The Effects of the 2020 COVID-19 Visitor Ban on Mood, Behavior, and Social and Cognitive Functioning in Older Long-Term Care Residents

Abstract

In order to prevent the spread of COVID-19 the Dutch government imposed a visitor ban on long term care facilities (LTCFs) on March 20,2020. We aimed to explore the association of this COVID-19 lockdown with changes in mood, behavior and functioning of LTCF residents prospectively. Mixed methods:1.Longitudinal analysis of Dutch interRAI LTCF assessments of residents ≥60 years. The group of residents who had been assessed during the Dutch visitor ban (March 20- May 24 2020) were compared with a group of other residents of the same LTCF wards who had two assessments prior to the lockdown. We used mixed models and GEE analyses to explore the difference between the two groups. Differences in changes over time were explored in: mood symptoms, withdrawal & aggressive behavior, loneliness & conflict with other residents and care staff, and cognition & delirium. We also explored whether the effect of the visitor ban differed for different subgroups, such as residents with different levels of cognitive impairment and residents who were assessed during the first/second half of the lockdown.2.In two digital focus groups, LTCF care professionals, ranging from nursing staff to elderly care physicians, reflected on the results of the quantitative analyses. 1.The lockdown group existed of 298 residents of 71 wards in 30 facilities. 625 residents of the same departments comprised the control group. In general the change in outcomes did not differ between the groups. Self-reported mood symptoms tended to show a greater increase in the lockdown group. This difference primarily existed in the first half of the lockdown. The subgroup of residents with at least moderate cognitive impairment showed a decrease in withdrawal during the lockdown, while the residents in the other subgroups showed an increase.2.Care professionals who participated in the focus groups described both negative and positive effects of the lockdown on residents. Possibly the effects of the lockdown were mitigated by, for example, video calling with family members and innovative and small-scale activities within the LTCF departments. The tranquility and coziness in the common rooms during the lockdown was experienced to have positive effects on some residents. Several facilities have undertaken efforts to preserve this tranquility, for example by continuing to organize more small-scale activities in the common room. We found no evidence for a group level effect of the lockdown on changes in mood, behavior, social and cognitive functioning in residents of Dutch LTCFs. In focus groups, care professionals described a great degree of individual variation in the effect of the lockdown on residents. Possibly, the efforts of care staff mitigated the effect of the lockdown at the group level. LTCFs have learned lessons from this historical event which they continue to apply.