Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic
Funding information: AARP Foundation; Michigan Medicine; U.S. Department of Veterans Affairs
Abstract
Background
Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks.
Methods
A nationally representative online survey of 2006 U.S. adults aged 50–80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling.
Results
Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling.
Conclusion
The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.
Key Points
- The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes.
- Poor fall outcomes reflected worsened physical functioning and reduced physical activity levels.
Why Does this Paper Matter?
Rapid deconditioning from the pandemic requires prompt policy responses.
Sedentary behavior and social isolation increase risks of functional impairment and injury among older adults, threatening their independence and safety.1-5 During extended periods of reduced physical activity or isolation, such disablement may accelerate, causing a progressive loss of mobility and physical conditioning, and greater need for assistance from others for daily activities.6-9
Although disability and functional trajectories have been extensively examined,10-13 it is less well understood how physical functioning of older adults has been affected by the COVID-19 pandemic. Some older adults may have maintained functional capacity through continued exercise, despite restrictions on physical and social engagement.14 For others, mobility and physical conditioning may have declined due to increased social isolation and sedentary behaviors, leading to higher risk for injuries such as falls.1-5
Limited prior research has described decreases in physical activity among older adults during the COVID-19 pandemic.15 The current study adds to this literature by examining self-reported changes in physical function and fall-related injury, and whether these changes are influenced by sedentary behavior and social isolation. Specifically, it assesses whether physical activity and social isolation influenced physical functioning, and how activity levels and social isolation influenced fall injuries and the fear of falling. These findings can improve understanding of how older adults' levels of physical disability and injury risk change under rapid shifts in opportunities for physical and social engagement.
