care. Drs. Seligman and Wysham are supported by CSR&D Career Development Awards. Drs. Maciejewski and Hynes are supported by HSR Research Career Scientist Awards.


Seligman B, Wysham KD, Shahoumian T, Orkaby AR, Goetz MB, Osbourne TF, Smith VA, Maciejewksi ML, Hynes DM, Boyko EJ, Ioannou GN. Change in Frailty Among Older COVID-19 Survivors. Journal of the American Geriatrics Society. November 9, 2024; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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