Predictors of mortality in nursing home residents: a 2-year prospective longitudinal study. (preprint)

Background The age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and to mortality in general. For this reason, our objective is to verify the incidence of general and COVID-19 mortality and to analyse its predictive factors in older people living in nursing homes over a 2-year period.Methods A two-year prospective longitudinal multicenter study was carried out in 5 nursing homes in Central Catalonia (Spain) between 2020 and 2022. Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect of mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression.Results The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3). A total of 59 (47.2%) deaths were recorded at 24 months (95% confidence interval [CI], 38.6–55.9) and 25 (20.0%) were due to COVID-19 most in first 3 months. In the multivariate analysis, functional impairment (hazard ratio [HR]: 2.40, 95% CI: 1.33–4.32, p = 0.003) was a significant risk factor for mortality independently of age (HR: 1.17, 95% CI: 0.69-2.00, p = 0.549) and risk of sarcopenia (HR: 1.40, 95% CI, 0.63–3.12, p = 0.403).Conclusions Nearly half of this sample of nursing home residents died within the 2-year period, and 20% were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.

Risk factors for developing symptomatic COVID-19 in older residents of nursing homes: A hypothesis-generating observational study (preprint)

Background. COVID-19 pandemic has had a major impact on society, including on residents of nursing homes (NH), who have a higher risk of complications and mortality due their physical and intellectual disabilities. Aim. To identify which risk factors associated with developing COVID-19 infection with symptoms in institutionalized older people. Methods. A 1-year longitudinal multicenter study was conducted in 5 NH during the period December 2019 to March 2021. The inclusion criteria used were residents aged 65 years or over, living in the NH permanently, with a diagnostic test for COVID-19 confirmed by reverse transcription polymerase chain reaction and/or serological test. The main variable was symptomatic COVID-19, with at least one of the following symptoms (fever, respiratory difficulties, cough, diarrhea, sudden urinary incontinence and disorientation or delirium). Three assessments were performed: baseline, six and twelve months follow-up. Descriptive and bivariate analysis (calculating relative risk-RR) were performed, considering a 95% confidence level and a statistically significant p <0.05. Results. Of the total sample of 78 individuals who tested positive for COVID-19, mean age 84.6 years (SD=7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p =0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p =0.033) were positively associated with developing COVID-19 infection with symptoms. Conclusions. Having suffered a stroke and living permanently in a private health care facility were positively associated with symptomatic COVID-19 in this sample of institutionalized older people.