COVID-19 in Older Adults: A Longitudinal Assessment (VALIANT)
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PROJECT SUMMARY / ABSTRACT Older adults with COVID-19 are much more likely than younger adults to develop severe disease and to die from their illness. Nevertheless, the best available data suggest that more than 90% of adults aged ≥60 will survive. Virtually nothing is known about the long-term effects of COVID-19 infection, but there are many reasons to be concerned that older survivors who were ill enough to require hospitalization are at risk of a substantial decline in their health and functional status. Normal aging involves a decline in physiologic reserve, and many older adults have other underlying vulnerabilities, including multiple chronic medical conditions and frailty. Hospitalized patients with COVID-19 endure long periods of immobility and social isolation. Upon discharge, there is the potential for limited access to community health care providers, such as physical therapists. Finally, reports have suggested that COVID-19 itself has the potential to cause long-term physiologic changes, including changes in metabolism. High quality data about these phenomena are needed to guide the development of targeted interventions for older COVID-19 survivors and to inform medical decision-making. Because the data available in the electronic health record (EHR) are not sufficient to assess the long-term health outcomes that matter to older adults, such as function, cognition, and symptom burden, longitudinal data about these key outcomes need to be collected from patients or their proxies. The Yale Older Americans Independence Center (OAIC), with a wealth of research expertise and a world-class Field Operations and Data Management Core, is uniquely positioned to collect such data. We propose to leverage this expertise to accomplish Specific Aim 1, the enrollment of a prospective cohort of 500 patients aged ≥60 years with COVID-19 from two large hospitals in southern Connecticut, near the center of the pandemic. We will perform a baseline assessment at or near the time of hospitalization and then follow-up assessments at 1, 3, and 6 months after discharge, with measures of physical and cognitive health, psychosocial support, frailty, quality of life, and, at the 6-month assessment, performance-based measures of mobility, pulmonary function testing, and a blood draw. This work will lead to a repository of outcome data that we will supplement with EHR-based variables and make available for use by other investigators. Specific Aims 2-4 draw upon the breadth of investigative and analytic expertise at the OAIC to illustrate projects to be undertaken with repository data. Aim 2 is an investigation of functional outcomes among critically ill and socioeconomically disadvantaged groups. Aim 3 involves work to characterize metabolic dysfunction among COVID-19 survivors, while Aim 4 is an examination of symptom burden. Because this study involves the collection of longitudinal data that would otherwise not be available, it will enable foundational research into the long-term health effects of COVID-19 in older patients.
