Older People Living in Long-Term Care Facilities and Mortality Rates During the COVID-19 Pandemic in Italy: Preliminary Epidemiological Data and Lessons to Learn

Abstract

Background: Long-Term Care Facilities (LTCF) in Italy have been particularly affected by the COVID-19 pandemic, especially in terms of mortality rates of older residents. However, it is still unclear the actual extent of this situation. The aim of this manuscript is to assess the extent of mortality rates of older adults in LTCF during the pandemic across different regions of Italy, compared to the previous years and to older general population not resident in LTCF. Methods: We extracted and analyzed data collected by three Italian institutions (i.e., Italian Statistician Institute ISTAT, Italian N.I.H, Milan Health Unit) about the number of deaths among older people living in the community and among LTCF residents during the pandemic and the previous years. We also compared the observed mortality rate among LTCF residents in each Italian Region with the corresponding expected number of deaths of the general older adult population to obtain an observed/expected ratio (O/E ratio). Results: During the pandemic, about 8.5% (N = 6,797) of Italian older adults residents in LTCF died. Findings resulting from the O/E ratio suggest that LTCF residents (in particular in the Lombardy Region) show higher mortality rates when compared to expected values of mortality rates among the older general population living in the community. Furthermore, we found that the risk of death among LTCF residents increased about 4 times during the pandemic when compared to the previous years. Conclusions: Mortality rates in LTCF were high during the pandemic, especially in Lombardy. Possible causes of higher mortality rates in LTCF and suggestions for specific targeted interventions are discussed.

Keywords: COVID-19; long-term care facilities; mortality rate; older people; risk factors.

Figure 1

Observed deaths in LTCF residents and expected deaths at 77 and 73 years. Old age groups of the Italian general population by Regions. For the numbering of different Regions, see numbers in Table 1.

Figure 2

Weekly number of deaths between residents in Long-Term Care Facilities of the “ATS Città Metropolitana di Milano” (Health Protection Agency of Milan) between 1/1/2020 and 28/4/2020 compared with the mean number of deaths of residents during the corresponding periods of 2015–2019. Week number 1 starts on January 1 and ends on January 7, and so on up to week number 17, which starts on April 22 and ends with April 28. A clear increase in the number of deaths is evident from week number 11 (which starts on March 11). The peak was observed during the week number 14 (which starts on April 1). Source: “Valutazione degli eccessi di mortalità nel corso dell'epidemia Covid-19 nei residenti delle Rsa” ATS di Milano, 11th June 2020.