Evolution of functional and mental status and quality of life in people aged 75 years and over after the COVID-19 pandemic in Spain: a prospective cohort study

Abstract

The COVID-19 pandemic has had significant health and psychosocial consequences in the older adults. However, there is little community-based evidence that clearly distinguishes the effect attributable to SARS-CoV-2 infection to be differentiated from the contextual impact of the pandemic itself. The objective of this study was to describe the 18-month evolution of multidimensional domains of comprehensive geriatric assessment and to compare trajectories according to the presence or absence of confirmed infection at the start of follow-up. Methods A prospective, multicenter cohort study was conducted in primary care across 11 Spanish regions. Non-institutionalized individuals aged 75 years and over recruited by trained nurses were included. Comprehensive geriatric assessments were performed at baseline and at 6, 12, and 18 months, including functional status, emotional state, nutritional risk, social support, and health-related quality of life. Exposure: confirmed SARS-CoV-2 infection documented by RT-PCR and/or rapid antigen testing recorded in the electronic health record from May 2020 until the time of inclusion in the study. Longitudinal trajectories and exposure time interactions were analyzed using linear mixed-effects models adjusted for relevant covariates, with sensitivity analyses based on complete-case analyses restricted to participants with complete follow-up. Results A total of 1,072 participants were included at baseline. In the overall cohort, there were significant time effects indicating gradual worsening in most domains (functional capacity, nutritional status, social support, and quality of life). Trajectories were generally parallel between infected and uninfected individuals, with no consistent exposure time interactions, except for anxiety (p = 0.043), which showed a differential pattern over time. Sensitivity analyses confirmed the robustness of the findings. Conclusions In non-institutionalized adults aged 75 years or older, we observed a slight, progressive decline in overall health during the post-pandemic period, generally unrelated to prior COVID-19. Trajectories were similar between exposed and unexposed individuals, with the exception of anxiety, which showed a differential course by exposure status, underscoring the need for targeted monitoring of emotional health after infection. Public health responses to health or social crises should prioritize functional autonomy, social support, and mental health to preserve quality of life in this population.