Increase in frailty in nursing home survivors of COVID-19: comparison with non-infected residents

Greco, Giada Ida; Noale, Marianna; Trevisan, Caterina; Zatti, Giancarlo; Pozza, Martino Dalla; Lazzarin, Martina; Haxhiaj, Labjona; Ramon, Roberto; Imoscopi, Alessandra; Bellon, Stefano; Maggi, Stefania; Sergi, Giuseppe

Objectives Institutionalized older adults have a high prevalence of frailty and disability, which may make them more vulnerable to the negative consequences of 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 [MMSE]) 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 increase 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 MMSE scores over the study period. Multivariable logistic regression showed that COVID-19 survivors had a four-fold increased chance of developing frailty compared with controls (OR = 4.95, 95% CI: 1.13-21.6, p=0.03), 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 due to the burden of social isolation and containment measures on neuropsychological health.