Frequency of Neglect and Its Effect on Mortality in Long-Term Care before and during the COVID-19 Pandemic.

Neglect of vulnerable adults living in long-term care (LTC) homes has been well documented. It often presents first in the physical symptoms of decubitus ulcers, dehydration and urinary tract infections (UTIs). A retrospective cohort study was conducted to examine the relationship between neglect and 90-day mortality among LTC residents in Ontario. An index of neglect was created. Of 106,765 residents, more than one-quarter were found to have at least one indicator of neglect: 13.1% had decubitus ulcers, 13.5% had dehydration, 6.2% had a UTI. Residents who exhibited clinical signs of neglect had higher risks of death within 90 days, both before and during the COVID-19 pandemic.

COVID-19 excess mortality among long-term care residents in Ontario, Canada.

The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.