Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak

Tarteret, Paul; Strazzulla, Alessio; Rouyer, M.; Gore, Cecile; Bardin, Guillaume; Noel, Coralie; Benguerdi, Zine-Eddine; Berthaud, Julien; Hommel, M; Aufaure, Sylvie; Jochmans, Sébastien; Diamantis, S.

doi:10.1016/j.ijid.2020.12.004

Cited by 23 publications

(22 citation statements)

References 26 publications

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“…36 It has also been hypothesized that malnutrition could be an important risk factor, 37,38 but we did not find an association between food intake and mortality after adjustment for other risk factors, as in a previous study. 18 However, there was a trend toward an increased risk of mortality in those with the lowest BMI. Although this did not reach statistical significance, likely because of the small number of people in that BMI category, it cannot be ruled out that underweight is a risk factor for COVID-19 mortality in LTCF residents.…”

Section: Discussionmentioning

confidence: 96%

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: Discussionmentioning

confidence: 96%

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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“…The coordination between NH, primary care, and hospital care has been key during the pandemic. A study carried out in France in three nursing homes highlights that those nursing homes that received support from the hospital had lower mortality [25] Furthermore, after the first wave, this new form of work and collaboration has served to implement worldwide new strategies with to improve the care of the older persons living in, such as the formation of liaison geriatric hospital-based team units in our region [9].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…In Europe, the fatality rate was very high in the early outbreak countries, as was it high in early period in China [26] . In France, for example, it was reported that in the rst three months of the epidemic, due to lack of validated COVID-19 treatment, the fatality rate in some medical institutions reached up to 44% [27] .…”

Section: Discussionmentioning

confidence: 99%

Global Pandemic Trends of COVID-19 in 2020

Chen

Cai

Chen

2021

Preprint

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Background: The novel coronavirus pneumonia (COVID-19) has been global threaten to public health. This paper provides perspective to the decision-making for public health control of the pandemic or the spread of epidemic.Methods: According to the WHO global reported database, we developed and used the number of cumulative cases, and the number of cumulative deaths to calculate and analyze rates of incidence, mortality, and fatality by country, with respect to the 30 highest outbreak (Top 30) countries.Results： As of December 31, 2020, of the global population of 7.585 billion, the cumulative number of reported cases was 81,475,053, and the cumulative number of deaths was 1,798,050. The incidence rate of COVID-19 was 1074.13 per 100,000 population, the mortality rate was 23.70 per 100,000, and the case fatality rate was 2.21%. Among the Top 30 countries, the five countries with the highest number of reported cumulative cases were, in rank, the United States (19,346,790 cases), India (10,266,674), Brazil (7,563,551), Russia (3,159,297) and France (2,556,708), and the five countries with the highest number of cumulative deaths were the United States (335,789 cases), Brazil (192,681), India (148,738), Mexico (123,845) and Italy (73,604). Globally, the countries with the highest incidence rate were, in rank, Andorra, Luxembourg, Montenegro, San Marino, and Czechia; the countries with the highest mortality rate were, in rank, San Marino, Belgium, Slovenia, Italy, and North Macedonia. The highest fatality rate was found in Yemen, Mexico, Montserrat, Isle of Man, and Ecuador, respectively. In China, 96,673 cases of COVID-19 and 4788 deaths were reported in 2020, ranking the 78th and the 43rd, respectively, in the world. The incidence rate and mortality rate were 6.90/105 and 0.34/105, respectively, ranking 207th and 188th in the world. The case fatality rate was 4.95%, ranking 11th in the world.Conclusions： The COVID-19 prevalence is still on the rise, and the turning points of incidence and mortality are not yet forecasted. Personal protection, anti-epidemic measures and efforts from public health personnel, medical professionals, biotechnology R&D personnel, effectiveness of the vaccination programs and the governments, are the important factors to determine the future prevalence of this coronavirus disease.

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Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak

Cited by 23 publications

References 26 publications

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

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

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

Global Pandemic Trends of COVID-19 in 2020

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