Symptom trajectories after COVID hospitalization and risk factors for symptom burden in older persons: a longitudinal cohort study.

BACKGROUND

Little is known about how psychosocial factors and geriatric conditions contribute to persistent post-COVID symptoms among older adults. We evaluated symptom burden following COVID-19 hospitalization and identified risk factors for persistent symptoms among -community-dwelling older adults.

METHODS

This prospective study recruited 281 older persons (mean age 70.6 years) hospitalized for SARS-CoV-2 infection between June 2020 and June 2021 from Yale-New Haven Health System. Post-COVID symptoms were assessed using a modified Edmonton Symptom Assessment System during hospitalization, and at 1, 3, and 6 months post-discharge. Trajectory analysis identified three symptom trajectories. Multinomial logistic regression evaluated associations between characteristics (sociodemographic, clinical, psychosocial factors, and geriatric conditions) obtained during hospitalization and trajectory membership.

RESULTS

Three symptom burden trajectory groups were identified: low (n = 70; 24.9%; reference); moderate (n = 149; 53.0%); and high (62; 22.1%). Female sex (adjusted odds ratio (adjOR)_moderate = 3.10 [95% CI = 1.68-5.72]; adjOR_high = 5.76 [2.70-12.27]), higher depression/anxiety (adjOR_moderate = 1.47 [1.24-1.74]; adjOR_high = 1.72 [1.43-2.07]), and less social support (adjOR_moderate = 0.91 [0.83, 0.99]; adjOR_high = 0.86 [0.78-0.95]) were associated with moderate and high symptom burden. Geriatric conditions, including delirium (adjOR_high = 7.74 [1.56-38.26]), frailty (adjOR_high = 5.26 [1.77-15.68]), impairment of physical function (adjOR_high = 1.18 [1.00-1.40]), and vision impairment (adjOR_high = 4.63 [1.33-16.11]), were associated with high symptom burden.

CONCLUSIONS

In older persons hospitalized with COVID-19, female sex, psychosocial factors, and geriatric conditions were associated with higher symptom burden over six months. Future work should investigate the biopsychosocial mechanisms through which psychosocial factors and geriatric conditions contribute to post-COVID symptom burden.