Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study.

Francesc X Marin-Gomez,Jacobo Mendioroz-Peña,Miguel-Angel Mayer,Josep-Maria Vilaseca,Eduardo Hermosilla,Leonardo Méndez-Boo,Angela Leis,Núria Mora,Queralt Miró Catalina,Manolo Medina,Ermengol Coma,Josep Vidal-Alaball

doi:10.3390/ijerph19010483

Abstract

Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.

Highlights

Retrospective data were collected on COVID-19 cases, coinciding with the first wave period, occurring between 1 March and 30 April 2020 [18], and the study individuals were grouped according to whether or not they resided in a geriatric centre in Catalonia
We excluded those people who had no linkage to the electronic health records (EHR) because they were not assigned to one of the primary care practices contributing to our database (146,723 persons)
The incidence of COVID-19 cases among the Institutionalised older people” (IOP) was higher, with 28.8% (13,140/45,584), while among the non-IOP population we found only 1.88% (23,970/1,274,255)

Summary

Introduction

Nursing homes accommodate elderly people with a sufficient degree of autonomy for the activities of daily living and who require a substitute home environment (accommodation, food, shelter, cohabitation and personal support) or elderly people who do not have this autonomy and need constant supervision and the replacement of the home by an environment that is adapted to their degree of dependence [1]. Estimates indicate that a significant proportion of population mortality is concentrated in these centres [2]. Mortality in residential facilities is higher in areas with poorer socio-economic conditions, and people with lower socio-economic status, living alone or without children, are more likely to die in a nursing home [3,4].

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Conclusion