Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;22(2):245-252.e2.
doi: 10.1016/j.jamda.2020.12.003. Epub 2020 Dec 11.

Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

Rafael Bielza  1 , Juan Sanz  2 , Francisco Zambrana  3 , Estefanía Arias  4 , Eduardo Malmierca  5 , Laura Portillo  6 , Israel J Thuissard  7 , Ana Lung  4 , Marta Neira  4 , María Moral  8 , Cristina Andreu-Vázquez  7 , Ana Esteban  9 , Marcela Irma Ramírez  10 , Laura González  11 , Guillermo Carretero  12 , Ricardo Vicente Moreno  13 , Pilar Martínez  13 , Javier López  14 , Mar Esteban-Ortega  15 , Isabel García  15 , María Antonia Vaquero  16 , Ana Linares  17 , Ana Gómez-Santana  18 , Jorge Gómez Cerezo  5
Affiliations

Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid

Rafael Bielza et al. J Am Med Dir Assoc. 2021 Feb.

Abstract

Objectives: To describe the clinical characteristics, 30-day mortality, and associated factors of patients living in nursing homes (NH) with COVID-19, from March 20 to June 1, 2020.

Design: This is a retrospective study. A geriatric hospital-based team acted as a consultant and coordinated the care of older people living in NHs from the hospital.

Setting and participants: A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs.

Methods: A logistic regression was performed to analyze the factors associated with mortality. In addition, Kaplan-Meier curves were applied according to mortality and its associated factors using the log-rank Mantel-Cox test.

Results: The diagnosis of COVID-19 was mainly made by clinical compatibility (N = 430). Median age was 87 years, 64.6% were women and 45.9% were transferred to be cared for at the hospital. A total of 282 patients died (44.7%) within the 30 days of first attention by the team. A severe form of COVID-19 occurred in 473 patients, and the most frequent symptoms were dyspnea (n = 332) and altered level of consciousness (n = 301). According to multiple logistic regression, male sex (P = .019), the Clinical Frailty Score (CFS) ≥6 (P = .004), dementia (P = .012), dyspnea (P < .001), and having a severe form of COVID-19 (P = .001), were associated with mortality, whereas age and care setting were not.

Conclusions and implications: Mortality of the residents living in NHs with COVID-19 was almost 45%. The altered level of consciousness as an atypical presentation of COVID-19 should be considered in this population. A severe form of the disease, present in more than three-quarters of patients, was associated with mortality, apart from the male sex, CFS ≥6, dementia, and dyspnea, whereas age and care setting were not. These findings may also help to recognize patients in which the Advance Care Planning process is especially urgent to assist in the decisions about their care.

Keywords: Nursing homes; clinical frailty score; geriatric hospital-based team; mortality.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart.
Fig. 2
Fig. 2
Multiple logistic regressions analyzing the factors associated with mortality.
Fig. 3
Fig. 3
Survival curves. (A) Kaplan-Meier curves for overall survival. (B) Kaplan-Meier curves according to presence of dyspnea vs non-dyspnea. Log-rank Mantel-Cox test. (C) Kaplan-Meier curves according to severity of the case. Log-rank Mantel-Cox test. (D) Kaplan-Meier curves according to sex. Log-rank Mantel-Cox test. (E) Kaplan-Meier curves according to presence of dementia vs nondementia. Log-rank Mantel-Cox test. (F) Kaplan-Meier curves according to CFS. Log-rank Mantel-Cox test.
Supplementary Fig. 1
Supplementary Fig. 1
Kaplan-Meier curves according to location of attention.
Supplementary Fig. 2
Supplementary Fig. 2
CFS. (A) CFS and severity. (B) CFS and mortality.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Liu K., Fang Y.Y., Deng Y. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl) 2020;133:1025–1031. - PMC - PubMed
    1. Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507–513. - PMC - PubMed
    1. Guan W., Ni Z., Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. - PMC - PubMed
    1. Liu K., Chen Y., Lin R., Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80:e14–e18. - PMC - PubMed