High-risk profiles for functional and cognitive decline following COVID-19 confinement in nursing home residents: A multicentre observational study High-risk profiles for functional and cognitive decl

The COVID-19 pandemic posed an unprecedented challenge to healthcare systems worldwide. Older adults living in nursing homes were particularly affected by the imposed isolation, experiencing considerable psychological and physical distress. The pandemic rapidly evolved into a global public health emergency. In the United States of America, approximately 40% of COVID-19-related deaths occurred in nursing homes, compared with 80% in Canada during the first wave, 47% across 22 European countries, and an estimated 68% in Spain. Advanced age was an independent and major risk factor for severe COVID-19 outcomes and mortality, particularly among nursing home residents. Individuals aged 75 years or older had a 13-fold higher risk of death than those aged 65 years or younger. Nursing homes became epicentres of infection and mortality, with high transmission rates driven by shared living spaces, residents´ underlying health conditions, and the challenges of implementing infection control measures. To protect residents and control outbreaks, strict measures were implemented worldwide, including visitor bans, suspension of group activities, and prolonged confinement. Although these interventions were essential for infection control, they also had adverse effects on residents’ physical and cognitive health. The nature and intensity of these measures varied according to national policies and available resources. For example, in the United States, efforts focused on isolating suspected cases and restricting visits, helping reduce transmission but increasing social isolation and emotional distres. In Canada, similar measures successfully controlled outbreaks but were associated with accelerated functional and emotional decline. In Asia, approaches ranged from preventive infection control strategies to more restricted confinement policies that substantially limited residents’ mobility. In Europe, particularly in Spain, strict infection prevention measures were widely implemented in nursing homes.