Recovery from or progression to frailty during the second year of the COVID-19 pandemic.

Dear Editor,

The coronavirus disease 2019 (COVID‐19) pandemic has had a huge impact on people's lives, especially those of older adults. In the first year of the pandemic, the “stay‐at‐home policy” to avoid COVID‐19 infection led to greatly limited physical activity (PA) and an increased risk of incident frailty in community‐dwelling older adults. However, in the second year of the pandemic, vaccination and other political measures were promoted, and the overall social atmosphere seemed to be different. This study aimed to observe changes in PA and social activity (SA) in older adults during this pandemic and to explore the factors associated with recovery from or progression to frailty in older adults from January 2021 to January 2022.

We conducted online baseline and first and second follow‐up surveys in April 2020, January 2021, and January 2022, respectively. This study excluded older adults who were frail at the baseline survey and those who did not respond to the follow‐up surveys. Among the 1600 baseline survey participants, 388 were already frail, and 275 and 140 older adults did not respond to the first and second follow‐up survey, respectively (final number of participants: 797; follow‐up rate: 65.8%).

We investigated PA and SA at six time points according to the waves of the COVID‐19 pandemic in Japan: January 2020 (by recalled answer at baseline survey), April 2020 (at baseline survey, PA only), August 2020 (by recalled answer at follow‐up survey), January 2021 (at first follow‐up survey), August 2021 (by recalled answer at second follow‐up survey), and January 2022 (at second follow‐up survey). We assessed PA using a questionnaire based on a short version of the International Physical Activity Questionnaire and determined the total PA time. We also assessed SA using a social participation score operationally defined by the frequency of participation in eight kinds of social activity on a 6‐point scale. The eight categories of social participation were volunteer groups, sports groups, hobby groups, cultural clubs, senior citizen clubs, neighborhood associations, town events, and jobs. The frequency of participation was assessed on a 6‐point scale (0–5 points): four or more times a week, 5 points; two to three times a week, 4 points; once a week, 3 points; one to three times a month, 2 points; several times a year, 1 point; and not participating, 0 points. Higher/ lower PA and SA were defined by the median PA and SA values in August 2021, and participants were categorized into four groups based on their combination of higher/lower PA and SA.

We assessed frailty, as defined by the Kihon Checklist, at three time points: January 2020, January 2021, and January 2022. Outcomes were defined as recovery from or progression to frailty from January 2021 to January 2022. We examined the relationship between these outcomes and PA and SA status using multivariate logistic regression analyses adjusted for age, sex, being underweight, living alone, polypharmacy, and lower health literacy.

The mean age, proportion of women, mean body mass index, and proportion of frailty at January 2021 were 73.1 ± 5.4 years, 46.3% (n = 369), 22.4 ± 2.8 kg/m2, and 14.6% (n = 116), respectively. Both PA and SA showed a worsening trend in the first year but a recovery trend in the second year of the pandemic (Fig. 1). Of the 116 participants who were frail in January 2021, 61 (52.6%) had recovered to non‐frailty in January 2022 (Fig. 1). Those in the higher PA and higher SA group (adjusted odds ratio [OR]: 9.51, 95% confidence interval [CI]: 3.05–29.66) and in the higher PA and lower SA group (adjusted OR: 5.24, 95% CI: 1.46–18.83) were more likely to recover from frailty than those in the lower PA and lower SA group, but not in the lower PA and higher SA group. On the other hand, of the 681 participants who were not frail in January 2021, 57 participants (8.4%) had progressed to frailty in January 2022 (Fig. 1), and those in the higher PA and higher SA group (adjusted OR: 0.35, 95% CI: 0.16–0.73) were less likely to progress to frailty than those in the lower PA and lower SA group.

Figure 1

PA, physical activity; SA, social activity. Both PA and SA showed a worsening trend in the first year but a recovery trend in the second year of the pandemic (a). Of the 116 participants who were frail in January 2021, 61 (52.6%) had recovered to non‐frailty in January 2022, and of the 681 participants who were non‐frail in January 2021, 57 (8.4%) had progressed to frailty in January 2022 (b).

During the COVID‐19 pandemic, managing frailty in older adults has become more important than ever before. Our findings suggest that the frailty caused by the pandemic is reversible and influenced by various factors such as PA and SA. However, a major limitation of the current study is that we could not investigate deterioration from frailty, such as the incidence of disability and death.

Disclosure Statement

None.