Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan.

Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.

Declined Activities of Daily Living as Immobility Syndrome in an Uninfected Elderly Patient Amidst a Cluster of COVID-19 Infections.

Although coronavirus disease 2019 can cause immobility syndrome in the patients positive for coronavirus disease 2019 and the survivors of coronavirus disease 2019, it is not described in elderly patients who are not positive for coronavirus disease 2019. A 90-year-old female with motor weakness of the lower extremities was admitted in the chronic care hospital. She had rehabilitation therapy for independent ambulation and toilet activities. Though she complained of irregular pulse related to atrial fibrillation during rehabilitation therapy, the symptom disappeared within a few minutes. Her ambulation and toilet activities became better with rehabilitation therapy. However, three weeks after initiating rehabilitation therapy, a cluster of coronavirus disease 2019 infections occurred. The patient was not infected, but rehabilitation therapy was discontinued for 25 days. The patient exhibited ambulation difficulty with shortness of breath and persistent irregular pulse, especially when rehabilitation therapy was reinitiated. These symptoms did not appear while the patient was outside of rehabilitation therapy. At the time of writing, she started to recover her declined ambulation with rehabilitation therapy, but was still dependent in toileting. Immobility syndrome in elderly patients negative for coronavirus disease 2019 can be aggravated following the occurrence of a low-level cluster of coronavirus disease 2019 infections. Medical workers should, therefore, always consider this hidden risk and should plan an adequate program in the early period of rehabilitation therapy for the elderly patients.