Authors (including presenting author) :
Chan RWY, Tsui AYY, Chan JSP, Woo CW, Wong EYW, Leung KKL, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
COVID-19 pandemic and hospitalization were devastating event for elderly patients. Government statistics showed significantly high mortality rate(up to 7.25% for age of 80+) in elderly. The sequelae, prevalent long COVID, comorbid conditions and physical deconditioning would impact on the elderly survivors with significant decline in functional status and quality of life, even for the premorbid community dwelling elderly.
Objectives :
To review the impact of COVID-19 and hospitalization on functional mobility in the geriatric patients for better rehabilitation services planning
Methodology :
A retrospective review of the confirmed COVID-19 patients referring for rehabilitation at convalescent hospital was conducted with sampling from 1 August 2020 to 30 November 2022. Modified Functional Ambulation Classification(MFAC) was designed for categorization of functional ambulation ability in seven categories ranging from bedbound to independent outdoor walker. The pre-morbid, admission and discharge MFAC, and the hospital length-of-stay(LOS) were studied using descriptive/nonparametric analysis(2-tailed Kendall’s tau correlation).
Result & Outcome :
1,007 patients referred for inpatient physiotherapy were recruited for analysis during sampling period. The referral rate for Physiotherapy was 85%. There were 542 males(mean age:78.75±11.9) and 465 females(mean age:83.1±13.6) with death toll of 110. The median premorbid-MFAC was category VI(indoor walker). Upon admission to convalescence, significant decline in functional mobility to median MFAC of category III(dependent walker) was detected. High majority(92.1%) of the elders demonstrated compromised mobility(47.0% in category I/II-bed/chairbound;45.1% in category III-V-assisted walker) with only 7.8% in category VI-VII(independent walker). The average LOS in convalescence was 26.0±25.6days. Upon discharge, increased patients(14%) achieved independent walking(category VI-VII) while 25.2% elders found to have improved functional mobility. There was a significant strong relationship between discharge-MFAC with premorbid-MFAC(r=.612,p<0.01) and admission-MFAC(r=.819,p<0.01). The improvement in functional mobility was very weakly related to premorbid-MFAC(r=.136,p<0.01) and negatively to age(r=-.116,p<0.01) reflecting that elderly survivors demonstrated progress regardless of advanced age or low initial functional mobility. While recovering from COVID, some initially ambulatory elders were able to benefit from course of convalescence rehabilitation in regaining full functional mobility while half of the elderly patients had not yet been optimized to premorbid functional status. In echo with recent systematic review supporting Physiotherapy for quicker recovery, acting as protective barrier, boosting immune and respiratory system, reducing LOS & treatment cost. The long COVID or its sequelae posted continuing post-hospitalization rehabilitation needs as pressing agenda in service planning while resuming normal.
