• Posted November 27, 2023

Long COVID Now Common in U.S. Nursing Homes

Repeated COVID-19 outbreaks in nursing homes have had a stark and lasting impact on vulnerable older residents, a new study reports.

Long COVID has left many residents of these facilities relying more and more on staff to help them months later with basic, everyday activities such as bathing and using the toilet.

Many also experience a drop-off in their brain function, according to the study by researchers from Michigan Medicine, the University of Michigan's academic medical center.

"Nursing home residents who had COVID-19 experienced new decline in their function and needed substantially more help with daily activities after their acute infection period, lasting for months," said study co-author Dr. Lona Mody, interim chief of geriatrics and palliative medicine at Michigan's medical school and a staff physician at VA Ann Arbor Health Care System. "This places an even greater burden on nursing home staff, who are already stretched thin."

Her team looked at physical and mental functioning in two groups: one made up of nursing home residents who had had COVID and a similar group who had not. They were followed for up to a year.

COVID survivors had continuing effects for about nine months, on average. And 30% of those with a confirmed case of COVID died during the follow up, more than double the percentage of deaths in the comparison group.

For the study, researchers looked at residents who lived in two Michigan nursing homes. They had full data on 90 who tested positive on a PCR test for COVID between March 2020 and October 2021, and 81 residents who lived there during that time but did not have a positive test.

Most were white women over 80 years of age. All had several chronic health conditions and half had dementia. Nearly all were unvaccinated when they got infected.

Researchers compared patients' scores from before the pandemic and over the next year on two scales that nursing homes use to gauge physical and mental functioning. Each had at least four quarterly reports of how much help they needed for activities such as getting dressed, going to the toilet and bathing. The team also looked at residents' scores on mental tasks such as repeating and recalling words and knowing the current date.

"Before the pandemic, the two groups scored about the same on both their need for help with activities of daily living, or ADL, and their cognitive status," said co-author Dr. Sophie Clark, a former geriatrics fellow at Michigan who is now at the University of Colorado. "But the patients who tested positive for COVID showed a sudden decline in both measurements that lasted long after their infection."

Those with dementia continued to decline faster than their peers who had not been infected.

Researchers noted that infection-fighting steps such as reducing social activity and visiting options in 2020 and 2021 may have played a role in the decline.

The study did have a bright spot: Little by little, COVID survivors without dementia regained their ability to do daily activities. A year after infection, they were nearly on par with their uninfected peers.

Researchers noted that the experience of patients in this study may not match what is happening today in vaccinated nursing home patients because those studied mostly got sick before vaccines were available.

"This is especially true for those who have gotten the updated vaccine that became available in September," Mody said. "We encourage all nursing home residents and staff, and the family members who visit these homes, to get vaccinated and help prevent more cases of acute and long COVID in this especially vulnerable population."

The findings were recently published in the Journal of the American Geriatrics Society.

More information

The U.S. Centers for Disease Control and Prevention has more about long COVID.

SOURCE: Michigan Medicine-University of Michigan, news release, Nov. 21, 2023