The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective: To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design: Multicenter prospective cohort study based on structured telephone interviews. Setting: Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants: 557 community-dwelling adults aged 60 years and older. Measurements: The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results: Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion: Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.

Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study

“…Restrictions in life-space mobility (12,13) and in active aging scores (12) were observed in community-dwelling older people during the COVID-19 pandemic. Active aging was evaluated using a novel scale that encompasses older people's striving for well-being through activities pertaining to their goals, abilities, and opportunities (14).…”

Actual Frailty Conditions and Lifestyle Changes in Community-Dwelling Older Adults Affected by Coronavirus Disease 2019 Countermeasures in Japan: A Cross-Sectional Study

“…Chen (2021) reported that older adults with pre-frailty or frailty expressed negative emotional reactions including anxiety and worry, toward COVID-19. Moreover, the presence of anxiety was independently associated with the impact of the COVID-19 pandemic on the quality of life of community-dwelling older adults (Saraiva, 2021). It is worth noting that frail women were particularly vulnerable to the effects on their quality of life during the COVID-19 pandemic.…”

Impact of the COVID-19 pandemic on the life-space mobility of older adults with cancer

“…Many factors are related to a decrease in their quality of life such as being housebound with no visitors, inevitable changes to diet, lack of physical exercise, reduced cognitive stimulation, withdrawal of functional support and rehabilitation therapies; that ultimately could lead to physical frailty and functional disability [2][3][4]. Cancer itself has been associated with an increased risk of mortality from COVID-19 [5], and it has been recommended to reevaluate interventions to avoid unnecessary exposure [6].…”