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. 2020 Sep 12;9(9):2946.
doi: 10.3390/jcm9092946.

Care Dependency in Non-Hospitalized Patients with COVID-19

Anouk W Vaes  1 , Felipe V C Machado  1   2   3 , Roy Meys  1   2   3 , Jeannet M Delbressine  1 , Yvonne M J Goertz  1   2   3 , Maarten Van Herck  1   2   3   4 , Sarah Houben-Wilke  1 , Frits M E Franssen  1   2   3 , Herman Vijlbrief  5 , Yvonne Spies  5 , Alex J Van 't Hul  6 , Chris Burtin  4 , Daisy J A Janssen  1   7 , Martijn A Spruit  1   2   3   4
Affiliations

Care Dependency in Non-Hospitalized Patients with COVID-19

Anouk W Vaes et al. J Clin Med. .

Abstract

Background: A large sample of "mild" COVID-19 patients still experience multiple symptoms months after being infected. These persistent symptoms are associated with many clinically relevant outcomes, including poor health status and impaired functional status. To date, no information is available about care dependency. Therefore, we aimed to explore the level of care dependency and the need for assistance with personal care in non-hospitalized COVID-19 patients.

Methods: Members of two Facebook groups for COVID-19 patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, and symptoms. In addition, patients were asked about their dependence on others for personal care before and after the infection. The level of care dependency was assessed with the Care Dependency Scale (CDS) in members of the Belgian Facebook group (n = 210).

Results: The data of 1837 non-hospitalized patients (86% women; median (IQR) age: 47 (38-54)) were analyzed. Only a small proportion of patients needed help with personal care before COVID-19, but the care need increased significantly after the infection (on average 79 ± 17 days after the onset of symptoms; 7.7% versus 52.4%, respectively; p < 0.05). The patients had a median (IQR) CDS score of 72 (67-75) points, and 31% of the patients were considered as care-dependent (CDS score ≤ 68 points).

Conclusions: COVID-19 has an important impact on care dependency in non-hospitalized patients. About three months after the onset of symptoms, a considerable proportion of non-hospitalized patients were to some degree dependent on others for personal care. This indicates that the impact of COVID-19 on patients' daily lives is tremendous, and more attention is needed to identify optimal treatment strategies to restore patients' independency.

Keywords: COVID-19; activities of daily living; care dependency.

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Conflict of interest statement

F.M.E.F. reports grants and personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, grants and personal fees from Novartis, personal fees from TEVA, outside the submitted work. M.A.S. reports grants from Lung Foundation Netherlands, grants from Stichting Astma Bestrijding, grants and personal fees from Boeheringer Ingelheim, and grants and personal fees from AstraZeneca, outside the submitted work.

Figures

Figure 1
Figure 1
Need for help with personal care before and after coronavirus disease 2019. * p < 0.05 versus before infection based on the McNemar test. All (n = 1837); care-dependent: Care Dependency Scale (CDS) score ≤ 68 points (n = 65); care independent: CDS score > 69 points (n = 145).
Figure 2
Figure 2
Care Dependency Scale (CDS) item scores for care-dependent (CD) and care-independent (CI) patients; differences in the proportion of patients across different item scores were compared using the McNemar test; care-dependent: CDS score ≤ 68 points; n = 65; care-independent: CDS score > 69 points n = 145.
Figure 3
Figure 3
Symptom intensity for care-dependent (CD) and care-independent (CI) patients; care-dependent: Care Dependency Scale (CDS) score ≤ 68 points (n = 65); care-independent: CDS score > 69 points (n = 145). Symptom intensity based on Utrecht Symptom Diary score: none: 0 point; mild: 1–3 points; moderate: 4–6 points; severe: 7–9 points; and very severe: 10 points. Differences in the proportion of patients across different symptom intensity categories between the CD patients and CI patients were tested with the McNemar test.
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