Post-COVID-19 recovery and geriatric rehabilitation care: a European inter-country comparative study

Abstract

COVID-19; Rehabilitació geriàtrica; Recuperació

COVID-19; Rehabilitación geriátrica; Recuperación

COVID-19; Geriatric rehabilitation; Recovery

Purpose: There is variation in organization of geriatric rehabilitation across Europe. The purpose of this study was to describe the selection criteria for referral to geriatric rehabilitation, care provided, and recovery trajectories of post-COVID-19 patients referred to geriatric rehabilitation in Europe. Methods: This observational cohort study included 723 patients in 59 care facilities for geriatric rehabilitation across 10 countries. Patient data were collected from medical records on admission to geriatric rehabilitation (between September 2020 and October 2021), discharge, 6 weeks and 6 months follow-up. The primary and secondary outcomes were recovery in daily functioning (Barthel Index) and Quality of Life (EQ-5D-5L) from admission to discharge. These were examined using linear mixed models with two levels (measurements nested in patients) and country as an independent variable. Random intercept and random linear slope parameters were added when they improved model fit. A survey about organization of geriatric rehabilitation for post-COVID-19 patients was filled out by country coordinators and data were analyzed using descriptive statistics and inductive coding of answers to open questions. Results: Patients had a mean age of 75.7 years old and 52.4% were male. Many countries used various combinations of the selection criteria, such as functional status, age, frailty, Comprehensive Geriatric Assessment, comorbidities, and cognitive impairments. Most patients received physiotherapy (88.8%) and occupational therapy (69.7%), but there was substantial variance between countries in the percentages of patients that received protein or calorie enriched diets, oxygen therapy, and other treatment components. In all countries, patients showed recovery in daily functioning and quality of life, although there was variation in between countries in rate of recovery. Daily functioning seemed to increase most rapidly in the Czech Republic, Germany, and Russia. The steepest increases in quality of life were seen in the Czech Republic, Germany, and Spain. Conclusion: Post-COVID-19 patients showed recovery during geriatric rehabilitation, albeit at variable rates. The observed variation may be explained by the heterogeneity in selection criteria and care provided. This study highlights the need for harmonization of measurements in geriatric rehabilitation order to perform explanatory research and optimize geriatric rehabilitation throughout Europe to ensure optimal patient recovery.

This study was partly funded by the Leiden University Fund (Leiden Empowerment Fund, grant number LEF2106-2-47). This work was supported by Zorg Onderzoek Nederland en Medische Wetenschappen (ZonMw), first, to the COVID-19 Outcomes in Older People (COOP) study (project number 10430102110005) under the COVID-19 program, and second, to the University Network of the Care sector SouthHolland (UNC-ZH) (grant number 640001003). Adam Gordon is part funded by the UK National Institute of Health Research Academic Research Collaboration-East Midlands (ARC-EM) and is an NIHR Senior Investigator. The views expressed are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. The funders had no role in the study design; in the collection, analysis, and interpretation of the data in the writing of the report; and in the decision to submit the article for publication.