Increase in Frailty in Nursing Home Survivors of Coronavirus Disease 2019: Comparison With Noninfected Residents

Abstract

Objectives: Institutionalized older adults have a high prevalence of frailty and disability, which may make them more vulnerable to the negative consequences of coronavirus disease 2019 (COVID-19). We investigated the impact of COVID-19 on the level of frailty, physical, and cognitive performance in nursing home residents.

Design: Nested case-control study.

Setting and participants: The study included nursing home residents who were infected with COVID-19 (case group, n = 76), matched by age to a control group (n = 76).

Methods: Participants' sociodemographic and medical data were collected, and they were also assessed for physical function (handgrip and walking speed), cognitive performance (Mini-Mental State Examination) and frailty (Frail-NH scale) before the first wave of the COVID-19 pandemic (October to December 2019, pre-COVID-19) and after (June to July 2020, post-COVID-19). COVID-19 symptoms and clinical course were recorded for the cases.

Results: Between the pre- and post-COVID-19 assessments, we found a 19% greater deterioration in handgrip, a 22% greater decrease in walking speed, and a 21% greater increase in Frail-NH scores in cases compared with controls. In both cases and controls, on the other hand, there was a significant 10% decrease in Mini-Mental State Examination scores over the study period. Multivariable logistic regression showed that COVID-19 survivors had a 4-fold increased chance of developing frailty compared with controls (odds ratio 4.95, 95% confidence interval 1.13-21.6, P = .03), but not cognitive decline.

Conclusions and implications: COVID-19 can accelerate the aging process of institutionalized older adults in terms of physical performance and frailty by around 20%. However, we found similar levels of decline in cognitive performance in both cases and controls, likely because of the burden of social isolation and containment measures on neuropsychological health.

Keywords: COVID-19; aged; frailty; nursing homes; physical functional performance.

Supplementary Fig. 1

Flow chart of the study.

Supplementary Fig. 2

Changes in cognitive status (A) and frailty (B) in cases and controls from the pre- to the post-COVID-19 assessments. Figures show the estimated mean changes from the pre-COVID-19 (time 0) to the post-COVID-19 phases (time 1) for MMSE and the Frail-NH scale. Error bars are SE. The percentage shown in (B)indicates the difference between cases and controls in the mean Frail-NH score changes. SE, standard error.

Supplementary Fig. 3

Changes in handgrip strength (A) and walking speed (B) in cases and controls from the pre- to the post-COVID-19 assessments. Figures illustrate the estimated mean changes from the pre-COVID-19 (time 0) to the post-COVID-19 phase (time 1) for handgrip and walking speed. Error bars are SE. Percentages indicate the differences between cases and controls in the mean handgrip and walking speed changes. SE, standard error.