Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents.
Methods
Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers.
Results
Mini Nutritional Assessment test scores decreased in 20% throughout the confinement (p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement (p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival.
Conclusion
After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.
AdamE. K.HawkleyL. C.KudielkaB. M.CacioppoJ. T. (2006). Day-to-day dynamics of experience-cortisol associations in a population-based sample of older adults. Proceedings of the National Academy of Sciences of the United States of America, 103(45), 17058–17063. https://doi.org/10.1073/pnas.0605053103
2.
BabiarczykB.TurbiarzA. (2012). Body mass index in elderly people - do the refernce ranges matter?Progress in Health Sciences, 2(1), 58–67.
3.
BakkerE. D.van der PasS. L.ZwanM. D.GillissenF.BouwmanF. H.ScheltensP.van der FlierW. M.van MaurikI. S. (2023). Steeper memory decline after COVID-19 lockdown measures. Alzheimer’s Research and Therapy, 15(1), 81. https://doi.org/10.1186/S13195-023-01226-5
4.
Cabrero-GarcíaJ.Muñoz-MendozaC. L.Cabañero-MartínezM. J.González-LlopísL.Ramos-PichardoJ. D.Reig-FerrerA. (2012). Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Atencion Primaria, 44(9), 540–548. https://doi.org/10.1016/j.aprim.2012.02.007
5.
CecilianiF.GiordanoA.SpagnoloV. (2002). The systemic reaction during inflammation: The acute-phase proteins. Protein and Peptide Letters, 9(3), 211–223. https://doi.org/10.2174/0929866023408779
6.
CederholmT.BarazzoniR.AustinP.BallmerP.BioloG.BischoffS. C.CompherC.CorreiaI.HigashiguchiT.HolstM.JensenG. L.MaloneA.MuscaritoliM.NyulasiI.PirlichM.RothenbergE.SchindlerK.SchneiderS. M.de van der SchuerenM. A. E.SingerP. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49–64. https://doi.org/10.1016/j.clnu.2016.09.004
7.
CederholmT.BosaeusI.BarazzoniR.BauerJ.Van GossumA.KlekS.MuscaritoliM.NyulasiI.OckengaJ.SchneiderS. M.de van der SchuerenM. A. E.SingerP. (2015). Diagnostic criteria for malnutrition - an ESPEN consensus statement. Clinical Nutrition, 34(3), 335–340. https://doi.org/10.1016/j.clnu.2015.03.001
8.
CesariM.KritchevskyS. B.PenninxB. W. H. J.NicklasB. J.SimonsickE. M.NewmanA. B.TylavskyF. A.BrachJ. S.SatterfieldS.BauerD. C.VisserM.RubinS. M.HarrisT. B.PahorM. (2005). Prognostic value of usual gait speed in well-functioning older people–results from the health, aging and body composition study. Journal of the American Geriatrics Society, 53(10), 1675–1680. https://doi.org/10.1111/J.1532-5415.2005.53501.X
9.
DentE.KowalP.HoogendijkE. O. (2016). Frailty measurement in research and clinical practice: A review. European Journal of Internal Medicine, 31(1), 3–10. https://doi.org/10.1016/J.EJIM.2016.03.007
10.
EvansP. D.FredhoiC.LovedayC.HucklebridgeF.AitchisonE.ForteD.ClowA. (2011). The diurnal cortisol cycle and cognitive performance in the healthy old. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 79(3), 371–377. https://doi.org/10.1016/J.IJPSYCHO.2010.12.006
11.
FieldingR. A.GuralnikJ. M.KingA. C.PahorM.McDermottM. M.Tudor-LockeC.ManiniT. M.GlynnN. W.MarshA. P.AxtellR. S.HsuF. C.RejeskiW. J.LIFE study group. (2017). Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial. PloS One, 12(8), e0182155. https://doi.org/10.1371/JOURNAL.PONE.0182155
12.
FriedL. P.TangenC. M.WalstonJ.NewmanA. B.HirschC.GottdienerJ.SeemanT.TracyR.KopW. J.BurkeG.McBurnieM. A.HeC.alth Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), M146–M156. https://doi.org/10.1093/gerona/56.3.m146, http://www.ncbi.nlm.nih.gov/pubmed/11253156
13.
FriesE.DettenbornL.KirschbaumC. (2009). The cortisol awakening response (CAR): Facts and future directions. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 72(1), 67–73. https://doi.org/10.1016/J.IJPSYCHO.2008.03.014
14.
GaffeyA. E.BergemanC. S.ClarkL. A.WirthM. M. (2016). Aging and the HPA axis: Stress and resilience in older adults. Neuroscience and Biobehavioral Reviews, 68, 928–945. https://doi.org/10.1016/J.NEUBIOREV.2016.05.036
15.
García-GollarteJ. F.García-AndradeM. M.Santaeugenia-GonzálezS. J.Solá HermidaJ. C.Baixauli-AlacreuS.SantabalbinaF. J. T.SantabalbinaF. J. T. (2020). Risk factors for mortality in nursing home residents: An observational study. Geriatrics (Basel, Switzerland), 5(4), 71. https://doi.org/10.3390/geriatrics5040071
16.
García-PrietoM. D.TébarF. J.NicolásF.LarquéE.ZamoraS.GarauletM. (2007). Cortisol secretary pattern and glucocorticoid feedback sensitivity in women from a mediterranean area: Relationship with anthropometric characteristics, dietary intake and plasma fatty acid profile. Clinical Endocrinology, 66(2), 185–191. https://doi.org/10.1111/j.1365-2265.2006.02705.x
17.
GardnerM.LightmanS.KuhD.ComijsH.DeegD.GallacherJ.GeoffroyM. C.KivimakiM.KumariM.PowerC.HardyR.RichardsM.Ben-ShlomoY. (2019). Dysregulation of the hypothalamic pituitary adrenal (HPA) axis and cognitive capability at older ages: Individual participant meta-analysis of five cohorts. Scientific Reports, 9(1), 4555. https://doi.org/10.1038/s41598-019-40566-x
18.
GarnerI. W.VareyS.Navarro-PardoE.MarrC.HollandC. A. (2022). An observational cohort study of longitudinal impacts on frailty and well-being of COVID-19 lockdowns in older adults in England and Spain. Health and Social Care in the Community, 30(5), Article e2905-e2916. https://doi.org/10.1111/hsc.13735
19.
GonzálezN.BilbaoA.ForjazM. J.AyalaA.OriveM.Garcia-GutierrezS.HayasC.QuintanaJ. M.OFF Older Falls Fracture-IRYSS group. (2018). Psychometric characteristics of the Spanish version of the Barthel index. Aging Clinical and Experimental Research, 30(5), 489–497. https://doi.org/10.1007/s40520-017-0809-5
20.
GrecoG. I.NoaleM.TrevisanC.ZattiG.Dalla PozzaM.LazzarinM.HaxhiajL.RamonR.ImoscopiA.BellonS.MaggiS.SergiG. (2021). Increase in frailty in nursing home survivors of coronavirus disease 2019: Comparison with noninfected residents. Journal of the American Medical Directors Association, 22(5), 943–947. https://doi.org/10.1016/J.JAMDA.2021.02.019
HeaneyJ. L. J.PhillipsA. C.CarrollD. (2010). Ageing, depression, anxiety, social support and the diurnal rhythm and awakening response of salivary cortisol. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 78(3), 201–208. https://doi.org/10.1016/J.IJPSYCHO.2010.07.009
23.
HekK.DirekN.NewsonR. S.HofmanA.HoogendijkW. J. G.MulderC. L.TiemeierH. (2013). Anxiety disorders and salivary cortisol levels in older adults: A population-based study. Psychoneuroendocrinology, 38(2), 300–305. https://doi.org/10.1016/J.PSYNEUEN.2012.06.006
24.
HidalgoV.AlmelaM.PulopulosM. M.SalvadorA. (2016). Memory performance is related to the cortisol awakening response in older people, but not to the diurnal cortisol slope. Psychoneuroendocrinology, 71, 136–146. https://doi.org/10.1016/J.PSYNEUEN.2016.05.019
HopfD.SchneiderE.Aguilar-RaabC.ScheeleD.DitzenB.EcksteinM. (2022). Loneliness and diurnal cortisol levels during COVID-19 lockdown: The roles of living situation, relationship status and relationship quality. MedRxiv, 12, 15076. https://doi.org/10.1101/2022.02.25.22271461
27.
Instituto Nacional de Estadística. (n.d.). Proporción de personas mayores de cierta edad por provincia(1488). Retrieved from July 23, 2022, https://www.ine.es/jaxiT3/Tabla.htm?t=1488
28.
JoharH.EmenyR. T.BidlingmaierM.ReinckeM.ThorandB.PetersA.HeierM.LadwigK.-H. (2014). Blunted diurnal cortisol pattern is associated with frailty: A cross-sectional study of 745 participants aged 65 to 90 years. The Journal of Clinical Endocrinology and Metabolism, 99(3), Article E464–E468. https://doi.org/10.1210/jc.2013-3079
29.
Jukic PeladicN.OrlandoniP.Dell’AquilaG.CarrieriB.EusebiP.LandiF.VolpatoS.ZulianiG.LattanzioF.CherubiniA. (2019). Dysphagia in nursing home residents: Management and outcomes. Journal of the American Medical Directors Association, 20(2), 147–151. https://doi.org/10.1016/j.jamda.2018.07.023
30.
KarinO.RazM.TendlerA.BarA.Korem KohanimY.MiloT.AlonU. (2020). A new model for the HPA axis explains dysregulation of stress hormones on the timescale of weeks. Molecular Systems Biology, 16(7), Article e9510. https://doi.org/10.15252/MSB.20209510
31.
KubotaK.KadomuraT.OhtaK.KoyamaK.OkudaH.KobayashiM.IshiiC.FujiwaraY.NishioraT.OhmaeY.OhmaeT.KitajimaM. (2012). Analyses of laboratory data and establishment of reference values and intervals for healthy elderly people. The Journal of Nutrition, Health and Aging, 16(4), 412–416. https://doi.org/10.1007/s12603-011-0355-3
32.
LippiG.PlebaniM. (2020). Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine, 58(7), 1131–1134. https://doi.org/10.1515/cclm-2020-0198
33.
MerchantR. A.SeetharamanS.AuL.WongM. W. K.WongB. L. L.TanL. F.ChenM. Z.NgS. E.SoongJ. T. Y.HuiR. J. Y.KwekS. C.MorleyJ. E. (2021). Relationship of fat mass index and fat free mass index with body mass index and association with function, cognition and sarcopenia in pre-frail older adults. Frontiers in Endocrinology, 12, 765415. https://doi.org/10.3389/fendo.2021.765415
34.
Monarque-FavardC.GarciaI.AbidiH.BannierE.RiviereJ.DraiJ.BonnefoyM. (2002). Malnourished elderly people and lipid status. The Journal of Nutrition, Health and Aging, 6(6), 370–374.
35.
MorleyJ. E.MalmstromT. K.MillerD. K. (2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middel aged African Americans. The Journal of Nutrition, Health and Aging, 16(7), 601–608. https://doi.org/10.1007/S12603-012-0084-2
36.
OliveiraA. C. D. S.GallegoM. G.MartínezC. G.MartínezE. C.MolinaJ. M.MoranteJ. J. H.PérezP. E. (2023). Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: A prospective observational study. BMC Geriatrics, 23(1), 71–79. https://doi.org/10.1186/s12877-023-03764-x
37.
O’NeillD.BriggsR.HolmerováI.SamuelssonO.GordonA. L.MartinF. C.Special Interest Group in Long Term Care of the European Geriatric Medicine Society. (2020). COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. European Geriatric Medicine, 11(4), 645–650. https://doi.org/10.1007/S41999-020-00347-6
38.
Parra-RodríguezL.SzlejfC.García-GonzálezA. I.MalmstromT. K.Cruz-ArenasE.Rosas-CarrascoO. (2016). Cross-cultural adaptation and validation of the Spanish-language version of the SARC-F to assess sarcopenia in Mexican community-dwelling older adults. Journal of the American Medical Directors Association, 17(12), 1142–1146. https://doi.org/10.1016/J.JAMDA.2016.09.008
39.
PulopulosM. M.Puig-PerezS.HidalgoV.VilladaC.SalvadorA. (2016). Cortisol awakening response and walking speed in older people. PloS One, 11(5), Article e0152071. https://doi.org/10.1371/JOURNAL.PONE.0152071
40.
RitzP. (2009). Should we be using new diagnostic criteria? In the journal of nutrition, health and aging. Editorial: Obesity in the elderly, 13(3), 168–169. https://doi.org/10.1007/s12603-009-0052-7
41.
RizkaA.IndrarespatiA.DwimartutieN.MuhadiM. (2021). Frailty among older adults living in nursing homes in Indonesia: Prevalence and associated factors. Annals of Geriatric Medicine and Research, 25(2), 93–97. https://doi.org/10.4235/agmr.21.0033
42.
RobinsonR. (2015). Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older. PeerJ, 3(1), Article e1181. https://doi.org/10.7717/peerj.1181
SheQ.ChenB.LiM.ZhaoH.ZhaoW.PengZ.WuJ. (2021). Effect of poor nutritional status and comorbidities on the occurrence and outcome of pneumonia in elderly adults. Frontiers in Medicine, 8, 719530. https://doi.org/10.3389/fmed.2021.719530
46.
Sánchez TorralvoF. J.PorrasN.Abuín FernándezJ.García TorresF.TapiaM. J.LimaF.SoriguerF.GonzaloM.Rojo MartínezG.OlveiraG.OlveiraG. (2018). Normative reference values for hand grip dynamometry in Spain. Association with lean mass. Nutricion Hospitalaria, 35(1), 98–103. https://doi.org/10.20960/nh.1052
TeixeiraD.Longo-MaugeriI. M.SantosJ. L. F.DuarteY. A. O.LebrãoM. L.BuenoV. (2011). Evaluation of lymphocyte levels in a random sample of 218 elderly individuals from São Paulo city. Revista Brasileira de Hematologia e Hemoterapia, 33(5), 367–371. https://doi.org/10.5581/1516-8484.20110100
49.
ThielA.AltmeierD.FrahsaA.EschweilerG. W.NießA.SudeckG.BaSAlt Study Team. (2021). Saving lives through life-threatening measures? The COVID-19 paradox of infection prevention in long-term care facilities. European Review of Aging and Physical Activity: Official Journal of the European Group for Research Into Elderly and Physical Activity, 18(1), 11, https://doi.org/10.1186/s11556-021-00265-x
50.
United Nations. (2020). Policy brief: The impact of COVID-19 on older persons. United Nations Sustainable Development Group, 5, 1–16.
51.
VellasB.GuigozY.GarryP. J.NourhashemiF.BennahumD.LauqueS.AlbaredeJ. L. (1999). The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition, 15(2), 116–122. https://doi.org/10.1016/S0899-9007(98)00171-3
52.
WangH.LiT.BarbarinoP.GauthierS.BrodatyH.MolinuevoJ. L.XieH.SunY.YuE.TangY.WeidnerW.YuX. (2020a). Dementia care during COVID-19. Lancet (London, England), 395(10231), 1190–1191. https://doi.org/10.1016/S0140-6736(20)30755-8
53.
WangJ.MaxwellC. A.YuF. (2019). Biological processes and biomarkers related to frailty in older adults: A state-of-the-science literature review. Biological Research for Nursing, 21(1), 80–106. https://doi.org/10.1177/1099800418798047
54.
WangJ.YangW.PanL.JiJ. S.ShenJ.ZhaoK.YingB.WangX.ZhangL.WangL.ShiX. (2020b). Prevention and control of COVID-19 in nursing homes, orphanages, and prisons. Environmental pollution (barking, Essex : 1987), 266(Pt 1), 115161. https://doi.org/10.1016/J.ENVPOL.2020.115161
WuC.ChenX.CaiY.XiaJ.ZhouX.XuS.HuangH.ZhangL.ZhouX.DuC.ZhangY.SongJ.WangS.ChaoY.YangZ.XuJ.ZhouX.ChenD.XiongW.SongY. (2020). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in wuhan, China. JAMA Internal Medicine, 180(7), 934–943. https://doi.org/10.1001/JAMAINTERNMED.2020.0994
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
