Health, functioning and social engagement among older people living in long-term care facilities during the COVID-19 lockdown in Finland: a register-based cohort study

Abstract

Background: There is a lack of consistent evidence on the effects of the COVID-19 lockdown among older long-term care facility (LTCF) residents. We utilised a versatile and comprehensive register-based data to assess the impact of the lockdown and to explore what kinds of individual-level factors were associated with changes in functioning and wellbeing of the older LTCF residents during the lockdown in 2020. Methods: This retrospective register-based cohort study (n = 7 260) with a 6-month follow-up utilised Resident Assessment Instrument (RAI) data combined with data on confirmed COVID-19 infections and death records of LTCF residents aged 65-year-old and older. Logistic regression analyses were conducted to detect cohort effects on health stability, cognitive performance, coping with activities of daily living (ADL), and social engagement. Additional subgroup analyses were performed to explore the effect among the oldest (85 years old and older), most severely cognitively impaired individuals (dementia diagnosis and Cognitive Performance Scale score 4–6), and those who experienced the lowest social engagement (Social Engagement Scale score 0–1) at baseline. Results: When all the RAI assessed LTCF residents were included in the analyses, belonging to the lockdown cohort was not observably associated with a decline in health stability, cognitive performance, coping with ADL, or social engagement. According to the subgroup analyses, the health stability of the oldest residents and the cognition of the most severely cognitively impaired residents deteriorated more in the lockdown than in the comparison cohort. Conclusions: The COVID-19 lockdown was not observably associated with deterioration in health, cognitive or ADL functioning, or social engagement among Finnish LTCF residents. However, subgroup analyses suggested that the effects of the lockdown were the most detrimental among the most severely cognitively impaired and the oldest residents. The vulnerability between different subgroups should be considered more closely in exceptional circumstances due to infectious diseases in the future and provide deliberately older people the opportunity to experience the physical closeness of their loved ones despite possible infections.