Clinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Vol. 77; no. 4; pp. e138 - e147
• Main Authors: Ramos-Rincón, José-Manuel, Bernabeu-Wittel, Máximo, Fiteni-Mera, Isabel, López-Sampalo, Almudena, López-Ríos, Carmen, García-Andreu, María-Del-Mar, Mancebo-Sevilla, Juan-José, Jiménez-Juan, Carlos, Matía-Sanz, Marta, López-Quirantes, Pablo, Rubio-Rivas, Manuel, Paredes-Ruiz, Diana, González-San-Narciso, Candela, González-Vega, Rocío, Sanz-Espinosa, Pablo, Hernández-Milián, Almudena, Gonzalez-Noya, Amara, Gil-Sánchez, Ricardo, Boixeda, Ramon, Alcalá-Pedrajas, José-Nicolás, Palop-Cervera, Marta, Cortés-Rodríguez, Begoña, Guisado-Espartero, María-Esther, Mella-Pérez, Carmen, Gómez-Huelgas, Ricardo
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-04-2022
• Subjects: Aged; C-reactive protein; COVID-19; Cross-Sectional Studies; Dementia disorders; Dyspnea; Epidemiology; Female; Hospitalization; Humans; Long term health care; Long-Term Care; Male; Mortality; Older people; Patients; Respiration; Retrospective Studies; Risk Factors; Spain - epidemiology; Spain; COVID-19; Nursing homes; Epidemiology; Mortality; Risk factors
• ISSN: 1079-5006; 1758-535X
• DOI: 10.1093/gerona/glab305

COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents.
This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis.
Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p < .001). Mortality risk factors in LTCF residents were severe functional dependence (adjusted odds ratios [aOR]: 1.79; 95% confidence interval [CI]: 1.13-2.83; p = .012), dyspnea (1.66; 1.16-2.39; p = .004), SatO2 < 94% (1.73; 1.27-2.37; p = .001), temperature ≥ 37.8°C (1.62; 1.11-2.38; p = .013); qSOFA index ≥ 2 (1.62; 1.11-2.38; p = .013), bilateral infiltrates (1.98; 1.24-2.98; p < .001), and high C-reactive protein (1.005; 1.003-1.007; p < .001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR: 0.74, 95%CI: 0.62-0.87; p < .001).
Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.