Weight Loss, Depressive Symptoms Intensified in SNF Residents During Lockdown

Even at skilled nursing facilities (SNFs) without known COVID-19 cases, weight loss and depressive symptoms in residents significantly increased in 2020 compared with before the pandemic, according to a study published in JAMA.

“When many lockdown policies were implemented early in the COVID-19 pandemic, policy makers and clinical leaders could not foresee that these policies would continue for many months,” wrote study corresponding author Michael L. Barnett, MD, of the Harvard TH Chan School of Public Health, Boston, Massachusetts, and coauthors. “As the lockdown continued and as many people recognized the importance of protecting medically vulnerable individuals from exposure to COVID-19, there was growing concern about the unintended effects of lockdown on long-term care residents.”

The retrospective observational study used Medicare claims and Minimum Data Set 3.0 data to investigate changes in health and quality of life at 15,477 SNFs in the United States during the COVID-19 pandemic. Researchers compared the COVID-19 pandemic period of January to November 2020, before vaccines were available, with the prepandemic period of January to November 2018 and 2019. Each SNF served as its own control.

SNFs with active COVID-19 cases experienced significant increases in mortality and functional decline during the first year of the pandemic compared with the prepandemic period, according to the study. Specifically, they had a 1.60% increase in mortality, and residents required assistance with an additional 0.36 activities of daily living (ADLs). At SNFs with no known COVID-19 cases, mortality decreased by 0.15%, and residents had no change in ADLs.

Meanwhile, residents in SNFs with active COVID-19 lost an additional 3.1 pounds and were 4.4% more likely to have worsened depressive symptoms in 2020 compared with the prepandemic period. Residents at SNFs with no known COVID-19 cases lost an additional 1.8 pounds and were 3.2% more likely to have worsened depressive symptoms.

“Overall, these findings suggest that pandemic policy and health system changes in 2020 were associated with negative changes in the physical and mental health of SNF residents not exposed to COVID-19 infection,” researchers wrote, “counterbalanced by lower mortality and hospitalization rates.”

Reference:
Barnett ML, Waken RJ, Zheng J, et al. Changes in health and quality of life in US skilled nursing facilities by COVID-19 exposure status in 2020. JAMA. 2022;328(10):941-950. doi:10.1001/jama.2022.15071