Change in frailty among older COVID-19 survivors

Introduction: COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one-disease-at-a-time approach. We investigated whether COVID-19 was associated with change in frailty among older Veterans. Methods: Data were from the Veterans Affairs (VA) COVID-19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID-19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those <50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA-FI). We assessed the number of new VA-FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID-19 cases versus controls during follow-up. Results: We identified 91,338 COVID-19-infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3-74.2), 5% were female, 71% were White, and baseline VA-FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0-2) for infected and 0 (0-1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52-1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%). Discussion: We found a greater increase in frailty among older Veterans with COVID-19 compared with matched uninfected controls, suggesting that COVID-19 infection has long-term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population.