Frontiers in Aging · Oct 22, 2026
Functional status following the COVID-19 lockdown and five-year survival among older adults with pre-existing functional dependence: a cohort study
By Martín Moreno V, García Mateos A, Martín Fernández A et al.
Introduction: Lockdown for the COVID-19 pandemic in Spain (14 March 2020 - 21 June 2020) represented a situation of prolonged stress; this study analyzed the association between changes in functional status observed after the lockdown and 5-year survival. Materials and Methods: A prospective longitudinal cohort study conducted between 22 June 2020, and 30 June 2025. As of 1 March 2020, Orcasitas (Madrid, Spain) had 150 residents with functional dependence. Four people died during the lockdown. Another 19 were excluded, leaving a final sample of 127 participants. Pre- and post-lockdown functional trajectories were analyzed in relation to the ability to perform basic (ADLs) and instrumental (IADLs) activities of daily living. Results: After lockdown for the COVID-19 pandemic, 62.2% of these individuals improved their functional capacity; 50.6% did so to a clinically significant degree (25–75 points); and 43.3% stopped meeting criteria for functional dependence according local protocol (Barthel>60). This improvement was associated with less dependence on performing ADLs and IADLs. At the 3-year follow-up, 50% maintained a better score compared to their pre-lockdown Barthel Index, but only 22.2% did so compared to their post-lockdown Barthel Index. A lower Barthel Index score before and after lockdown was associated with a lower probability of survival at 5 years. Maintaining functional dependence (Barthel≤60) after the lockdown was also associated with a higher risk of mortality (HR 2.130; CI 1.322–3.434). Age, having no formal education, living with children, being unable to leave the house independently, and being unable to shop on one’s own, were associated with a lower probability of survival. Conclusion: Functional trajectories observed after lockdown in this cohort showed that the outcome associated with survival was not the improvement in functional capacity or the intensity of that improvement, but rather exceeding the 60-point threshold on the Barthel Index. In this cohort, a combined analysis of ADLs and IADLs might better reflect the potential capacity to make these changes than an analysis of the Barthel Index alone. The observed functional trajectories suggest as an exploratory hypothesis of a latent intrinsic capacity, construct that would encompass functional reserves not routinely utilized in daily life.