Vulnerability associated with sociodemographic and health determinants and survival after the Covid-19 Pandemic among women with functional dependence in the Orcasitas neighborhood of Madrid (Spain)

Background Population aging is a markedly female-dominated process, and this gender difference extends to functional dependence in performing activities of daily living (ADL). Understanding the situations that contribute to vulnerabilities which may lead to functional dependence, the changes triggered by life stressors such as the Covid-19 pandemic, and their impact on long-term survival is relevant for healthcare planning. Methods A prospective observational study with a 4-year follow-up. The study included 100 functionally dependent women over the age of 65 from the Orcasitas neighborhood in Madrid, Spain, and analyzed the relationships between functional dependence and several socioeconomic and health determinants, changes observed during the Covid-19 pandemic, and survival. Results In this cohort, functional dependence showed gender overexpression, with a female-to-male ratio of 3.8, compared with the ratio of 1.5 observed in the general non-dependent population (OR 2.392; CI 1.610–3.552). Higher level of functional dependence increased the risk of mortality (HR 2.380; CI 1.336–4.240); during this four-year period, 74.1% of women with severe dependence died. During the lockdown due to the Covid-19 pandemic, 62% of these women improved their functional capacity, and 43% no longer met the criteria for functional dependence. Regaining functional independence was associated with a higher probability of survival (OR 0.401; CI 0.178–0.905). Remaining functionally dependent after lockdown, being widowed, and living with children were associated with a lower probability of survival. Having a low income and severe functional dependence were associated with higher mortality in the following year, while being married, living independently, living independently as a homeowner, and maintaining the ability to leave the home after lockdown were associated with a higher probability of survival. Conclusions Functional dependence for performing basic and instrumental activities occurs within an ecological context, which in this study was associated with survival outcomes. This context was disrupted by the lockdown, which served as a nudge to make changes. These changes were independent of the women’s socioeconomic status, and when they involved regaining functional independence, they were associated with improved survival. These findings may help identify targets for interventions to promote healthy aging.