Frailty and risk of mortality and hospitalization in nursing home residents affected by COVID-19

Veronese, Nicola; Stangherlin, Vanni; Mantoan, Paola; Chiavalin, Marco; Tudor, Florina; Pozzobon, Gianfranco

doi:10.4081/gc.2021.9635

Cited by 6 publications

(7 citation statements)

References 23 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%

“…Indeed, during the first wave, more than half of SARS-CoV-2-positive residents were admitted to acute and intermediate care hospitals, while only one in ten was hospitalized during the second wave of the pandemic. The hospitalization rate observed during the second wave was much lower than that described by previous studies, reporting that about 20% of SARS-CoV-2-positive NH residents have been admitted to hospital during COVID-19 disease, with rates up to 45% among severely symptomatic cases, both in large US studies as well as in Italian samples [ 7 , 13 , 33 ]. The results we observed can be explained by the progressive upgrading of COVID-19 “bubbles” to create on-site IC units, where SARS-CoV-2 infected patients could be isolated from the negative ones while receiving appropriate multidisciplinary care, thus avoiding the need for hospitalization.…”

Section: Discussioncontrasting

confidence: 57%

“…In addition, significant hospitalization rates have been reported in SARS-CoV-2-positive NH residents [7,12,13], substantially contributing to hospital overcrowding. In NH residents, hospital admission frequently results in prolonged stays and hospital-related complications such as delirium, infections, malnutrition and functional decline, that negatively impact patients' prognosis [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Finally, MPI has already been used as a prognostic factor in settings other than ICFs during the COVID-19 epidemic. In particular, in nursing home residents, we have shown that higher MPI values indicate a higher risk of mortality, independently of the presence or not of COVID-19 and vice versa (i.e., COVID-19 increases the risk of mortality independently of MPI values) [13]. More recently, we have reported that in older patients hospitalized for COVID-19, MPI is useful for better stratifying the risk of mortality, whilst more data are needed for predicting the risk of ICU admission [25].…”

Section: Discussionmentioning

confidence: 78%

“…A version of the MPI, modified from the original version that originally included information regarding nutritional status, disability, number of medications, risk of pressure sores, severity of comorbidities, social aspects [4] and using tests commonly used for the admission to the ICFs, was used [12,13]. This tool requires about 15-20 min for trained health professionals [12].…”

Section: Exposure: the Multidimensional Prognostic Index (Mpi)mentioning

confidence: 99%

Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study

Veronese

Vianello²,

Danesin³

et al. 2021

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Multidimensional prognostic index (MPI) is a frailty assessment tool used for stratifying prognosis in older hospitalized people, but data regarding older people admitted to intermediate care facilities (ICFs) are missing. The aim of this study is to evaluate whether MPI can predict mortality in older patients admitted to the ICFs. MPI was calculated using different domains explored by a standard comprehensive geriatric assessment and categorized into tertiles (MPI-1 ≤ 0.20, MPI 2 0.20–0.34, MPI 3 > 0.34). A Cox’s regression analysis, taking mortality as the outcome, was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 653 older patients were enrolled (mean age: 82 years, 59.1% females). Patients in MPI-2 (HR = 3.66; 95%CI: 2.45–5.47) and MPI-3 (HR = 6.22; 95%CI: 4.22–9.16) experienced a higher risk of mortality, compared to MPI-1. The accuracy of MPI in predicting mortality was good (area under the curve (AUC) = 0.74, 95%CI: 0.70–0.78). In conclusion, our study showed that prognostic stratification, as assessed by the MPI, was associated with a significantly different risk of mortality in older patients admitted to the ICFs, indicating the necessity of using a CGA-based tool for better managing older people in this setting as well.

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Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

et al. 2021

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Summary In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. Purpose Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. Methods Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox’s regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. Results The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11–2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008–1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. Conclusion Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

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Frailty and risk of mortality and hospitalization in nursing home residents affected by COVID-19

Cited by 6 publications

References 23 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

Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study

Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

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