Moreno-Martin Pau, Minobes-Molina Eduard, Escribà-Salvans Anna, Oliveira Vinicius Rosa, Rierola-Fochs Sandra, Farrés-Godayol Pau, Gràcia-Micó Pol, de Souza Dyego Leandro Bezerra, Skelton Dawn A, Jerez-Roig Javier
Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), Vic, Spain.
Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil.
J Geriatr Phys Ther. 2025;48(2):98-110. doi: 10.1519/JPT.0000000000000418. Epub 2024 Aug 15.
The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity.
A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression.
The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6 months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline.
A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.
新冠疫情引发了人们对养老院居民福祉的担忧，近期研究表明在此关键时期功能衰退率显著上升。然而，疫情期间养老院居民功能能力轨迹的全面探索仍未开展。本研究旨在通过深入分析新冠疫情对养老院居民功能能力的影响来填补这一研究空白。
一项为期24个月的多中心前瞻性研究，涉及来自西班牙的123名养老院居民，在疫情开始前启动，分5个阶段每隔6个月收集一次数据。使用改良巴氏指数评估功能能力，并采用精算方法、对数秩检验和考克斯回归分析数据。
维持功能能力的可能性不容乐观，巴氏评分下降1分（FD-1）时保持功能的几率仅为19.3%，下降10分（FD-10）时为50.5%。个人卫生、进食和如厕被确定为受影响最大的日常生活活动。尿失禁下降是FD-1的一个风险因素，而粪失禁下降与FD-10相关。疫情最初6个月维持功能能力的概率与非疫情期间2年的随访相当。疫情引发的隔离策略对如厕和个人卫生产生了重大影响。尿失禁下降与轻微功能衰退（FD-1）相关，而粪失禁下降与严重功能衰退（FD-10）相关。值得注意的是，房间禁闭的天数对观察到的功能衰退没有显著影响。
发现与疫情前相比，新冠疫情期间养老院居民功能衰退风险大幅增加。实施紧急、有针对性的干预措施至关重要，这些措施应优先促进身体活动以及实施移动和如厕计划。这些措施对于减轻功能衰退以及在疫情背景下提高养老院居民的整体健康和福祉至关重要。
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