Resilience in Residents: Understanding Mood Transitions Among Older Canadian Long-Term Care Residents During COVID-19

This study examined the transitions between different mood (depressive symptoms) states among residents of long-term care (LTC) homes during the first 2 waves of COVID-19. It also examined the transitions from these mood states to terminal clinical outcomes. A retrospective longitudinal analysis of older residents in Canadian LTC homes in 3 provinces from January 2010 to February 2021. Canadian LTC residents aged 65+ assessed in Alberta, British Columbia, and Ontario were divided into 2 cohorts: pre-COVID-19 (January 2010-February 2020) and COVID-19 (March 2020-February 2021), further divided into 2 subgroups: Wave 1 (March-August 2020) and Wave 2 (September-December 2020). Inclusion required admission during each period, a stay of at least 90 days, and either 2 assessments or 1 with discharge details. Residents admitted for fewer than 90 days or with only 1 assessment and no discharge data were excluded. We used a 1-step Markov multistate transition model to examine probabilities in mood transitions and the associated factors with each transition. Our primary outcome of interest was transition in mood measured by the Depression Rating Scale, which is a proxy measure for mood. Our results suggest improved mood among surviving residents during the first 2 waves of COVID-19. Compared with the pre-pandemic period, residents were more likely to transition from mild depressive symptoms to no symptoms during wave 1 [odds ratio (OR), 1.06] and wave 2 (OR, 1.08), and from moderate-severe symptoms to no symptoms during wave 1 (OR, 1.14) and wave 2 (OR, 1.14). Regardless of baseline mood, residents were more likely to be discharged home or die, and less likely to be discharged to hospital during waves 1 and 2, compared with the pre-pandemic period. COVID-19 may not have worsened LTC home residents' mood, contrary to other findings.