Fear of contracting COVID-19 and the measures implemented to manage the health crisis—particularly during the first lockdown—had profound effects on people’s lifestyles (isolation, sedentary behavior, self-restriction of healthcare use, etc.) and on the functioning of the healthcare system.

Numerous studies have shown that medical appointments and hospitalizations were postponed or canceled, which likely had an impact on the population’s health, particularly among vulnerable groups such as older adults. Indeed, older adults frequently have multiple physiological and psychological risk factors that make them particularly vulnerable to a worsening of their initial health status during a crisis, due to insufficient adaptive capacity.

Our study aimed to examine, on a national scale, the rates of hospitalization and mortality for 10 Geriatric Syndromes (GS) during the first wave of COVID-19 and through September 2020, compared to previous years. The 10 GS studied are those most frequently cited in the literature, namely dementia, cognitive decline, confusion/disorientation, depression, malnutrition, dehydration, pressure ulcers, incontinence, falls and injuries, with a particular focus on femoral neck fractures. Most of these conditions are preventable; their occurrence may indicate a failure in care (family, social, or healthcare-related) that can lead to serious consequences in terms of functional decline, quality of life, or mortality.

To identify hospitalizations and mortality linked to these 10 SG, we analyzed data from the National Health Data System (SNDS) (see Box). First, we identified the ICD-10 codes for each SG based on literature data and expert consultation. These codes were then used in the PMSI (Program for the Medicalization of Information Systems) databases to estimate the incidence of new hospitalizations [all causes combined and for each SG as a primary diagnosis (PD) or related diagnosis (RD)] during the period under consideration. Hospitalizations for COVID-19 as a primary or related diagnosis were excluded. Mortality was assessed using the statistical database of the Center for Epidemiology on Medical Causes of Death (CépiDc - Inserm).

These analyses were broken down by age, sex, region, and place of residence for hospitalizations (home versus institution) and place of death for mortality (home, institution, healthcare facility, or other).

Our study shows a very significant decrease in hospitalizations for general medical conditions, accompanied by a corresponding increase in excess mortality for most of these conditions—particularly among patients at home and in long-term care facilities—during the spring 2020 lockdown period (March 17–May 12).

Overall in France, during this first lockdown, 314,421 people aged 65 and older were hospitalized for causes other than COVID-19, which is lower than the average number of hospitalizations over the previous three years, which was 557,033 (-56%). Compared to the 2017–2019 period, hospitalizations for the health conditions included in our study decreased during the first lockdown. The magnitude of this decrease varied by health condition: -59% for incontinence, -51% for depression, -49% for cognitive decline, -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 COVID-19 viral circulation: the regions most impacted by the epidemic were also those where the decline in hospitalizations was greatest. For example, the decrease in hospitalizations for dementia during the first lockdown was 61% in the hardest-hit regions (Ile-de-France and Grand Est), whereas in regions with a lower COVID-19 mortality rate (Occitanie, Brittany, and Nouvelle-Aquitaine), this decrease was 40%.

Furthermore, during this first lockdown, excess mortality was observed for nearly all of these health conditions compared to the 2015–2017 period. This excess mortality reflects not only COVID-19-related excess mortality among older adults with these health conditions but also, for most of these conditions, non-COVID-19 excess mortality: +74% in non-COVID-19 deaths for confusion/disorientation, +44% for femoral neck fractures, +32% for depression, +20% for dehydration, +9% for malnutrition, +8% for falls/injuries. This excess mortality was particularly evident at home and in nursing homes. For example, excess mortality during the first lockdown due to malnutrition was 39% at home and 40% in long-term care facilities (nursing homes, long-term care units), whereas in hospitals there was a 12% decrease in mortality.

This study highlights that the COVID-19 pandemic and the spring 2020 lockdown had significant and short-term detrimental impacts on the health of older adults in France. It suggests that these impacts are linked to the saturation of the healthcare system, particularly in regions within epidemic zones, and to the isolation of people over 65 and their own reluctance to seek care, even in areas where the virus was not circulating.

These findings underscore the need to monitor changes in the health status of older adults in order to assess the impacts of measures implemented to manage the health crisis—impacts that must be weighed against the COVID-19-related morbidity and mortality that were prevented.

Our study has established a robust surveillance system for the health status of older adults and will enable us to continue studying the impacts of the pandemic over the coming years.

When combined with frailty indicators,1 indicators of geriatric syndromes will be invaluable for tracking changes in older adults’ health within the social, economic, environmental, and health contexts of the coming years.

Monitoring geriatric syndromes—which are often preventable—will also help evaluate the new strategy to be implemented, which includes free medical consultations at three key life stages, particularly at age 65.

These preventive appointments, designed to “promote physical and sports activity and a healthy diet, prevent certain cancers and addictions, and promote mental and sexual health,” are intended to help combat the loss of independence. Even at age 65 and older, it is not too late to take action, as frailty is largely reversible.