Sarcopenia as a Predictor of Hospital-Associated Disability in Older Adults
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PROJECT SUMMARY/ABSTRACT At least half of all physical disability among older adults develops in the setting of an acute hospitalization, and those with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are at particular risk for physical disability after an acute hospitalization. Older adults hospitalized for specific illnesses, such as pneumonia and sepsis, are particularly at risk for developing new physical disability. During the COVID-19 pandemic, older adults, compared to younger adults, are also at greater risk of developing more severe COVID-19, including greater risk of needing to be hospitalized, of requiring ICU admission, and of developing pneumonia and sepsis. As of May 6, 2020, over 3.7 million individuals throughout the world have developed COVID-19, of which over 258,000 have died. Given the historic scale of the COVID-19 pandemic, the increased burden of physical disability associated with COVID-19 is very likely to have a vast public health impact, particularly among older adults and those with AD/ADRD. However, little is known about the functional outcomes of COVID-19, especially among older adults and those with AD/ADRD who are most likely to be adversely affected. Addressing this key knowledge gap is critical in identifying key clinical risk factors for adverse outcomes, informing understanding of pathogenesis of physical disability after COVID-19, and ultimately developing interventions to prevent or rehabilitate physical disability in these patients. This administrative supplement proposal is an extension of the existing K23 grant (5K23AG058756-01; “Sarcopenia as a Predictor of Hospital Associated Disability in Older Adults”), which was awarded to determine the ability of sarcopenia, operationalized as muscle mass and strength, to predict the development of activity of daily living (ADL) disability among hospitalized older adults. The additional studies proposed herein will leverage existing research infrastructure and experience to conduct an original prospective cohort study (COPE: COVID-19 Outcomes in Physical hEalth) that will compare short- and long-term functional outcomes of hospitalization for COVID-19 between older and younger adults and between those with and without AD/ADRD. These studies will also identify important pre-hospitalization risk factors (e.g. comorbidities and medication use) for adverse functional outcomes. We propose to enroll a cohort of 200 survivors of COVID-19 hospitalization (age 65 years and older, n=100, of whom n=25 with AD/ADRD; and age 64 years and younger, n=100) and to measure physical function outcomes (ADLs, frailty, mobility, sarcopenia, Health Assessment Questionnaire (HAQ), fatigue) by telephone interview at 1- and 3-months after hospital discharge. A subset of participants (n=50) will also undergo in-person assessments of body composition (DXA, ultrasound) and physical performance (muscle strength, Short Physical Performance Battery (SPPB)).
