High-risk profiles for functional and cognitive decline following COVID-19 confinement in nursing home residents: A multicentre observational study High-risk profiles for functional and cognitive decline during confinement in nursing homes: a multicentre observational study

BACKGROUND: To examine changes in functional and cognitive status among nursing home residents following COVID-19 confinement and to identify personal and clinical resident characteristics associated with greater decline. METHODS: A multicentre retrospective observational study was conducted in nursing homes in Navarra, Spain. Functional and cognitive status were assessed before and after the confinement using the Barthel Index (BI), Mini Cognitive Examination (MEC), and Global Deterioration Scale (GDS). Resident characteristics, nursing home characteristics, and the nursing diagnosis Disrupted Thought Processes were analysed. Univariate and multivariable linear mixed-effects models were used to identify factors associated with changes in BI, MEC, and GDS scores. RESULTS: The final analytical sample comprised 178 residents. All three outcomes deteriorated significantly following confinement. Mean BI and MEC scores decreased by 5.0 and 2.0 points, respectively, whereas mean GDS scores increased by 0.24 points. In multivariable analyses, Disrupted Thought Processes was associated with greater cognitive decline measured by MEC (B = 1.29; 95% CI: 0.40-2.18; p = 0.005). Difficulties in instrumental activities of daily living were associated with greater deterioration in GDS (B = 0.19; 95% CI: 0.02-0.37; p = 0.030) and BI scores (B = 3.60; 95% CI: 0.01-7.19; p = 0.049). Male sex was associated with greater BI decline (B = 4.07; 95% CI: -7.68 to -0.45; p = 0.028). CONCLUSIONS: COVID-19 confinement associates with functional and cognitive decline among nursing home residents. Disrupted Thought Processes may be a useful clinical indicator for identifying residents at increased risk of cognitive deterioration during prolonged isolation.