The Impact of COVID-19 on Functional Decline in Nursing Home Residents

Research published in the Journal of the American Geriatrics Society examines the post-acute sequelae of SARS-CoV-2 (PASC) among nursing home residents and finds that COVID-19 infection affects the trajectory of functional dependence for up to 9 months following acute infection, highlighting the need for additional rehabilitation services to mitigate functional decline. 

Limited research has been conducted on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) among residents of nursing homes (NH). PASC is characterized by a persistent decline in physical and cognitive abilities even after the acute phase of infection has resolved. 

Researchers analyzed the impact of COVID-19 on nursing home patients in a retrospective cohort study undertaken at two nursing homes in Michigan. Individuals positive for COVID-19 were identified from March 21, 2020, to October 26, 2021, while a comparison group consisted of patients who resided in the same nursing homes but were never infected during this period. The researchers utilized the Minimum Data Set to assess the changes in functional dependence (as measured by the Activity of Daily Living [ADL] composite score) and cognitive function (measured by the Brief Interview for Mental Status [BIMS]).  

By constructing linear mixed-effects models, the study aimed to estimate the short-term change in function and cognition immediately after diagnosis, as well as the long-term changes over an additional 12 months compared to the pre-COVID and non-COVID trajectories, while adjusting for sex, age, and dementia status. 

Of 171 NH residents, 90 tested positive for COVID-19, and 81 tested negative. Most of the cohort were 80 years or older (63%), mostly female (71%), and predominantly non-Hispanic White (94%). There were no significant differences in characteristics between the two groups.  

Following the COVID-19 infection, patients experienced an initial decline in functional status (-0.60 points, P = .002), but subsequent improvement towards the expected trajectory (0.04 points per month, P=.271) over the first 9 months of recovery. 

“NH residents experienced a significant functional decline that persisted for 9 months following acute infection,” said researchers. “Further research is needed to determine whether increased rehabilitation services after COVID-19 may help mitigate this decline.”  

Reference  

Clark SE, Bautista L, Neeb K, et al. Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A retrospective cohort study. Journal of the American Geriatrics Society. Published online November 10, 2023. doi: 10.1111/jgs.18678