The fear of contracting COVID-19 and the measures implemented to manage the health crisis—particularly during the first lockdown—had a profound impact both on people’s lifestyles (isolation, sedentary lifestyles, self-imposed restrictions on healthcare use, etc.) and on the functioning of the healthcare system.

Numerous studies have shown that medical appointments and hospitalizations were either postponed or canceled, which likely affected the population’s health status, particularly among vulnerable groups such as older adults. Older adults often have multiple physiological and psychological risk factors, which puts them at particular risk of deteriorating health during crises due to the difficulties they face in adapting.

Our study aimed to investigate hospitalizations and mortality for ten geriatric syndromes (GS) at the national level during the first COVID-19 wave up until September 2020, in comparison to previous years. The ten GS studied were those most frequently cited in the literature: dementia, cognitive decline, confusion/disorientation, depression, malnutrition, dehydration, pressure ulcers, incontinence, falls and injuries, with a specific focus on femoral neck fractures. Most of these conditions are preventable, and their occurrence may reflect a lack of care (whether within the family, social, or healthcare sectors) that could have serious consequences in terms of functional decline, quality of life, or mortality.

To identify hospitalizations and mortality related to these ten GS, we utilized data from the National Health Data System (SNDS, Système national des données de santé: see box). We first identified the ICD-10 codes for each GS by compiling data from the literature and expert opinions. These codes were then used in the hospital database of the Medical Information Systems Program (PMSI, Programme de médicalisation des systèmes d’information) to estimate the incidence of new hospitalizations (all causes combined for each GS as a primary or related diagnosis) during the period in question. Hospitalizations for COVID-19 as a primary or related diagnosis were excluded. Mortality was assessed using the statistics database from the Centre for Epidemiology on the Medical Causes of Death (CépiDc, Centre d'épidémiologie sur les causes médicales de Décès – INSERM).

The analysis was performed by age, region, and place of residence for hospitalizations (home or institution) or place of death for mortality (home, institution, health facility, or other).

Our study shows a very significant decrease in hospitalizations for general medical conditions during the spring 2020 lockdown period (March 17–May 2). Conversely, this is reflected in excess mortality for most causes, particularly among patients at home and in care facilities.

Across France during this first lockdown, 314,421 people aged 65 and older were hospitalized for causes other than COVID-19, which is below the average number of hospitalizations for the three previous years (approximately 557,033, representing a 56% decrease). Compared to the 2017–2019 period, hospitalizations decreased during the first lockdown for all health groups (GS) included in our study. The extent of this decrease varied by health group: -59% for incontinence, -51% for depression, -49% for other cognitive disorders and symptoms, -43% for dementia, -37% for malnutrition, -37% for dehydration, -36% for pressure ulcers, -30% for falls/injuries, -18% for confusion/disorientation, and -13% for femoral neck fractures.

A dose-response relationship was observed with respect to the level of COVID-19 circulation: the regions most affected by the epidemic were also those with the greatest drop in hospitalizations. For instance, the decrease in hospitalizations for dementia during the first lockdown was 61% in the regions most affected by COVID-19 (Île-de-France and Grand Est), compared to 40% in regions with a lower COVID-19 mortality rate (Occitania, Brittany, and Nouvelle-Aquitaine).

Moreover, during this first lockdown, excess mortality was observed for almost all GS compared to the 2015–2017 period. This represents COVID-19-related excess mortality among elderly people with GS but also, for most syndromes studied, excess mortality unrelated to COVID-19: a 74% increase in non-COVID-19-related deaths for confusion/disorientation, a 44% increase for femoral neck fracture, a 32% increase for depression, a 20% increase for dehydration, a 9% increase for malnutrition, and an 8% increase for falls/injuries. This excess mortality was particularly notable for deaths occurring at home and in nursing homes. For instance, excess mortality for malnutrition during the first lockdown was +39% at home and +40% in institutions (nursing homes, long-term care facilities), compared to a -12% drop in mortality in hospitals.

This study highlights that the COVID-19 pandemic and the spring 2020 lockdown had immediate and significant negative impacts on the health of older adults in France. It suggests that these impacts were related to the strain on the healthcare system, particularly in regions hardest hit by the pandemic, and to the isolation of people aged 65 and older, many of whom chose not to seek medical care even in areas where the virus was not circulating.

These results underscore the importance of studying changes in health status among older adults for understanding the impact of measures implemented to manage the health crisis. These impacts should be compared to the COVID-19-related morbidity and mortality that were averted.
Our study has established a robust system for monitoring the health status of older adults and will enable further research into the impacts of the pandemic in the coming years.

When combined with indicators of frailty, indicators of geriatric syndromes will be valuable for monitoring changes in the health status of older adults in future social, economic, environmental, and public health contexts.

Geriatric syndromes are often preventable. Monitoring them will also make it possible to evaluate the new prevention strategy, which includes free medical consultations offered at three key life stages, including age 65. These prevention appointments aim to help prevent loss of independence by promoting physical activity, sports, and a healthy diet; preventing certain cancers and addictions; and promoting mental and sexual health. It is never too late to take action, even at age 65 or older, as frailty is largely reversible.