Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness

Abstract

Background/objectives Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under‐studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). Design Protective observational cohort study. Setting Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. Participants A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. Measurements Influenza was laboratory‐confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100‐point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. Results Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty‐six (37.4%) had laboratory‐confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. Conclusion Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.

Tools and Techniques for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/COVID-19 Detection

“…For example, to further streamline testing for respiratory viruses, some methods have now been multiplexed to simultaneously detect SARS-CoV-2, influenza A and B viruses, and other respiratory viruses like respiratory syncytial virus (RSV). In nonpandemic years, influenza and other viral etiologies of respiratory tract infections represented a leading cause of death in North America, particularly among hospitalized patients with community-acquired pneumonia ( 547 – 553 ). Interestingly, while cocirculation and coinfection with other respiratory viruses were reported, there was little activity for non-SARS-CoV-2 respiratory viruses ( 554 ).…”

Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19

“…Given the logistical limitations of collecting data during the pandemic, we were not able to collect data on longer term outcomes, such as worsening frailty and function, which we have previously found to be important sequelae of influenza and are likely important outcomes of COVID-19. ( 39 , 40 )…”

Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study

“…A meta-analysis reported the prevalence of a loss of independence with ADL as 30% (95% CI, 24 to 33%) in acute care hospital units, despite a large heterogeneity between studies [20]. Another study has shown that moderate to catastrophic functional decline following hospitalization for influenza or acute respiratory illness was 18.2% [21]. The difference in the frequency of functional decline between our study and the previous studies may be partly due to stricter isolation to prevent the secondary infection of COVID-19 during hospitalization, which might also disturb adequate rehabilitation to maintain ADL.…”

“…ADL impairment before the onset of COVID-19, which was identified as a strong factor associated with functional decline, is also known as a risk factor for in-hospital mortality among older patients with COVID-19 [24,25]. Among patients with pneumonia or acute respiratory infection, older age, cognitive impairment, malnutrition, and baseline ADL impairment are well-known risk factors for hospital-associated disability [21,26]. Notably, the risk of functional decline at discharge was higher even in patients with mild ADL impairment before the onset of COVID-19 than in those without ADL impairment in our study.…”