Families of nursing home residents have spent the past year appealing to policymakers that COVID-19 lockdowns were having a significantly negative effect on their loved ones’ health — and a new study put some sobering numbers on the physical impact of loneliness.
The proportion of residents experiencing unexpected weight loss accelerated by 150% during the pandemic, while the prevalence of depressive symptoms grew by 15%, according to a new study published in JAMDA, the Journal of the American Medical Directors Association.
“These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents,” the researchers concluded. “Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.”
The analysis was published the same month that the Centers for Medicare & Medicaid Services (CMS) lifted a blanket ban on non-essential indoor visits to nursing facilities that had been in place since March 13, 2020.
“Our findings suggest that loneliness and isolation play an important role,” the researchers noted.
What began as an emergency short-term measure to curb the spread of the novel coronavirus among the most vulnerable extended into a nearly year-long separation. While outdoor visits were eventually allowed under CMS guidance, normal everyday interactions inside facilities were severely limited, and often subject to state-level bans based on positive test results among residents and staff.
The study, funded by the Connecticut Department of Public Health and conducted by third-party analytics firm Mathematica, focused on resident assessment data from 224 nursing facilities across Connecticut. Using information from 2017 to 2020, the Mathematica team was able to compare a series of pre-pandemic health metrics against the results during early days of the crisis on the East Coast.
Prior to the pandemic, for instance, about 45% of residents reported having depressive symptoms — a figure that rose by six percentage points by mid-May 2020, or a relative increase of 15%, according to the researchers. The rate of depressive symptoms fell thereafter, which coincided with declines in cases and the opening of outdoor visits, the Mathematica team observed.
The team found an even more drastic trend around unexpected weight loss, a key risk factor for hospitalization and death.
“Weight loss started to slowly increase in mid-April — the height of the pandemic,” the team noted. “Each week in June and July, the six-percentage-point increase in the share experiencing substantial weight loss represented a 150% increase relative to the beginning of March (and relative to the average from 2017 to 2019).”
While residents who contracted COVID-19 experienced the greatest increases in weight loss, the effect was still significant among those who remained virus-free.
The study determined that residents experienced a brief but significant decline in cognitive function during the height of the outbreaks in April and May, along with gains in episodes of incontinence.
Several other indicators of nursing home care quality — including the prevalence of pressure ulcers, falls, urinary tract infections, or anti-psychotic drug use — did not change significantly during the pandemic, according to the research.
The study also comes as resident advocates have expanded the focus of their work beyond lifting the federal visitation ban to ensure that similar lockdowns cannot happen in the future; one proposal, for instance, would create a federal essential caregiver designation that would allow residents to appoint a family member who can continue visits while using the same infection-control protocols as staff.
“We’re not talking visitors,” Mikko Cook, a co-founder of the Essential Caregivers Coalition, told SNN earlier this month. “We are talking people who are a massive part of the emotional, social wellbeing — and sometimes physical wellbeing — of residents.”
The Mathematica team similarly called on legislators and policymakers to consider the wider consequences of lockdowns when determining future strategies for keeping residents safe during emergencies.
“These policies assisted nursing homes in procuring sufficient PPE for residents and staff and cohorting residents according to their COVID-19 status,” they wrote of visitation restrictions. “Yet, they may have also been one contributing factor to the reduction in well-being we found, suggesting that policymakers need to consider both the costs and benefits of such policies. Previous research has found that, through targeted interventions, the negative impacts of social isolation can be mitigated.”