Measuring the Impact of COVID-19 Restrictions on Mobility in Older Patients with a Fragility Fracture Using the New Mobility Score

ABSTRACT

Introduction: The World Health Organization declared COVID-19 a pandemic in March 2020. In Ireland, public health restrictions were implemented with specific measures for older adults who were advised to 'cocoon' or remain at home as much as possible. While this has a positive effect on disease spread, a reduction in physical activity in older individuals even for short periods has been shown to increase the risk of falls and fractures as well as all-cause mortality. The New Mobility Score (NMS) stratifies patients with fractures according to pre-fracture mobility based on the ability to perform three activities;indoor walking, outdoor walking and shopping. The NMS is an independent predictor of in-hospital outcome and a cutoff score of 5 has been found to be a valid predictor of 6-month functional level and 1-year mortality. Using the NMS score, we evaluated patient mobility pre and post implementation of restrictions. We also obtained basic data, information on the frequency of patient falls pre and post restrictions together with Clinical Frailty Scale (CFS). Methods: We prospectively studied 50 patients admitted following a fracture and reviewed by our Orthogeriatric team at our hospital from August-October 2020. Results: The mean age was 80 years [range 53-99], over 80% (41) were over 70 years and 43 (86%) were female. A hip fracture (78%) was the most common reason for admission and the mean CFS was 4 [Range 1-7] classifying our cohort as living with very mild frailty. There was a statistically significant difference in mean NMS with a lower mean NMS post implementation of COVID-19 restrictions compared to pre restrictions;[5 [SD 2.19] vs 6.5 [SD 2.15] [P = 0.0074]]. There was no difference in the mean number of falls pre and post restrictions [pre COVID-19;1.1 [S.D 2.3] and post COVID-19 1.9 [S.D 1.9] [P = 0.0609]. Conclusion: Our study has shown that in a vulnerable cohort of patients, COVID-19 restrictions have significantly impacted patient mobility over a short period of time. Our results show that as result of the reduction in mobility following implementation of COVID-19 restrictions, our patients are less likely to regain pre-fracture functional level and are at a higher risk of all-cause mortality. As further public health restrictions are implemented across the world to control the spread of COVID-19, public health strategies and advice for older people should be prioritised to maintain mobility and physical activity and prevent adverse outcomes.