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COVID-19 is associated with high morbidity and mortality in nursing home (NH) residents. 1e3 Although most of the literature on COVID-19 has focused on the pathogenesis and management of hypoxic respiratory failure from pneumonia, less well described are geriatric complications such as dehydration, delirium, and falls. The objective of this study was to describe the frequency of dehydration and intravenous hydration during COVID-19 in NH residents and examine its interaction with delirium, dementia, and other complications. MethodsThe study setting was a 514-bed NH in New York City. Subjects were all symptomatic NH residents with a positive COVID-19 PCR or antibody test between March 1 and June 1, 2020. We reviewed medical, nursing, and other clinical notes to ascertain illness and treatment characteristics up to 30 days after symptom onset. Dehydration was defined as any blood urea nitrogen (BUN)ecreatinine ratio greater than 20. 4 Free water deficit 4 was calculated in those with sodium (Na) > 145 mmol/L.We compared the occurrence of delirium, falls, hospitalization, and death between residents with dehydration and those without using chi-square tests. We quantified the association between dehydration and cognitive impairment from dementia and/or delirium using multivariable logistic regression, using SPSS version 24 (IBM, Inc). Institutional review board approval was obtained from the NH and affiliated medical school.