Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

Bielza, Rafael; Sanz, Juan Ramón; Zambrana, Francisco; Arias, Estefanía; Malmierca, Eduardo; Portillo, Laura; Thuissard, Israel; Lung, Ana; Álvarez, Marta Neira; Moral, M. Seral; Andreu‐Vázquez, Cristina; Esteban, Ana Victoria; Ramírez, Marcela Irma; González, Laura Goiburú; Carretero, Guillermo; Moreno, Ricardo Vicente; Martínez, Pilar; López, J Romero; Esteban-Ortega, Mar; García, Isabel; Vaquero, María Antonia; Linares, Ana Margarita Valiente; Gómez-Santana, Ana; Cerezo, Jorge Gómez

doi:10.1016/j.jamda.2020.12.003

Cited by 61 publications

(90 citation statements)

References 28 publications

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“…It should also be noted that because different conditions are likely less often diagnosed in LTCFs, and primary care diagnoses care are not captured in the NPR, the sensitivity to capture different diagnoses is likely lower than in community-dwelling individuals. Regardless, our results are similar to previous studies of nursing home residents, 15,19,29 geriatric patients, 32 and veterans. 42 This study has several important strengths.…”

Section: Discussionsupporting

confidence: 92%

“…Two other common patient characteristics that were associated with higher mortality were impaired walking ability and urine and bowel incontinence. Previous studies found physical function and frailty to be risk factors for 30-day mortality after COVID-19 in LTCFs 15,19 and in-hospital mortality in older adults. 32 In one study, bowel incontinence was a risk factor for COVID-19 diagnosis.…”

Section: Discussionmentioning

confidence: 92%

“…Smaller studies, conducted in age groups similar to ours, showed more comparable mortality rates. 15,28,29 A limitation of all these studies is that they lacked a control group, impeding assessment of excess mortality. In this sense, our results add important evidence regarding the profound dangers of COVID-19 in LTCFs, as illustrated by the 7-fold higher mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, older age, male sex, and neuropsychological conditions were among the most important risk factors for 30-day mortality in LTCF residents with COVID-19. Although these risk factors are known from previous studies, 15,16,19,29 less is known about their additive effects. Therefore, we also examined how the absolute risk of death varied depending on these 3 risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

Ballin¹,

Bergman²,

Kivipelto³

et al. 2021

Journal of the American Medical Directors Association

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Objective: To compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. Design: Retrospective cohort study. Setting and Participants: All residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. Methods: We selected residents with confirmed COVID-19 until September 15, 2020, along with timedependent propensity scoreematched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality.Results: A total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30day mortality was 2.44 (95% CI 1.57-3.81) in cases aged 80-84 years, 2.99 (95% CI 1.93-4.65) in cases aged 85-89 years, and 3.28 (95% CI 2.11-5.10) in cases aged 90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.60, 95% CI 2.22-3.05), neuropsychological conditions (OR, 2.18; 95% CI 1.76-2.71), impaired walking ability (OR, 1.45, 95% CI 1.17-1.78), urinary and bowel incontinence (OR 1.51, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.68) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. Conclusions and Implications: In Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for an extensive number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

Ballin¹,

Bergman²,

Kivipelto³

et al. 2021

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

show abstract

“…During the COVID-19 pandemic, healthcare systems worldwide have striven to address the increasing and diverse needs of SARS-CoV-2 infected patients, while minimizing exposure of uninfected patients and healthcare workers [1]. The difficulties in managing high numbers of older subjects in the community, combined with caregivers' fears, have led to the hospitalization of many mild or asymptomatic patients, at risk of sudden clinical deterioration not much because of COVID-19 itself but because of frailty and hospital-related adverse events such as delirium, reduced mobility, and social isolation [2,3]. Hospital at Home (HaH) is an alternative healthcare model that provides hospital-level care to acutely ill frail subjects in their home and has been proven as a safe and effective alternative for selected patients with a variety of conditions [4,5].…”

mentioning

confidence: 99%

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

et al. 2021

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Hospital at Home (HaH) has been proposed as a solution to relieve pressure on hospital beds during the COVID-19 pandemic; however, caregivers' feelings of inadequacy and concerns on the need for tighter clinical monitoring might lead to unnecessary and potentially harmful hospital admissions in frail older patients with mild or atypical COVID-19. Here we report the case of a 91-year old woman with severe dementia and atypical COVID-19 that could be successfully managed by our HaH thanks to her highly motivated caregivers and the support of a telemedicine solution (TMS) to provide caregiver training and support as well as supplementary telemonitoring. Despite some well-known issues on TMS use, the hybrid inperson and tele-visit approach of TMS-assisted HaH could help to create a "secure" environment, empowering caregivers to manage frail older adults with COVID-19 at home, avoiding unnecessary admissions to closed wards and their negative physical, functional and psychological outcomes.

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Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status

et al. 2021

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Clinical and biological assessment of the COVID-19 vaccine efficacy in the frail population is of crucial importance. The study focuses on measuring the levels of anti-SARS-CoV-2 IgG antibodies before and after BNT162b2 mRNA COVID-19 vaccination among long-term care facility (LTCF) elderly residents. We conducted a prospective, single-center, observational study among LTCF residents. The study protocol was based on three blood sample acquisitions: first taken at baseline—5 days before the first dose of the vaccine, second—20 days after the first dose, and third—12 days after the second shot of the vaccine. The comparison was made for two cohorts: patients with and without prior COVID-19 infection. The data was collected from January to March 2021. A total number of 78 LTCF residents (55 women and 23 men) aged 62–104, 85.72 ± 7.59 years (mean ± SD), were enrolled in the study. All study participants were investigated for the presence of SARS-CoV-2 anti-spike (S) protein IgG, using a chemiluminescent immunoassay. Frailty was assessed with the Clinical Frailty Scale. Among elderly COVID-19 survivors in LTCF, a single dose of vaccine significantly increased anti-SARS-CoV-2 IgG antibody levels. IgG concentration after a single and double dose was comparable, which may suggest that elderly COVID-19 survivors do not require a second dose of vaccine. For residents without a previous history of COVID-19, two doses are needed to achieve an effective serological response. The level of anti-SARS-CoV-2 IgG antibodies after vaccination with BNT162b2 mRNA COVID-19 did not correlate with the frailty and age of the studied individuals.

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Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

Cited by 61 publications

References 28 publications

Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

Telemedicine-assisted care of an older patient with COVID-19 and dementia: bridging the gap between hospital and home

Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status

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