Management of COVID-19 very Elderly Patients in Nursing Homes and Long-Term Care Facilities: Description of a New Model and Experience in a Medicalized Nursing Home

Abstract

Introduction: COVID-19 have been a challenge for healthcare, mainly in elderly patients in Nursing Homes (NHs) and Long-Term Care Facilities (LTCFs). We present a pioneering novel experience in addressing healthcare of very elderly patients with COVID-19 in these facilities by a reconversion of a NH in a medicalized NH. Methods: All patients admitted to the center were included, recording clinical and epidemiological variables. We conducted a descriptive analysis and a multivariate analysis to identify variables linked to mortality and persistence of positive PCR test. Results: we included 84 patients (40% men), women presented more symptomatology. We found a positive correlation between the duration of symptoms and the days required to obtain a negative PCR test (r=0.512, P<0.001). We also found an independent and significative association between asthenia (OR=2.58; IC95% 1.22–5.46) and mutism (OR=5.21; IC95% 1.58–17.15) and a longer time to achieve a negative PCR test. All patients, except contraindication, were treated with hydroxychloroquine and azithromycin, which was the recommended treatment during the period of the study. The early start of corticoid treatment (within the first 72 hours since the start of symptoms) was linked to a lower mortality in patients with moderate-severe symptoms. Mortality was lower than expected (which was higher than 20% in that period and group of age), reaching 14%, the main factors linked to mortality were the presence of mutism (OR=19; IC95% 3.4–108; P=0.001) and dyspnea (OR=12; IC95% 1.3–111; P=0.029). Conclusions: We present an alternative system for the care of these patients through the reconversion of a basic NH in a medicalized one, which showed a significant reduction in the expected mortality.