Intended and Unintended Effects of Nursing Home Isolation Measures

Millions of people were isolated for several months during the COVID-19 pandemic. While the intention was to save lives, little is known about their effects. In “Intended and Unintended Effects of Nursing Home Isolation Measures,” Vitor Melo argues that isolating nursing home residents caused more deaths than it prevented.

MENTAL HEALTH EFFECTS OF ISOLATION CAN BE SUBSTANTIAL

For nursing home residents, the lack of in-person contact with loved ones and other residents increased loneliness and depression and expedited death. The negative mental health effects of isolation were severe and long-lasting and increased the number of non-COVID deaths even after the pandemic.

Using novel cell phone tracking data, Melo assesses the isolation index, defined as the percentage reduction in visitors compared to 2019, and finds that isolation is predictive of substantially more deaths.

IMPACT ON NURSING HOME RESIDENTS WITH DEMENTIA

From May 2020 to March 2022, increase in isolation measures decreased COVID-19 cases. However, during the same time period, deaths from other causes increased.

• The isolation index is predictive of lower COVID-19 cases and COVID-19 deaths in the first year of the pandemic. This shows that the measures accomplished their intended goal of reducing the spread of COVID-19.
• The Isolation index is also predictive of higher non-COVID deaths after the first year of the pandemic. This increase was greater than the decrease in COVID-19 deaths in the first year of the pandemic.
• The effect of isolation on non-COVID deaths was much greater in nursing homes with a higher proportion of residents with dementia. This shows that the level of isolation needed to minimize non-COVID deaths likely depends on the proportion of dementia residents.

KEY TAKEAWAYS AND LESSONS FOR THE FUTURE

During the pandemic, policymakers encouraged isolation measures, and they were heavily implemented at nursing home facilities. Long-term implementation of such measures, however, is predictive of more deaths from non-COVID causes than the reduction of deaths from COVID. These isolation measures not only prevented residents from being with their loved ones for extended periods of time but also have increased the likelihood of dying.

When designing measures aimed at preventing the spread of infectious diseases in the future, it is important to consider the mental health deterioration caused by isolation, especially for those with dementia.