Frailty under COVID‐19 pandemic in Japan: Changes in prevalence of frailty from 2017 to 2021

Abstract

Background After the outbreak of the coronavirus disease 2019 (COVID‐19), “pandemic‐associated‐frailty” or profound health deterioration, in older adults has been considered a health concern. In this study, we sought to demonstrate whether pandemic‐associated‐frailty is occurring in Japan, where the population is aging, by showing the prevalence of frailty before and during the COVID‐19 outbreak, using the same method. Methods A total of 5222 older adults in Otawara City, Tochigi Prefecture, aged 70 and 75 were surveyed annually using a complete survey, excluding those who were certified as requiring long‐term care. Frailty during 2017–2019 before the COVID‐19 outbreak and during 2020–2021 during the COVID‐19 outbreak was determined using the Kihon Checklist (KCL). Statistical analysis was performed using the χ2 test to compare annual frailty status and Kruskal–Wallis test to compare the scores. Results The frailty statuses over the five‐year period showed a significant decrease in Robust and a significant increase in Pre‐frailty and Frailty (p < 0.001). Frailty increased markedly during the second year of the pandemic. Based on the category, the scores deteriorated significantly for activities of daily living (p < 0.001), physical function (p = 0.003), oral function (p < 0.001), outdoor activity (p < 0.001), and depression (p < 0.001). Moreover, there was a significant deterioration in the total score for 25 items (p < 0.001). In addition, a significant deterioration was observed in the total score of 23 items, excluding the social withdrawal affected by self‐restraint life (p < 0.001). Conclusions The population prevalence of frailty in older adults increased steadily from the pre‐pandemic year through the first and second years of the pandemic. Based on the 25 questions of the KCL, two aspects including visiting friends and going out less stood out. This suggests that pandemic‐associated‐frailty occurred in Japan.

Flaws and uncertainties in pandemic global excess death calculations

“…These data are available for some populations, for example, frailty has been documented to have increased during the pandemic in Japan. 12 Changes in frailty indicators may affect calculations not only for elderly strata, but also younger ages. In some countries a large share of COVID-19 non-elderly deaths happened in young residents of LTCFs.…”

Frailty after COVID‐19: The wave after?

“…The role of COVID‐19 in the development of frailty is currently not well understood 12 . Recently, preliminary studies have shown that the prevalence of frailty in the older adult population increased in the first and second years of the pandemic compared with the prepandemic situation 23 . For example, an Italian study of nursing home residents found a 19% greater decline in grip strength and a 22% greater decline in walking speed in COVID‐19 cases compared with controls between pre‐ and post‐COVID‐19 assessments, and multivariable logistic regression showed that COVID‐19 survivors had a fourfold increased risk of developing frailty compared with controls.…”

Prevalence and factors associated with changes in frailty among community‐dwelling older adults in Japan during the COVID‐19 pandemic: A prospective cohort study from 2020 to 2022

“…[1][2][3][4][5] The transition from a usual lifestyle to one of prolonged self-restraint has been linked to an exacerbation of frailty among older adults, a condition referred to as "COVID-19 pandemic-associated frailty." 6 Frailty is characterized by a decline in physiological reserve capacity during old age, resulting in increased vulnerability to stress and a higher likelihood of transitioning to outcomes of functional impairment, states requiring long-term care, or death; however, it may be reversible through appropriate interventions that can restore a healthy state. 7,8 Indeed, reports during the COVID-19 pandemic have indicated that a subset of individuals exhibited improvement in frailty even amidst prolonged selfrestraint measures, despite initial predictions of worsening frailty.…”