Sarcopenia After COVID-19 Infection and Rehabilitation in Former Homeless Older Adults Residing in Supportive Housing: A Case Study Research

Abstract

Introduction Sarcopenia is a multifactorial geriatric syndrome characterized by progressive loss of skeletal muscle mass, muscle strength, and physical performance, leading to functional decline and increased mortality among older adults. Major contributing factors include malnutrition, chronic inflammation, comorbidities, and physical inactivity. Coronavirus disease 2019 (COVID-19) infection induces a severe inflammatory and catabolic state that accelerates muscle protein breakdown, particularly in older adults with limited physiological reserve. During the post-acute phase, prolonged immobilization, fatigue, reduced physical activity, and inadequate nutritional intake further increase the risk of sarcopenia. Older adults with a history of homelessness are particularly vulnerable due to long-standing nutritional deficits, multimorbidity, and social disadvantage. Although supportive housing provides a structured care environment, evidence regarding post-COVID-19 sarcopenia and recovery among former homeless older adults remains limited.

Objective This study aimed to describe the progression of sarcopenia following COVID-19 infection and the rehabilitation in former homeless older adults residing in supportive housing, with an emphasis on nursing assessment, rehabilitation care, and functional outcomes.

Design This study employed a descriptive case study design.

Methodology The participants were two cases: an 84-year-old former homeless man who had resided in a supportive housing facility for 13 years and a 62-year-old former homeless man who had resided in the same supportive housing facility for 7 years, who were purposively selected for comparison based on similar exposure to COVID-19 infection and comparable baseline risk of sarcopenia. Following recovery from COVID-19 infection, post-infection screening was conducted as part of routine health monitoring. Sarcopenia risk and status were assessed using standardized screening and diagnostic criteria recommended by the Asian Working Group for Sarcopenia 2019. Nursing assessment focused on muscle strength, and physical performance. A multidisciplinary rehabilitation program was implemented, coordinated by nurse researchers in collaboration with supportive housing personnel. The program included individualized resistance exercise, balance and gait training, and mobility exercises performed three times per week. Nutritional management emphasized adequate energy intake and protein supplementation, with a recommended protein intake of 1.2 g/kg body weight/day. Ongoing nursing monitoring supported adherence, safety, and continuity of care throughout the rehabilitation period. Case 1 participated in the rehabilitation program, while Case 2 did not engage in the program and maintained usual daily activities. Clinical indicators were monitored 4 points of time in both cases (T1: 3 months post-COVID-19, T2: 1-year follow-up, T3: pre-rehabilitation baseline conducted 6 months after T2, and T4: post-rehabilitation assessment. A cross-case analysis was conducted to examine similarities and differences in sarcopenia progression and functional outcomes.

Results Across the 4 time points, Case 1 had calf circumference of 26.5, 23.5, 25.5, and 27.0 cm, respectively; handgrip strength of 15.5, 10.85, 11.3, and 19.5 kg, respectively; physical performance score of 17.4, 20.91, 12.00, 10.71, respectively. Appendicular skeletal muscle mass index (ASMI) at T1 and T4 was 6.74 and 7.56 kg/m2, respectively. In Case 2, calf circumference was 28.5, 28.0, 28.5, 28.0 cm, respectively; handgrip strength was 16.0, 17.5, 16.0, 10.5 kg, respectively; physical performance score was 19.08, 22.33, 20.55, 27.95, respectively. ASMI at T1 and T4 was 6.30 and 5.55 kg/m2, respectively.

Recommendation This case study highlights the importance of early nursing-led screening for sarcopenia following COVID-19 infection, particularly among vulnerable older adults. Supportive housing can serve as an effective setting for post-COVID-19 rehabilitation when structured exercise, nutritional support, and multidisciplinary collaboration are integrated into routine care. Nursing practice should emphasize early identification, individualized rehabilitation planning, and continuous functional assessment to promote recovery and prevent further functional decline. Further research is recommended to examine post-COVID-19 sarcopenia management strategies in supportive housing.