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Original Article • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0128en copy

Effects of SARS-CoV-2 infection on health and functional capacity in institutionalized older adults

Efectos de la infección por SARS-CoV-2 en la salud y capacidad funcional de personas mayores institucionalizadas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the effect of SARS-CoV-2 infection on the health conditions and functional capacity of older adults living in long-term care units in Maceió City – Alagoas State.

Methods:

A prospective cohort was conducted with institutionalized older adults of both sexes. Older adults were assessed for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity, and nutritional status. All assessments were repeated on two occasions, maintaining a 6-month interval between them.

Results:

The sample was composed of 289 older adults. Of the total, 98 (33.9%) were positive for COVID-19 and eight died (2.8%). Men were more likely to have COVID-19 (OR = 3.50; p < 0.01). It was observed that the disease contributed to increasing the frequency of dependent older adults after six months (OR = 1.38; p-interaction < 0.01). It was also observed that after six months of positive diagnosis for COVID-19, there was greater weight loss (p < 0.01), reduced BMI (p < 0.01), increased mean SBP (p = 0.04), and DBP (p = 0.03).

Conclusion:

Effects of COVID-19 in institutionalized older adults go beyond acute complications and compromise blood pressure control, functional capacity, and favor weight loss.

DESCRIPTORS
Aged; COVID-19; Functional Status; Nutritional Status

Variables	NCOV-g (n = 191)		COV-g (n = 98)		OR	p-value	Cramer’s V
Variables	N	%	N	%	OR	p-value	Cramer’s V
Age
<80 years	102	53.4	47	48.0	1.25	0.38^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.05
≥80 years	89	46.6	51	52.0	1.25		0.05
Sex (female)	128	67.0	36	36.7	3.50	<0.01^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.29
Marital status (without partner)	175	91.6	90	91.8	0.97	0.95^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.01
Education (≤4 years)	125	65.4	51	52.0	0.57	0.03^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.13
Alcohol consuption (yes)	8	4.2	7	7.1	1.76	0.28^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.06
Smoker (yes)	30	15.7	17	17.3	1.13	0.72^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.02
Physical activity (inactive)	144	75.4	68	69.4	0.74	0.27^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.06
Diag. of hypertension (yes)	92	48.2	56	57.1	1.44	0.15^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.09
Diag. of diabetes (yes)	43	22.5	29	29.6	1.45	0.19^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.08
Diag. of CVD (yes)	12	6.3	8	8.2	1.33	0.55^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.04
Diag. of COPD (yes)	7	3.7	4	4.1	1.12	0.55^#	0.01
Diag. of demencia (yes)	17	8.9	10	10.2	1.16	0.72^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.02
Diag. of other CD (yes)	46	24.1	20	20.4	0.81	0.48^* * p-value obtained by Pearson’s chi-square test; #p-value obtained by Fisher’s exact test.	0.04

Functional capacity		NCOV-g (n = 191)		COV-g (n = 90)		OR	95%CI	p-value*	p-interaction^#
Functional capacity		N	%	N	%	OR	95%CI	p-value*	p-interaction^#
Univariable analysis ^a aOR: Odds Ratio referring to the group with COVID presenting the diagnosis of functional capacity dependence compared to the group without COVID. *p-value obtained through univariable logistic regression. #p-value for the interaction between the Odds Ratio obtained at the initial and final time points, calculated using generalized estimating equations.									<0.01
Initial	Independent	81	42.4	42	46.7	1	–	–
	Dependent	110	57.6	48	53.3	0.84	0.5; 1.39	0.50
Final	Independent	78	40.8	30	33.3	1	–	–
	Dependent	113	59.2	60	66.7	1.38	0.81; 2.33	0.22

Multivariable analysis ^b bOR: Odds Ratio adjusted for sex, age, education, smoking, and diagnoses of hypertension, DM, CVD and COPD, referring to the group with COVID presenting functional capacity classification as “dependent” in relation to the group without COVID. *p-value obtained by multivariable logistic regression. #p-value for the interaction between the adjusted Odds Ratio obtained at the initial and final time points, calculated using generalized estimating equations.									<0.01
Initial	Independent	81	42.4	42	46.7	1	–	–
	Dependent	110	57.6	48	53.3	0.67	0.37; 1.22	0.19
Final	Independent	78	40.8	30	33.3	1	–	–
	Dependent	113	59.2	60	66.7	1.27	0.69; 2.34	0.44

	NCOV-g (n = 191)		COV-g (n = 90)		p-value	Effect size
	Mean	SD	Mean	SD	p-value	Effect size
Crude analysis ^a NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔWeight (kg)	–0.38	1.27	–1.02	1.79	<0.01	0.35^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔBMI (kg/m²)	–0.15	0.519	–0.42	0.74	<0.01	0.35^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔWC (cm)	–0.19	1.17	–0.21	0.57	0.87	0.01^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔSBP (mmHg)	–0.13	5.28	1.33	4.75	0.02	0.94^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔDBP (mmHg)	–0.17	6.17	1.67	8.43	0.07	0.35^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔHemoglobin (g/dL)	–0.31	1.97	–0.51	2.09	0.45	0.18^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔHematocrit (%)	–0.76	4.98	–0.79	5.41	0.97	0.04^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔLeukocytes (cont/uL)	–19.96	2679.74	38.74	1268.55	0.87	0.08^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔLymphocytes (cont/mm³)	–90.31	854.60	–85.33	1268.55	0.97	0.01^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔGlucose (mg/dL)	–1.06	66.01	–1.47	69.66	0.96	0.02^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔBlood urea (md/dL)	–1.44	17.99	2.86	16.97	0.06	0.23^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔCreatinine (md/dL)	0.15	1.68	0.07	0.33	0.64	0.06^* NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.

Adjusted analysis ^b NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔWeight (kg)	–0.38	1.27	–1.02	1.79	<0.01	0.02^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔBMI (kg/m²)	–0.15	0.52	–0.42	0.74	<0.01	0.02^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔWC (cm)	–0.19	1.17	–0.21	0.57	0.65	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔSBP (mmHg)	–0.13	5.28	1.33	4.75	0.04	0.16^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔDBP (mmHg)	–0.17	6.17	1.67	8.43	0.03	0.02^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔHemoglobin (g/dL)	–0.31	1.97	–0.51	2.09	0.56	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔHematocrit (%)	0.76	4.98	0.79	5.41	0.98	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔLeukocytes (cont/uL)	–19.96	2679.74	38.72	2817.81	0.52	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔLymphocytes (cont/mm³)	–90.31	854.60	–85.33	1268.55	0.48	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔGlucose (mg/dL)	–1.06	66.01	–1.74	69.66	0.78	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔBlood urea (md/dL)	–1.44	17.99	2.86	16.97	0.07	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.
ΔCreatinine (md/dL)	0.15	1.68	0.07	0.33	0.56	0.01^** NCOV-g: negative for COVID-19; COV-g: positive for COVID-19. SD = standard deviation; 95% CI: 95% confidence interval; Cohen’s d; *ω2; ap-value obtained using t-test for independent variables. bp-value obtained by analysis of covariance (ANCOVA) adjusted for sex, age, education, smoking and diagnoses of hypertension, DM, CVD and COPD.

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