Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article

Abstract

Background: The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. Methods: A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results: 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the firstcall. According to multivariate logisticregression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea(p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associatedwith mortality. No mortality differences were found between those referred tothe hospital or cared at the nursing home. Conclusions and implications: 31% of the nursing home patients assessed by aliaison geriatric hospital-based team for COVID-19 were referred to thehospital, being more frequently referred those with a better functional and cognitivesituation. The 60-days mortality rate due to COVID-19 was 36.8% and wasassociated with older age, functional dependence, the presence of tachypnea andfever, and the use of ceftriaxone. Geriatric comprehensive assessment andcoordination between NH and the hospital geriatric department teams werecrucial.