Health and sociodemographic determinants of excess mortality in Spanish nursing homes during the COVID-19 pandemic: a2-year prospective longitudinal study.

Abstract

Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a2-year period. Design: A2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. This study involved five nursing homes in Central Catalonia (Spain). Residents aged 65years or older who lived in the nursing homes on apermanent basis. Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. The total sample of 125 subjects had amean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24months (95% confidence interval, CI, 38.6-55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33-4.32) was asignificant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69-2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63-3.12). Almost half of this sample of nursing home residents died in the 2‑year period, and one fifth were attributed to COVID-19. Functional impairment was arisk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.