Observational Study

. 2024 Dec;72(12):3800-3809.

doi: 10.1111/jgs.19255. Epub 2024 Nov 9.

Change in frailty among older COVID-19 survivors

Benjamin Seligman^{1

2}, Katherine D Wysham^{3

4

5}, Troy Shahoumian⁶, Ariela R Orkaby^{7

8}, Matthew Bidwell Goetz^{9

10}, Thomas F Osborne^{11

12}, Valerie A Smith^{13

14

15}, Matthew L Maciejewski^{13

14

15}, Denise M Hynes^{16

17

18}, Edward J Boyko³, George N Ioannou^{3

19}

Affiliations

¹ Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.
² Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³ VA Puget Sound Healthcare System, Seattle, Washington, USA.
⁴ Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
⁵ Geriatric Research, Education, and Clinical Center, VA Puget Sound, Seattle, Washington, USA.
⁶ Population Health Informatics, Digital Health, Veterans Health Administration, Washington, DC, USA.
⁷ New England Geriatric Research, Education, and Clinical Center, VA Boston Health Care System, Boston, Massachusetts, USA.
⁸ Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Division of Infectious Diseases, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
¹¹ US Department of Veterans Affairs, Palo Alto Healthcare System, Palo Alto, California, USA.
¹² Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
¹³ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
¹⁴ Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
¹⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.
¹⁶ Center to Improve Veteran Involvement in Care, (CIVIC), VA Portland Healthcare System, Portland, Oregon, USA.
¹⁷ College of Health, Oregon State University, Corvallis, Oregon, USA.
¹⁸ School of Nursing, Oregon Health and Science University, Portland, Oregon, USA.
¹⁹ Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 39520139
PMCID: PMC11684395 (available on 2025-12-01)
DOI: 10.1111/jgs.19255

Observational Study

Change in frailty among older COVID-19 survivors

Benjamin Seligman et al. J Am Geriatr Soc. 2024 Dec.

. 2024 Dec;72(12):3800-3809.

doi: 10.1111/jgs.19255. Epub 2024 Nov 9.

Authors

Affiliations

¹ Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.
² Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
³ VA Puget Sound Healthcare System, Seattle, Washington, USA.
⁴ Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
⁵ Geriatric Research, Education, and Clinical Center, VA Puget Sound, Seattle, Washington, USA.
⁶ Population Health Informatics, Digital Health, Veterans Health Administration, Washington, DC, USA.
⁷ New England Geriatric Research, Education, and Clinical Center, VA Boston Health Care System, Boston, Massachusetts, USA.
⁸ Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Division of Infectious Diseases, VA Greater Los Angeles Health Care System, Los Angeles, California, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
¹¹ US Department of Veterans Affairs, Palo Alto Healthcare System, Palo Alto, California, USA.
¹² Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
¹³ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
¹⁴ Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.
¹⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.
¹⁶ Center to Improve Veteran Involvement in Care, (CIVIC), VA Portland Healthcare System, Portland, Oregon, USA.
¹⁷ College of Health, Oregon State University, Corvallis, Oregon, USA.
¹⁸ School of Nursing, Oregon Health and Science University, Portland, Oregon, USA.
¹⁹ Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 39520139
PMCID: PMC11684395 (available on 2025-12-01)
DOI: 10.1111/jgs.19255

Abstract

Introduction: COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one-disease-at-a-time approach. We investigated whether COVID-19 was associated with change in frailty among older Veterans.

Methods: Data were from the Veterans Affairs (VA) COVID-19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID-19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those <50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA-FI). We assessed the number of new VA-FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID-19 cases versus controls during follow-up.

Results: We identified 91,338 COVID-19-infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3-74.2), 5% were female, 71% were White, and baseline VA-FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0-2) for infected and 0 (0-1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52-1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%).

Discussion: We found a greater increase in frailty among older Veterans with COVID-19 compared with matched uninfected controls, suggesting that COVID-19 infection has long-term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population.

Keywords: COVID‐19; frailty; function; veterans.

Published 2024. This article is a U.S. Government work and is in the public domain in the USA.

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Conflict of interest statement

Conflict of Interest Statement:

The authors have no conflicts of interest to report. The sponsors played no role in the design, methods, analysis, or preparation of the manuscript.

References

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Change in frailty among older COVID-19 survivors

Affiliations

Change in frailty among older COVID-19 survivors

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous