Mortality attributable to COVID-19 in nursing home residents: a retrospective study

Nicola Veronese,Alberto Pilotto,Ai Koyanagi,Michele Tessarin,Paola Mantoan,Marco Chiavalin,Gianfranco Pozzobon,Vanni Stangherlin,Florina Tudor

doi:10.1007/s40520-021-01855-6

Abstract

AimCoronavirus-19 disease (COVID-19) is a widespread condition in nursing home (NH). It is not known whether COVID-19 is associated with a higher risk of death than residents without COVID-19. Therefore, the aim of this study was to assess whether COVID-19 is associated with a higher mortality rate in NH residents, considering frailty status assessed with the Multidimensional Prognostic Index (MPI).MethodsIn this retrospective study, made in 31 NHs in Venice, Italy, the presence of COVID-19 was ascertained with a nasopharyngeal swab. Frailty was evaluated using the MPI, modified according to the tools commonly used in our NHs. A Cox’s regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs), using COVID-19 as exposure and mortality as outcome and stratified by MPI tertiles. Similar analyses were run using MPI tertiles as exposure.ResultsOverall, 3946 NH residents (median age = 87 years, females: 73.9%) were eligible, with 1136 COVID-19 + . During a median follow-up of 275 days, higher values of MPI, indicating frailer people, were associated with an increased risk of mortality. The incidence of mortality in COVID-19 + was more than doubled than COVID-19- either in MPI-1, MPI-2 and MPI-3 groups. The presence of COVID-19 increased the risk of death (HR = 1.85; 95% CI 1.59–2.15), also in the propensity score model using MPI as confounder (HR = 2.48; 95% CI 2.10–2.93).ConclusionIn this retrospective study of NH residents, COVID-19 was associated with a higher risk of all-cause mortality than those not affected by COVID-19 also considering the different grades of frailty.

Highlights

MethodsThe spread of coronavirus-19 disease (COVID-19) is becoming unstoppable meeting the necessary epidemiological criteria to be declared a pandemic [1]
The aim of this study was to assess whether COVID-19 is associated with a higher mortality rate in older persons living in nursing home (NH), taking in consideration frailty status assessed with the Multidimensional Prognostic Index (MPI), a common tool for stratifying prognosis and for clinical decisionmaking in geriatric medicine [21]
NH residents with COVID-19 did not differ in terms of mean age (p = 0.85) or female sex (p = 0.08) compared to people never affected by COVID-19 (n = 2810)

Summary

Introduction

MethodsThe spread of coronavirus-19 disease (COVID-19) is becoming unstoppable meeting the necessary epidemiological criteria to be declared a pandemic [1]. The epidemiological data so far indicated that COVID-19 could be considered as a condition typical of older people [4]. NHs commonly include people that can be considered frail (e.g. for the presence of severe dementia) or disabled [9]. These structures have a high proportion of people with relevant social problems, e.g., they are without relatives or they cannot live alone at their homes since they are disabled. All these conditions are, per se, considered to increase mortality risk. Even if less than 10% of all COVID-19 cases are observed in NH in the world, NH and assisted living facilities residents and staff accounted for more than one third of the all deaths recorded [10, 11]

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