Factors Associated With COVID-19 Hospitalizations and Deaths in French Nursing Homes

Couderc, Anne-Laure; Correard, Florian; Hamidou, Zeinab; Nouguerède, Emilie; Arcani, Robin; Weiland, Joris; Courcier, Anais; Caunes, Pierre; Clot-Faybesse, Priscilla; Gil, Patrick; Berard, Charlotte; Miola, Charlène; Berbis, Julie; Villani, Patrick; Daumas, Aurélie

doi:10.1016/j.jamda.2021.06.023

Cited by 15 publications

(9 citation statements)

References 35 publications

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“…Similar to other studies, we found that men died more often despite being a minority of nursing home residents and that residents’ autonomy was a strong factor in their survival, with those who were more reliant on staff for daily support most likely to succumb to their disease 8–10 29–33. Living with multiple comorbidities (especially diabetes and dementia) was also strongly predictive of COVID-19 mortality in our group 8 10 29–33. The negative effects of understaffing (seen as sick leave or AWAS in our data) were similar to those reported in the USA,8 Spain33 and the UK,34 35 and constitute a vicious cycle: during periods of high transmission, more staff needed sick leave.…”

Section: Discussionsupporting

confidence: 89%

“…Our multivariate analyses confirmed mortality trends seen in other settings. Similar to other studies, we found that men died more often despite being a minority of nursing home residents and that residents’ autonomy was a strong factor in their survival, with those who were more reliant on staff for daily support most likely to succumb to their disease 8–10 29–33. Living with multiple comorbidities (especially diabetes and dementia) was also strongly predictive of COVID-19 mortality in our group 8 10 29–33.…”

Section: Discussionsupporting

confidence: 88%

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COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

Dujmovic¹,

Roederer²,

Frison³

et al. 2022

BMJ Open

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IntroductionFrench nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.MethodsA cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.ResultsThe average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.ConclusionDespite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

Dujmovic¹,

Roederer²,

Frison³

et al. 2022

BMJ Open

View full text Add to dashboard Cite

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“…In addition, the SARS-CoV-2 has had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world [ 40 ]. Individuals living in nursing homes for the elderly present higher indexes of frailty than the general population, making them more vulnerable to health problems such as infection by SARS-CoV-2 [ 37 , 41 , 42 , 43 , 44 , 45 ]. It is also known that people with greater frailty have a higher mortality by COVID-19 [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Agoües

Gallego

Resa

et al. 2021

IJERPH

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Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.

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“…Identification of high risk patients are of paramount importance for the optimal use of hospital capacity and patient safety. There have been attempts to identify prognostic factors that might predict the outcome of early SARS-CoV-2 infection and COVID-19-associated pneumonia (4,(9)(10)(11). Comorbidities, such as hypertension, hyperlipidemia, ischemic heart disease, congestive heart failure, chronic pulmonary disease, diabetes mellitus, cerebrovascular disease, dementia, liver disease, chronic kidney disease, malignancies, sickle cell disease, organ transplantation, and other immunocompromising conditions have been associated with a higher risk of severe disease and death (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Severity and prognostic factors of SARS-CoV-2-induced pneumonia: The value of clinical and laboratory biomarkers and the A-DROP score

Szabó

Kardos

Oláh³

et al. 2022

Front. Med.

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IntroductionNumerous clinical and laboratory scores that include C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase (LDH), interleukin 6 (IL-6), procalcitonin (PCT), blood urea nitrogen (BUN), creatinine levels and oxygenation (PaO2 and SaO2) have been used for the prognosis of COVID-19. In addition, composite scores have been developed for the assessment of general state and risk in community-acquired pneumonia (CAP) that may be applied for COVID-19 as well. In this study, we assessed severity and potential prognostic risk factors for unfavorable outcome among hospitalized COVID-19 patients. We also applied the A-DROP general scoring system used in CAP to COVID-19.Patients and methodsAltogether 233 patients admitted to our center with COVID-19 were included in the study. Clinical status, several laboratory biomarkers described above, indicators of oxygenation were determined at hospital admission. We also applied the A-DROP composite scoring system that includes Age (≥ 70 years in males and ≥ 75 years in females), Dehydration (BUN ≥ 7.5 mmol/l), Respiratory failure (SaO2 ≤ 90% or PaO2 ≤ 60 mmHg), Orientation disturbance (confusion) and low blood Pressure (systolic BP ≤ 90 mmHg) to COVID-19.ResultsAt the time of admission, most patients had elevated CRP, LDH, ferritin, D-dimer, and IL-6 levels indicating multisystemic inflammatory syndrome (MIS). Altogether 49 patients (21.2%) required admission to ICU, 46 (19.7%) needed ventilation and 40 patients (17.2%) died. In the binary analysis, admission to ICU, the need for ventilation and death were all significantly associated with the duration of hospitalization, history of hypertension or obesity, confusion/dizziness, as well as higher absolute leukocyte and neutrophil and lower lymphocyte counts, elevated CRP, PCT, LDH, ferritin, IL-6, BUN, and creatinine levels, low PaO2 and SaO2 and higher A-DROP score at the time of admission (p < 0.05).ConclusionNumerous laboratory biomarkers in addition to obesity, dizziness at the time of admission and the history of hypertension may predict the need for ICU admission and ventilation, as well as mortality in COVID-19. Moreover, A-DROP may be a suitable scoring system for the assessment of general health and disease outcome in COVID-19.

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Factors Associated With COVID-19 Hospitalizations and Deaths in French Nursing Homes

Cited by 15 publications

References 35 publications

COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Severity and prognostic factors of SARS-CoV-2-induced pneumonia: The value of clinical and laboratory biomarkers and the A-DROP score

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