Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents

Mehta, Hemalkumar B.; Li, Shuang; Goodwin, James S.

doi:10.1001/jamanetworkopen.2021.6315

Cited by 88 publications

(109 citation statements)

References 47 publications

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“…In the UK, 907 cases of SARS-CoV-2 infection were recorded in 189 care homes leading to a 48% lethality rate [ 1 ]. In the present study, infection lethality was significantly lower during the second wave of the pandemic, reaching 23.4% ( p < 0.001), similar to what was observed in a sample of Italian NHs in Veneto region and in a large sample of US NHs [ 13 , 33 ]. The fall in NH COVID-19 deaths reported in our study is consistent with a recent study by Ioannidis et al, describing a significant reduction in NH mortality rates in the second vs the first wave in 8 countries [ 21 ].…”

Section: Discussionsupporting

confidence: 89%

Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

et al. 2021

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Background Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality. Aims To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy. Methods The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Results The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively). Discussion Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

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Section: Discussionsupporting

confidence: 89%

Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

et al. 2021

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“…The characteristics of nursing homes in our sample, including size and residents’ average score of dependence and morbidity, was consistent with value reported for the surveyed area. The 8.2% incidence of COVID-19 in nursing homes was higher than in the general population of the surveyed area (4.4%) and in France (4.9%), even when stratifying on those ≥70 years of age (from 1.7% in in Auvergne-Rhône-Alpes, to 4.5% in France), but much lower than in United States nursing homes (28.4%) [ 10 , 19 ]. This higher incidence is likely to be driven by the frailty and underlying conditions of nursing home residents, and the close living environment which may favor viral spread [ 4 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area

Piet

Maillard²,

Mallaval

et al. 2021

JCM

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In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing homes, 74 (32.8%) completed the survey. Among 5891 residents, the incidence of confirmed or probable COVID-19 was 8.2% (95CI, 7.5% to 8.9%), and 22 (29.7%) facilities had an outbreak with at least 3 cases. Among the 4652 staff members, the incidence of confirmed or probable COVID-19 was 6.3% (95CI, 5.6% to 7.1%). A strong positive correlation existed between residents and staff members for both numbers of cases (r2 = 0.77, p < 0.001) and the incidence (r2 = 0.76, p < 0.001). In univariate analyses, cases among the staff were the only factor associated with the occurrence of an outbreak among residents (OR = 11.2 (95CI, 2.25 to 53.6)). In bivariate analysis, this relationship was not influenced by any nursing home characteristics, nor the action they implemented to mitigate the COVID-19 crisis. Staff members were, therefore, likely to be a source of contamination and spread of COVID-19 among nursing home residents during the first wave of the pandemic.

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“…FGF21 is reported to induce angiotensin-converting enzyme 2, which has recently been focused on as a key mechanism against SARS-coronavirus 2 (SARS-CoV-2) infection, and prevent hypertension and vascular damage in mice 30,31 . Since FGF21 upregulating factors, including smoking, type 2 diabetes, and obesity, are also known risk factors for SARS-CoV-2-related mortality 32 , it is intriguing to speculate the protective effects of FGF21 on SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

Serum FGF21 levels are altered with various factors including lifestyle behaviors

Nakanishi

Ishibashi

Ide

et al. 2021

Preprint

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Fibroblast growth factor (FGF) 21 has various functions, including glucose and lipid metabolism, yet the biology of FGF21 remains unclear. This study aimed to investigate specific conditions that might affect the functions of FGF21. Subjects included 398 healthy men who underwent health examinations to obtain information on physical and biochemical parameters and lifestyle behaviors. Associations of serum FGF21 levels with each parameter were assessed in the study. FGF21 levels correlated with age, body mass index, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure, aspartate aminotransferase, alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (γ-GTP), uric acid, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, and HbA1c. Moreover, FGF21 levels were significantly associated with lifestyle behaviors, including smoking status and breakfast and alcohol consumption frequency. Multivariable regression analysis showed that age, ALT, γ-GTP, smoking status, and breakfast and alcohol consumption frequency were independent variables for FGF21 levels. Assessment among the non-obese and obese groups showed that FGF21 levels correlated with WC, SBP, and TC only in the non-obese group. Thus, serum FGF21 levels were affected by several factors, including lifestyle behaviors, age, and liver function. To assess the functions of FGF21 in individuals, considering these factors would be essential. (199 words)

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Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents

Abstract: IMPORTANCE Nursing home residents account for approximately 40% of deaths from SARS-CoV-2. OBJECTIVE To identify risk factors for SARS-CoV-2 incidence, hospitalization, and mortality among nursing home residents in the US.

Cited by 88 publications

References 47 publications

Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

Caring for nursing home residents with COVID-19: a “hospital-at-nursing home” intermediate care intervention

Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area

Serum FGF21 levels are altered with various factors including lifestyle behaviors

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