The impact of COVID-19 lockdown measures on cognition and physical function of older adults in long term care facilities: a systematic review

COVID-19 lockdown measures were implemented to prevent COVID-19 transmission in long term care facilities (LTCF) and to protect LTCF residents. This systematic review aimed to evaluate the effect, from studies using standardised objective outcome measures, of COVID-19 lockdown measures on the cognitive and physical functions of older adults living in LTCF. Records published between January 2020 and July 2025 in CINAHL, Embase, Pubmed, Scopus and Web of Science databases were eligible. Two researchers independently screened papers and later independently extracted data. The Newcastle - Ottawa Quality Assessment Scale for Cohort Studies was used to assess the methodological quality of studies. In total, 472 studies were screened and 12 cohort studies were included, representing 168,911 residents, from over 1418 LTCF, over a 3 to 15 months period. There was good evidence for there being no increased worsening of cognition (over natural decline), low-moderate quality evidence of no increased worsening of ADL dependency and low quality evidence of no increased worsening of physical performance in older adults living in LTCF due to COVID-19 lockdown measures. This suggests that LTCF residents may not experience the same declines as community dwelling older adults during lockdown. Lockdown measures were associated with a trivial to small increased percentage of residents with any fall; rates of falls likely rose, and of injurious falls possibly rose. There was insufficient evidence of lockdown effects on delirium, frailty or sarcopenia. Thus, more evidence is required to rule out long-term detrimental effect of lockdown on wellbeing of older adults living in LTCF but the evidence to date dies not support a worsening in function but some increase in falls rates. Future lockdown measures should consider LTCF residents’ well-being as well as infection risk. PROSPERO CRD42023403211.