COVID-19 in Older Adults: A Longitudinal Assessment (VALIANT)

PROJECT SUMMARY / ABSTRACTOlder adults with COVID-19 are much more likely than younger adults to develop severe disease and to diefrom their illness. Nevertheless, the best available data suggest that more than 90% of adults aged ≥60 willsurvive. Virtually nothing is known about the long-term effects of COVID-19 infection, but there are manyreasons to be concerned that older survivors who were ill enough to require hospitalization are at risk of asubstantial 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 andfrailty. Hospitalized patients with COVID-19 endure long periods of immobility and social isolation. Upondischarge, there is the potential for limited access to community health care providers, such as physicaltherapists. Finally, reports have suggested that COVID-19 itself has the potential to cause long-termphysiologic changes, including changes in metabolism. High quality data about these phenomena are neededto guide the development of targeted interventions for older COVID-19 survivors and to inform medicaldecision-making. Because the data available in the electronic health record (EHR) are not sufficient to assessthe 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 OlderAmericans Independence Center (OAIC), with a wealth of research expertise and a world-class FieldOperations and Data Management Core, is uniquely positioned to collect such data. We propose to leveragethis expertise to accomplish Specific Aim 1, the enrollment of a prospective cohort of 500 patients aged ≥60years with COVID-19 from two large hospitals in southern Connecticut, near the center of the pandemic. Wewill 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 functiontesting, and a blood draw. This work will lead to a repository of outcome data that we will supplement withEHR-based variables and make available for use by other investigators. Specific Aims 2-4 draw upon thebreadth of investigative and analytic expertise at the OAIC to illustrate projects to be undertaken withrepository data. Aim 2 is an investigation of functional outcomes among critically ill and socioeconomicallydisadvantaged 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 longitudinaldata that would otherwise not be available, it will enable foundational research into the long-term health effectsof COVID-19 in older patients.