Abstract
BackgroundCovid-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.ResultsA 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).ConclusionsOur results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
Highlights
It is estimated that in spite of representing less than five per cent of the elderly population (> 65 years old), 47% of all Covid-19 deaths occurred among residents from LongTerm Care Facilities (LTCF) nursing homes during the first wave of the SARS-CoV-2 pandemic in high-income countries [1]
Participant characteristics A total of 9158 residents ≥65 years residing in 168 LTCF were included in the study, with a median occupancy of 41 and distributed over 52 local catchment areas
At the LTCF level, 97 institutions (57.7%) reported at least one confirmed case of SARS-CoV-2 infection, with attack rates ranging from 1% to 95%
Summary
It is estimated that in spite of representing less than five per cent of the elderly population (> 65 years old), 47% of all Covid-19 deaths occurred among residents from LongTerm Care Facilities (LTCF) nursing homes during the first wave of the SARS-CoV-2 pandemic in high-income countries [1]. This appalling data could be explained by Soldevila et al BMC Geriatrics (2022) 22:123 the fact that LTCF show the ideal epidemiological conditions for transmission of an airborne infectious agent like SARS-CoV-2 since they are densely populated spaces with large numbers of staff who have extensive contact with highly vulnerable residents. Covid-19 pandemic has affected older people living in Long-term Care settings in terms of infection and mortality
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