Post‐acute sequelae of SARS‐CoV‐2 (PASC) in nursing home residents: A retrospective cohort study

Abstract

BackgroundPost‐acute sequelae of SARS‐CoV‐2 (PASC) describes a syndrome of physical and cognitive decline that persists after acute symptoms of infection resolve. Few studies have explored PASC among nursing home (NH) residents.MethodsA retrospective cohort study was conducted at two NHs in Michigan. COVID‐positive patients were identified from March 21, 2020 to October 26, 2021. The comparison group were patients who lived at the same NH but who were never infected during the study period. Minimum Data Set was used to examine trajectories of functional dependence (Activity of Daily Living [ADL] composite score) and cognitive function (Brief Interview for Mental Status [BIMS]). Linear mixed‐effects models were constructed to estimate short‐term change in function and cognition immediately following diagnosis and over time for an additional 12 months, compared to pre‐COVID and non‐COVID trajectories and adjusting for sex, age, and dementia status.ResultsWe identified 171 residents (90 COVID‐19 positive, 81 non‐COVID) with 719 observations for our analyses. Cohort characteristics included: 108 (63%) ≥ 80 yrs.; 121 (71%) female; 160 (94%) non‐Hispanic white; median of 3 comorbidities (IQR 2–4), with no significant differences in characteristics between groups. COVID‐19 infection affected the trajectory of ADL recovery for the first 9 months following infection, characterized by an immediate post‐infection decrease in functional status post‐infection (−0.60 points, p = 0.002) followed by improvement toward the expected functional trajectory sans infection (0.04 points per month following infection, p = 0.271).ConclusionsNH residents experienced a significant functional decline that persisted for 9 months following acute infection. Further research is needed to determine whether increased rehabilitation services after COVID‐19 may help mitigate this decline.

The Value of the COVID-19 Yorkshire Rehabilitation Scale in the Assessment of Post-COVID among Residents of Long-Term Care Facilities

“…Functioning is one of the primarily impaired aspects of post-COVID sequelae and was extensively studied before in a population of residents of long-term facilities [12,13,19]. Older patients more frequently reported mobility and ADL impairments [23].…”

“…Knowledge about post-COVID in older adults, especially those with the most advanced age, complex disabilities, and frailty, is scant [18]. This also concerns the population of residents of long-term facilities who experience rapid and significant functional decline following infection and disabilities persisting from a few to several months [12,13,19]. Investigating delayed COVID-19 effects on long-term care residents requires careful attention to their intricate health issues and varied physical, psychological, and social needs.…”