Post-Discharge Outcomes in Older Patients Hospitalized for COVID-19 Infection

Background Little is known about recovery among older patients hospitalized for severe COVID-19 infection We analyzed the impact of severe COVID-19 on the mental and physical health of older patients at 1 and 6 months following discharge Methods This is a subanalysis of subjects ≥65 years enrolled in a prospective observational cohort study of patients hospitalized at one health system for COVID-19 infection requiring the use of at least 6 L of oxygen Eligible patients had intact cognition and function at baseline and were discharged alive to a home or non-hospice facility Patients were contacted 30-40 days following discharge to complete two validated surveys (PROMIS Dyspnea Characteristics and PROMIS Global Health-10) based on current and pre-COVID-19 health;surveys were repeated 180-211 days following discharge with a review of systems Results Among 58 patients (median age 71) who completed 1-month surveys, global self-rated health was worse following COVID-19 (median score 3/5) compared to before (4/5), p<0 001;at 6-months (52 patients), overall health remained lower than baseline (3/5), p<0 001 Patients experienced a decline in physical (score 42 8 vs 52 0, p<0 001) and mental health (46 0 vs 52 7, p<0 001) at one month At 6 months, physical (43 6) and mental health (46 8) were still worse than baseline, p<0 001 for both Among those with 6-month follow-up, dyspnea persisted in 46 patients (88 5%) at 1 month and 35 (67 3%) at 6 months There was an increase in the intensity, frequency, and duration of dyspnea at 1 month (2/10, 2/10, and 2/10, respectively) compared to before (0/10 each), p<0 001 for all Dyspnea at 6 months was improved but continued to be worse than baseline in intensity (0/10, p=0 02), frequency (1/10, p<0 001) and duration (1/10, p=0 006) 29 patients (50%) required oxygen 1 month following discharge, a new requirement for 27 (93 1%) At 6 months, 37 patients (71 2%) stated that their health had not returned to a pre-COVID state, with new onset memory changes being most common (64 9%) Conclusions Most older patients hospitalized for COVID-19 suffer a decline in mental and physical health for at least six months following discharge Refining longitudinal care for these patients, including access to pulmonary rehabilitation, may help to improve quality of life