Abstract
BackgroundCoronavirus disease 2019 (COVID-19), is a disease with diverse presentation. Several studies have shown different occurrence of symptoms for women and men, but no studies have been found examining sex differences in clinical presentation for nursing home residents dying from COVID-19.The objective of this study was to describe sex and age differences and the impact of a dementia diagnosis on symptom occurrence during the last week in life for persons dying from COVID-19 in nursing homes.MethodsThis is a population-based retrospective study based on data from the Swedish Register of Palliative Care. A total of 1994 residents aged 65 or older who died from COVID-19 in nursing homes were identified. The impact of sex, age and a dementia diagnosis on six different symptoms was analysed using chi2-test and multivariate logistic regression.ResultsResidents dying from COVID-19 were more often men (p < .002). Men more often had dyspnoea and death rattles (p < .001). Nausea was more common in women (p < .001). No sex differences in the occurrence of pain, anxiety or confusion were seen. Dyspnoea and nausea were less commonly reported in residents with dementia (p < .001).ConclusionsWe found sex differences in symptom presentation for fatal COVID-19 in nursing home settings which remained after adjusting for age. Residents with a dementia diagnosis had fewer symptoms reported before death compared to those without dementia.Clinical presentation of fatal COVID-19 differs between women and men in nursing homes. Residents with fatal COVID-19 present with more unspecific and less prominent symptoms when also suffering from dementia.
Highlights
Coronavirus disease 2019 (COVID-19), is a disease with diverse presentations
Demographics and COVID-19 diagnosis A total of 17,356 residents who had died in a nursing home in Sweden were reported to the Swedish Register of Palliative Care (SRPC) during 2020 at the time of data collection
In the COVID group, 1418 had an ongoing infection at time of death, 318 a suspected ongoing infection and 258 a previous infection. Out of these 1994 persons with COVID19, 1632 (82%) were lab-verified with polymerase chain reaction (PCR) according to the healthcare staff reporting to the SRPC
Summary
Coronavirus disease 2019 (COVID-19), is a disease with diverse presentations. Common symptoms reported are fever, cough and dyspnoea [1]. Delirium as the first clinical presentation of COVID-19 was shown by Poloni et al to be associated with old age and with multiple comorbidities, but not with sex, in a dementia facility [8]. In a Spanish study examining patients with COVID-19 admitted to an emergency department, older patients were less likely to present with fever, cough and dyspnoea, and more likely to present with unspecific symptoms such as confusion or presyncope/syncope [9]. Several studies have shown different occurrence of symptoms for women and men, but no studies have been found examining sex differences in clinical presentation for nursing home residents dying from COVID-19. The objective of this study was to describe sex and age differences and the impact of a dementia diagnosis on symptom occurrence during the last week in life for persons dying from COVID-19 in nursing homes
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