For months, families and operators of long-term care facilities have been telling me about the indirect toll the covid-19 pandemic has taken on residents. Not on those who have sickened or died from the virus, but on those whose quality of life has been severely harmed by the social isolation it caused. Now, we are beginning to learn more about the devastating consequences for seniors who may have been spared by the virus but suffered nonetheless.
An important new study by the research firm Mathematica for the Connecticut Dept of Public Health finds that during the early months of the pandemic, nursing home residents were significantly more likely to become depressed, lose substantial amounts of weight, suffer incontinence, and lose cognitive function. And most striking, these conditions occurred at high rates even among those residents who did not contract the virus.
Why? Isolation appears to be a significant cause. The dangers of loneliness for older adults were well-known long before the pandemic. But covid-19 forced government regulators and operators of long-term care facilities to make a difficult choice.
Last March the Trump Administration locked down facilities to reduce the aggressive spread of coronavirus. Facilities ended communal meals and activities and family visits were barred for months. This left residents with very limited human contact. The strategy likely reduced the rate of infection among residents. But the price was steep.
Last summer, a resident survey by the Altarum Program to Improve Eldercare showed the severity of covid-19-driven loneliness. Now, in an article published in the Journal of The American Medical Directors Association, the Mathematica researchers have begun to quantify the decline in resident well-being.
Depression and weight loss
They looked at about 14,000 long stay residents living in 224 Connecticut nursing homes from March through July, 2020. They analyzed weekly assessments of these residents over those four months and compared them with the status of residents just before the pandemic began. They controlled for resident characteristics and outcomes by comparing them those living in the facilities during the same period in the years 2017 to 2019.
Relative to pre-pandemic times, they found depression increased by 15 percent and substantial weight loss rose by a staggering 150 percent. Not surprisingly, much of that decline occurred among residents who contracted covid-19, but a significant share happened to residents who did not.
Another striking finding: Increases in these poor outcomes closely tracked the course of the pandemic itself, with the greatest increases from mid-April to mid-May. Once the pandemic peaked, so did the increases in depression, weight loss, and most other conditions.
Some good news
The pattern of accelerating cognitive decline was equally troublesome, but it came with a bit of good news: The increases largely faded with time so that by mid-May, as facilities began to allow limited outdoor visits, for example, memory loss returned to pre-pandemic levels.
While nursing facilities faced enormous staffing challenges that may have led to some of these negative outcomes, other health conditions ordinarily tied to shortages of care workers did not increase above pre-pandemic levels. For example, the researchers found little difference in falls, urinary tract infections, or severe pressure ulcers—a frequent result of poor care—during the height of the pandemic than prior to the outbreak.
The study raises many important and interesting questions. For example, it focused on nursing homes because staff are required to perform regular assessments of residents—a data gold mine for researchers. But did frail older adults living at home or in other congregate settings such as assisted living suffer similar declines in health status during the pandemic? How much variation was there among facilities? And were there any patterns we can learn from?
This Connecticut study is likely to be the first of many looking at the health effects of the pandemic on older adults who did not contract covid-19. And there is much more to learn. But these findings confirm what families and staff have known for months: Covid-19 has been a terrible disease, even for those who avoided the virus itself. And it may teach government and facilities operators an important lesson: While infection control is really important, it isn’t everything. Quality of life matters too.