Sarcopenia as a Predictor of Hospital-Associated Disability in Older Adults

PROJECT SUMMARY/Abstract: At least half of all physical disability among older adults develops in the setting of an acute hospitalization, andthose with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are at particular risk forphysical disability after an acute hospitalization. Older adults hospitalized for specific illnesses, such aspneumonia and sepsis, are particularly at risk for developing new physical disability. During the COVID-19pandemic, older adults, compared to younger adults, are also at greater risk of developing more severeCOVID-19, including greater risk of needing to be hospitalized, of requiring ICU admission, and of developingpneumonia and sepsis. As of May 6, 2020, over 3.7 million individuals throughout the world have developedCOVID-19, of which over 258,000 have died. Given the historic scale of the COVID-19 pandemic, theincreased burden of physical disability associated with COVID-19 is very likely to have a vast public healthimpact, particularly among older adults and those with AD/ADRD. However, little is known about the functionaloutcomes of COVID-19, especially among older adults and those with AD/ADRD who are most likely to beadversely affected. Addressing this key knowledge gap is critical in identifying key clinical risk factors foradverse outcomes, informing understanding of pathogenesis of physical disability after COVID-19, andultimately developing interventions to prevent or rehabilitate physical disability in these patients. Thisadministrative supplement proposal is an extension of the existing K23 grant (5K23AG058756-01; "Sarcopeniaas a Predictor of Hospital Associated Disability in Older Adults"), which was awarded to determine the ability ofsarcopenia, 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 existingresearch infrastructure and experience to conduct an original prospective cohort study (COPE: COVID-19Outcomes in Physical hEalth) that will compare short- and long-term functional outcomes of hospitalization forCOVID-19 between older and younger adults and between those with and without AD/ADRD. These studieswill also identify important pre-hospitalization risk factors (e.g. comorbidities and medication use) for adversefunctional outcomes. We propose to enroll a cohort of 200 survivors of COVID-19 hospitalization (age 65years and older, n=100, of whom n=25 with AD/ADRD; and age 64 years and younger, n=100) and to measurephysical 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) willalso undergo in-person assessments of body composition (DXA, ultrasound) and physical performance(muscle strength, Short Physical Performance Battery (SPPB)).