Surviving through solitude: A prospective national study of the impact of the early COVID-19 pandemic and a visiting ban on loneliness among nursing home residents in Sweden

Objectives: Targeted social distancing measures were widely implemented for nursing home residents when the extremely high COVID-19 mortality in this setting became apparent. Still, there is still scarce rigorous research examining how the pandemic and accompanying social distancing measures impacted loneliness in this group. This prospective nation-wide Swedish study of nursing home residents aimed to examine the impact on loneliness of the early phase of the pandemic and of a national visiting ban at nursing homes. Methods: A panel was selected from a total population survey of all nursing home residents in Sweden March-May 2019 and 2020 (N=11,782; age range 70-110 years; mean age 88.2 years; 71% women). Prospective pretest-posttest and controlled interrupted time series designs were employed, with time trends estimated by date of returned questionnaire. Generalized linear models were used for estimation of effects, adjusting for demographic, survey-, and health-related covariates. Results: Loneliness prevalence increased from 17 to 19% from 2019 to 2020 (Risk Ratio, RR (95% confidence interval, CI)=1.104 (1.060; 1.150)), but which was explained by self-reported health (RR(95%CI)=1.023 (0.982; 1.066)). No additional impact of the visiting ban on loneliness trends was found in the interrupted time series analyses (RR(95%CI)=0.984 (0.961; 1.008)). Discussion: The moderate but health-dependent increased risk of loneliness, and the lack of impact of the nation-wide visiting ban at nursing homes, suggest that this ostensibly vulnerable group of nursing home residents also show signs of resilience, at least during the early phase of the pandemic