Among middle-aged and older adults who get Covid-19, even mild disease was associated with worse mobility and functioning months later in a study involving roughly 24,000 residents of Canada aged 50 and older.
The analysis of data from the Canadian Longitudinal Study on Aging (CLSA) showed a 2-fold increase in worsening mobility and physical function among study participants who reported confirmed, suspected, or probable Covid-19 infection, compared to those who were not infected, even though the vast majority of Covid cases (94.2%) did not require hospitalization.
The findings, published online in JAMA Network Open, add to the growing evidence that even mild to moderate Covid-19 can lead to long-term symptoms, and suggest that older people may be especially vulnerable to long Covid.
Researcher Marla Beauchamp, PhD, of McMaster University, Hamilton, Canada, and co-authors, wrote that the study is the first “to our knowledge, to evaluate the associations of confirmed, probable, or suspected Covid-19 with the mobility and functioning of a community-based sample of middle-aged and older adults.”
“There is an ongoing effort by both health professionals and patients alike to recognize long Covid as a long-term condition and to increase access to treatments and rehabilitative care,” they added. “Our findings confirm that individuals with Covid-19 who did not require hospitalization were more likely than those without Covid-19 to experience worsening of overall mobility since the start of the pandemic and a deterioration in physical functioning at the Covid-19 exit survey compared with the Canadian Longitudinal Study on Aging first follow-up survey.”
The CLSA Covid-19 study was launched in mid-April of 2020, and exit questionnaires were completed between September and December of 2020. The researchers also evaluated prepandemic data from the first CLSA follow-up (2015-2018) as part of the analysis, and enrolled participants who were middle-aged and older, and community-dwelling.
Covid-19 exposures were identified using data from the Public Health Agency of Canada and the Centers for Disease Control and Prevention, and cases and non-cases were classified as confirmed or probable, suspected, or non–Covid-19.
The main study outcome was self-reported change in mobility since the start of the Covid-19 pandemic, assessed using global rating of change in mobility scales at the Covid-19 exit questionnaire.
Of the 24,114 CLSA participants who completed the Covid-19 exit questionnaire, 121 (0.6%) either had a positive Covid-19 test result (70 subjects), were classified as having probable or confirmed Covid-19, or were diagnosed with Covid-19 by a healthcare professional but did not have a confirmatory test (n=51).
During the Covid-19 pandemic, more than 1 in 4 people who completed the questionnaire (25.2%) reported worsening ability to engage in physical activity, and 5.7% reported much worse ability. In all, 2,111 (8.9%) reported worsening ability to move around the home and 1.4% reported much worse ability. And 8.6% and 1.6% reported worsening or much worse ability to engage in housework, respectively.
- After adjusting for covariants, people with confirmed or probable Covid-19 had a nearly 2-fold higher odds of reporting worsening ability to engage in household activities, compared to people without Covid-19 (adjusted odds ratio, 1.89; 95% CI, 1.11-3.22) as well as worsening ability to engage in physical activity (aOR, 1.91; 95% CI, 1.32-2.76).
- Those with suspected but unconfirmed Covid-19 had a roughly 2-fold greater likelihood of reporting worsening ability to move around the house (aOR, 2.30; 95% CI, 2.01-2.63); perform housework (aOR, 2.09; 95% CI, 1.82-2.41); or engage in physical activity (aOR, 1.78; 95% CI, 1.61-1.97).
- Older age, lower income, living in an apartment or condominium instead of a house, having three or more chronic conditions, inadequate physical activity, and poor nutritional status were all associated with worsening mobility and functional outcomes among people with confirmed or suspected Covid-19.
“These risk factors have been associated with severe Covid-19 and its complications, and our findings indicate that these risk factors are also negatively associated with physical health outcomes in community-dwelling individuals, some of whom may have mild to moderate Covid-19,” Beauchamp and co-authors wrote.
Study limitations cited by the researchers included the relatively small number of people in the cohort with confirmed or probable Covid-19, “which may have resulted in lower statistical power to examine associations for this group.” In addition, the researchers noted that people with worsening mobility may have been more likely to withdraw from the study, “which may underestimate the associations.”
The study also excluded older people living in long-term care facilities, limiting the generalizability of the findings to this group.
Funding for the support of the CLSA COVID-19 Questionnaire-based study was provided by Juravinski Research Institute, Faculty of Health Sciences, McMaster University, Provost Fund from McMaster University, McMaster Institute for Research on Aging, Public Health Agency of Canada and Government of Nova Scotia. Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) and the Canada Foundation for Innovation.
The researchers declared no relevant conflicts related to this study.
Salynn Boyles, Contributing Writer, BreakingMED™
Kaiser Health News
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.