Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces

TitleFunctional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces
Publication TypeJournal Article
Year of Publication2024
AuthorsEgbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP
JournalJournal of the American Medical Directors Association
Volume25
Issue2
Pagination282-289
ISBN Number1538-9375
Accession Number37839468
Keywords*COVID-19/epidemiology, *Long-Term Care, Activities of Daily Living, Aged, aging, cohort study, COVID-19, functional decline, Humans, InterRAI, Long-Term Care, Longitudinal Studies, Ontario/epidemiology, Pandemics
Abstract

We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.

DOI10.1016/j.jamda.2023.09.007
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Disclosure The authors declare no conflicts of interest.