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Geriatrics

Assessment of Functional Mobility After COVID-19 in Adults Aged 50 Years or Older in the Canadian Longitudinal Study on Aging

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: January 12, 2022

Original Investigation

Article Information and Disclosures

Marla K. Beauchamp, PhD^1,2,3;

Divya Joshi, PhD^2,3,4;

Jacqueline McMillan, MD^5,6;

Urun Erbas Oz, PhD⁴;

Lauren E. Griffith, PhD^2,3,4;

Nicole E. Basta, PhD⁷;

Susan Kirkland, PhD^8,9;

Christina Wolfson, PhD^7,10,11;

Parminder Raina, PhD^2,3,4,12;

for the Canadian Longitudinal Study on Aging (CLSA) Team

Author Affiliations

¹School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
²Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
³McMaster Institute for Research on Aging, McMaster University, Hamilton, Canada
⁴Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
⁵Department of Medicine, Section of Geriatric Medicine, University of Calgary, Calgary, Canada
⁶O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
⁷Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
⁸Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
⁹Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
¹⁰Department of Medicine, McGill University, Montreal, Canada
¹¹Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
¹²Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada

Canadian Longitudinal Study on Aging (CLSA) Teamfor the

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Key Points

Question What is the association of a COVID-19 diagnosis and mobility and physical function among community-living middle-aged and older Canadians during the initial pandemic lockdown in 2020?

Findings This cohort study of 24 114 participants found that community-living middle-aged and older adults with confirmed, probable, or suspected COVID-19 had nearly 2-fold higher odds of worsening mobility and physical function compared with adults without COVID-19, although most participants with COVID-19 had mild to moderate disease and were not hospitalized.

Meaning These findings suggest that individuals with mild and moderate COVID-19 who were predominantly not hospitalized experienced deficits in functional mobility compared with those without COVID-19.

Abstract

Importance The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated.

Objective To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown.

Design, Setting, and Participants This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021.

Exposures The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non–COVID-19.

Main Outcomes and Measures Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined.

Results Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 24 114 participants who completed the COVID-19 exit questionnaire, 2748 individuals had confirmed, probable or suspected COVID-19. Of 121 individuals with confirmed or probable COVID-19, 113 (93.3%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41).

Conclusions and Relevance This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.

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Article Information

Accepted for Publication: December 6, 2021.

Published: January 12, 2022. doi:10.1001/jamanetworkopen.2021.46168

Correction: This article was corrected on February 14, 2021, to fix errors in the presentation of data in the Abstract, main text, and Supplement 1.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Beauchamp MK et al. JAMA Network Open.

Corresponding Author: Parminder Raina, PhD, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 309A McMaster Innovation Park (MIP), 1280 Main St. W. Hamilton, ON L8S 4K1, Canada (praina@mcmaster.ca).

Author Contributions: Dr Raina had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Beauchamp and Joshi contributed equally as co–first authors.

Concept and design: Beauchamp, McMillan, Basta, Kirkland, Raina.

Acquisition, analysis, or interpretation of data: Beauchamp, Joshi, Erbas Oz, Griffith, Kirkland, Wolfson, Raina.

Drafting of the manuscript: Beauchamp, Joshi, McMillan, Raina.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Beauchamp, Erbas Oz, Raina.

Obtained funding: Kirkland, Wolfson, Raina.

Administrative, technical, or material support: Basta, Kirkland, Raina.

Supervision: Raina.

Conflict of Interest Disclosures: None reported.

Funding/Support: 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) under grant No. LSA 94473 and the Canada Foundation for Innovation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

The Canadian Longitudinal Study on Aging Team: The Members of the Canadian Longitudinal Study on Aging Team are listed in Supplement 2.

Disclaimer: The opinions expressed in this manuscript are the authors’ own and do not reflect the views of the Canadian Longitudinal Study on Aging.

Additional Contributions: This research was conducted using the CLSA Baseline Tracking Dataset version 3.7, Baseline Comprehensive Dataset version 5.1, Follow-up 1 Tracking Dataset version 2.2, Follow-up 1 Comprehensive Dataset version 3.0, CLSA Sample Weights Version 1.2, and COVID-19 questionnaire data under Application ID No. 21CON001. The CLSA is led by Drs. Raina, Wolfson, and Kirkland. Dr Raina holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, is the Director of the McMaster Institute for Research on Aging and the Labarge Centre for Mobility in Aging, and holds a Tier 1 Canada Research Chair in Geroscience. Dr Beauchamp holds a Tier 2 Canada Research Chair in Mobility, Aging, and Chronic Disease. Lauren Griffith is supported by the McLaughlin Foundation Professorship in Population and Public Health.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.