Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article

Abstract

Background The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. Methods A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. Conclusions and implications 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.

Clinical Features of Hypoxemia Due to Infection Under Home-Based Medication During the COVID-19 Pandemic Period

“…During the COVID-19 pandemic, nursing homes have become epicenters for the transmission of SARS-CoV-2, with a high mortality rate of 10-50% [20,21]. Regarding the nature of the disease, the severity of COVID-19 increases with age; however, the analysis of 30 days mortality in hospitalized patients over 65 years old seemed to be similar to that observed in nursing homes [22,23].…”

Mortality Predictive Value of the C2HEST Score in Elderly Subjects with COVID-19—A Subanalysis of the COLOS Study

“…Combined with comorbidities and frailty, it leads to the increased risk of an unfavorable outcome in this specific population. The high prevalence of atypical symptoms [13] and more rapid progression of disease indicated that the development of a simple risk-scoring system faced with limited resources could optimize the treatment process. Some elderly subjects can recover spontaneously without any medical intervention when the disease course is mild.…”

Atypical Presentation of COVID-19 in Older Adults: A Scoping Review

“…Delirium was the most frequent geriatric syndrome presented in case studies and cohort studies (n = 23 studies) (Table 2). Among the cohort studies (n = 17), 16 reported the percentage of delirium with a prevalence of 37.1 ± 18.16%, ranging from 9.1 to 67.1% [8,9,16,31,32,34,[37][38][39][40][42][43][44][45][46][47]. Anorexia (noted in 2 case studies and 7 cohort studies) had a prevalence of 27.25 ± 22.63%, ranging from 2.1 to 61.3% [8,9,28,30,36,42,48].…”