The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents

Abstract

Background Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. Methods We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. Results A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: A retrospective survey among nursing home managers

“…In contrast to previous ndings from Rothgang et al [26], our results suggest that COVID-19 cases are more likely to be found in medium and large nursing homes (>50 residents) in Germany. However, our results support research from the USA [32], Canada [33], and Spain [34,35]. For example, in a study of 9,395 nursing homes in the USA, Abrams et al [32] showed that larger facility size, urban location, and state were signi cantly related to an increased probability of having COVID-19 cases in nursing homes [32].…”

Short- and Long-Term Mortality and Mortality Risk Factors among Nursing Home Patients after COVID-19 Infection

“…As our population size was limited, this study may have lacked power to find other significant risk factors for mortality as demonstrated in larger nationwide studies conducted among nursing home patients. 2,5,6 Fig. 2.…”

“…7 Another study found that patients who experienced COVID-19 infection had persisting complaints such as fatigue, muscle weakness, difficulty sleeping, and depression, up to 6 months after infection. 8 The impact of surviving COVID-19 on physical functioning is presumably similar or possibly even higher in frail older individuals and could have an effect on longterm mortality, as suggested by Soldevila et al 6 However, to our knowledge, no studies have yet investigated the consequences of COVID-19 infection on long-term mortality among nursing home patients after COVID-19 infection. Therefore, we aimed to assess mortality as well as risk factors for short-term mortality and long-term mortality in nursing home patients with COVID-19.…”

“…2e4 Within this population, especially patients with Parkinson disease, cognitive impairment, or dementia, overall frailty, chronic kidney disease, diabetes, and male sex are at risk. 2,5,6 Regarding long-term effects, a study by Rooney et al found that physical functioning and fitness are impaired within the general population after 12 months of follow-up. 7 Another study found that patients who experienced COVID-19 infection had persisting complaints such as fatigue, muscle weakness, difficulty sleeping, and depression, up to 6 months after infection.…”

The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain

“…LTCH location. The local incidence of COVID-19 is a strong risk factor for mortality in LTCHs [17,20]. During March and April 2020, SARS-CoV-2 infections surged in the city of Madrid and its metropolitan area.…”