Study explores long COVID in aged care homes

COVID-19 disproportionately affected aged care facilities across the world, with high rates of infection and mortality.

Now, a new US study by the University of Michigan has demonstrated that the virus can leave a lasting impact, making the older adults who live in these facilities more dependent on staff to help them with basic daily activities for months after their infection. They also experience a decline in their brain function.

The researchers compared a group of aged care home residents who had COVID-19 with a similar group who had not, and looked at their physical and mental functioning for up to a year.

On average, residents who caught COVID-19 and survived had effects that lasted about nine months. In addition, 30% of those who had a confirmed case of COVID-19 died during the study follow-up period, more than twice the percentage that died in the comparison group.

The researchers looked at data from two aged care homes in Michigan, focusing on residents who lived there between 2019 and 2022. They were able to study full data on 90 residents who tested COVID-19 positive on a PCR test between March 2020 and October 2021, and 81 residents who lived in the same nursing homes during that time but did not test positive.

The majority were women, over age 80 and were white and non-Hispanic. Half had dementia, and all had multiple chronic health conditions. Nearly all of those who had COVID during the study period were unvaccinated at the time they got infected.

The results are published in the Journal of the American Geriatrics Society by a team led by former U-M geriatrics fellow Sophie Clark, M.D., now at the University of Colorado, and Lona Mody, M.D., M.Sc., interim chief of the division of geriatrics and palliative medicine at the U-M Medical School, and staff physician at VA Ann Arbor Healthcare System.

The study’s authors also included Lillian Min, M.D., M.S.H.S., a geriatrician and, like Mody, a member of the U-M Institute for Healthcare Policy and Innovation. The study was funded by the Agency for Healthcare Research and Quality (HS25451), the National Institute on Aging (AG050685), and the Michigan Institute for Clinical and Health Research and the Veterans Affairs Ann Arbor Healthcare System.

Rapid decline and some recovery

“Nursing home residents who had 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,” Mody said.

“This places an even greater burden on nursing home staff, who are already stretched thin.”

The good news was that COVID survivors without dementia gradually regained their ability to do daily activities and were nearly on par with the uninfected group by the end of a year post-infection.

Those with dementia continued to decline, faster than their peers who had dementia but had not had COVID-19.

On the cognitive test, patients showed a rapid decline immediately after COVID infection and stayed far below the uninfected group for months — though both groups had about the same cognitive results by the end of a year.

The measures taken to protect aged care home residents from coronavirus infections, including reducing visiting options and social activities, may have contributed to the overall decline in both groups, suggested researchers.

Vaccination

The US researchers also noted that recent data shows that COVID vaccination can reduce the risk of long COVID. So the experience of the patients in their study (who mostly caught COVID before vaccines were available) may not match what is happening today in vaccinated residents.

“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,” Mody said.

Closer to home, the Immunisation Coalition is urging Australians not to delay their next COVID-19 vaccination, following the federal government’s decision to accept the latest advice from the Australian Technical Advisory Group on Immunisation (ATAGI) on the use of the new COVID-19 XBB 1.5 vaccine as part of the National COVID-19 Vaccine Program.¹

There are two new monovalent booster vaccines soon to come online (manufactured by Pfizer and Moderna) that will be available to those who meet the respective eligibility criteria.² In addition, there is an effective Novavax vaccine already available.

Professor Robert Booy, Chairman of the Immunisation Coalition’s Scientific Advisory Committee, said, “The announcement of the new monovalent vaccines is great news, but they will not be available for another three weeks. People aged 75 years or older, people with major medical conditions, travellers and healthcare workers should get the vaccine that is available to them now.

“Australia has done an impressive job of managing COVID-19, and while it is important that vulnerable people receive their vaccination, it is also important to remember the role that masks, sensible social distancing, and washing and other hygiene measures can play in our post-pandemic response,” Booy said.

<sup>1. ATAGI Advice
2. Recommended doses</sup>

Image credit: iStockphoto.com/gece33