Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain.
Department of Dermatology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain.
J Am Med Dir Assoc. 2021 Feb;22(2):245-252.e2. doi: 10.1016/j.jamda.2020.12.003. Epub 2020 Dec 11.
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.
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.
A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs.
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.
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.
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.
描述 2020 年 3 月 20 日至 6 月 1 日期间，养老院（NH）中患有 COVID-19 的患者的临床特征、30 天死亡率和相关因素。
这是一项回顾性研究。一个老年医院团队作为顾问，协调来自医院的 NH 中老年人的护理。
共有 630 名年龄在 70 岁及以上的患有 2019 年冠状病毒病（COVID-19）的患者，他们居住在 55 家 NH 中。
采用逻辑回归分析死亡率相关因素。此外，根据死亡率及其相关因素，应用 Kaplan-Meier 曲线，采用对数秩 Mantel-Cox 检验。
COVID-19 的诊断主要通过临床相符性（N=430）做出。中位年龄为 87 岁，64.6%为女性，45.9%转至医院接受治疗。在团队首次关注后的 30 天内，共有 282 名患者死亡（44.7%）。473 例患者出现严重的 COVID-19 形式，最常见的症状是呼吸困难（n=332）和意识水平改变（n=301）。根据多变量逻辑回归，男性（P=0.019）、临床虚弱评分（CFS）≥6（P=0.004）、痴呆（P=0.012）、呼吸困难（P<0.001）和严重的 COVID-19 形式（P=0.001）与死亡率相关，而年龄和护理环境则没有。
NH 中 COVID-19 患者的死亡率接近 45%。意识水平改变作为 COVID-19 的一种非典型表现，应在该人群中考虑。超过四分之三的患者存在严重疾病，与死亡率相关，除了男性、CFS≥6、痴呆和呼吸困难外，年龄和护理环境则没有。这些发现还可以帮助识别那些特别需要进行预先护理计划的患者，以帮助他们做出护理决策。
