# Health service use and work related outcomes in older adults with functional and cognitive impairments during the COVID-19 pandemic

## TL;DR

This study examines how older adults with functional and cognitive impairments were affected by the pandemic in terms of health service use and work outcomes.

## Contribution

The study investigates whether prior COVID-19 infection interacts with pre-existing impairments in older adults during the pandemic.

## Key findings

- Older adults with severe functional limitations were more likely to use health services, regardless of their COVID-19 history.
- There was no significant interaction between baseline impairments and COVID-19 history for health services use or work outcomes.
- Hospitalizations and nursing home stays were more common among those with functional limitations, but not significantly linked to prior infection.

## Abstract

The COVID-19 pandemic had a lasting global health impact, with many survivors facing Long Covid. Older adults, already vulnerable to disability and cognitive decline, may also experience long-term challenges after COVID-19 infection. This study explores whether a history of COVID-19 infection interacts with pre-existing impairments in older adults, focusing on its effects on health services and work-related outcomes.

This longitudinal cohort study used data from the Health and Retirement Study (HRS), spanning 2018 to 2022. Participants ≥ 50 years old in 2018 with documented functional and cognitive status scores and self-reported presence or absence of COVID-19 infection were included. Functional status was assessed using the Functional Limitation score, and cognitive status using the Crimmins cognitive scale or Langa scale if the HRS respondents were represented by a proxy. Health services use and work outcomes were evaluated using the 2022 HRS survey. Multivariable logistic regression models examined the association between baseline functional and cognitive status and outcomes, controlling for COVID-19 history, 2018 functional or cognitive status, age, gender, marital status, number of chronic conditions, household size, graduation from high school, and self-report of COVID-19 vaccination.

The study included 8,621 respondents. Those with severe functional limitations in 2018 were more likely to report health services use in 2022, irrespective of COVID-19 history. COVID-19 history did not significantly interact with baseline functional or cognitive impairments when evaluating health services use, ability to work, or disability benefit access. While older adults with moderate or severe functional limitations were more likely to report hospitalizations and nursing home stays, these outcomes were not significantly different based on COVID-19 history.

In this cohort of older adults, the relationship between baseline functional and cognitive impairment with health services use, ability to work, or disability benefit access did not significantly vary by self-reported COVID-19 infection history. While COVID-19 may have long-term impacts on older populations, our data suggest that infection history alone did not amplify the effects of pre-existing impairments in those who survived the pandemic. Further research using validated measures of persistent symptoms is needed to understand how Long Covid may manifest in older adults.

The online version contains supplementary material available at 10.1186/s12889-025-25129-2.