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

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

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Evaluar el efecto de la infección por SARS-CoV-2 sobre las condiciones de salud y la capacidad funcional de personas mayores que viven en unidades de cuidados a largo plazo en la ciudad de Maceió – Alagoas.

Métodos:

Se realizó una cohorte prospectiva con ancianos institucionalizados de ambos sexos. Los ancianos fueron evaluados en cuanto a condiciones clínicas (diagnóstico de enfermedades crónicas y pruebas bioquímicas), capacidad funcional y estado nutricional. Todas las evaluaciones se repitieron en dos ocasiones, manteniendo un intervalo de 6 meses entre ellas.

Resultados:

La muestra estuvo compuesta por 289 personas mayores. Del total, 98 (33,9%) dieron positivo a la COVID-19 y ocho fallecieron (2,8%). Los hombres tenían más probabilidades de tener COVID-19 (OR = 3,50; p <0,01). Se observó que la enfermedad contribuyó al aumento de la frecuencia de ancianos dependientes después de seis meses (OR = 1,38; interacción p < 0,01). Se observó que la enfermedad contribuyó al aumento de la frecuencia de ancianos dependientes después de seis meses (OR = 1,38; interacción p < 0,01). También se observó que después de seis meses de diagnóstico positivo para COVID-19, hubo mayor pérdida de peso (p < 0,01), reducción del IMC (p < 0,01), aumento de la PAS media (p = 0,04) y la PAD (p = 0,03).

Conclusión:

Los efectos del COVID-19 en ancianos institucionalizados van más allá de las complicaciones agudas y comprometen el control de la presión arterial, la capacidad funcional, favoreciendo la pérdida de peso.

DESCRIPTORES
Anciano; COVID-19; Estado Funcional; Estado Nutricional

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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