Clinical Medicine Department, Miguel Hernandez University of Elche, Alicante, Spain.
Internal Medicine Department, Virgen del Rocío University Hospital, Seville, Spain.
J Gerontol A Biol Sci Med Sci. 2022 Apr 1;77(4):e138-e147. doi: 10.1093/gerona/glab305.
COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents.
This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis.
Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p < .001). Mortality risk factors in LTCF residents were severe functional dependence (adjusted odds ratios [aOR]: 1.79; 95% confidence interval [CI]: 1.13-2.83; p = .012), dyspnea (1.66; 1.16-2.39; p = .004), SatO2 < 94% (1.73; 1.27-2.37; p = .001), temperature ≥ 37.8°C (1.62; 1.11-2.38; p = .013); qSOFA index ≥ 2 (1.62; 1.11-2.38; p = .013), bilateral infiltrates (1.98; 1.24-2.98; p < .001), and high C-reactive protein (1.005; 1.003-1.007; p < .001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR: 0.74, 95%CI: 0.62-0.87; p < .001).
Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
COVID-19 对老年人和长期护理机构（LTCF）居民造成了严重影响。我们的主要目的是描述 COVID-19 住院患者中 LTCF 居民与社区居住的老年人在临床和流行病学变量、院内管理和结局方面的差异。次要目的是确定导致住院 LTCF 居民 COVID-19 死亡的风险因素。
这是一项回顾性队列研究的横断面分析，纳入了 160 家西班牙医院收治的≥75 岁且确诊 COVID-19 的住院患者。通过比较和逻辑回归分析评估了两组之间的差异以及 LTCF 居民的死亡相关因素。
在≥75 岁的 6189 名患者中，1185 名（19.1%）为 LTCF 居民，4548 名（73.5%）为社区居住。LTCF 居民年龄更大（中位数：87.4 岁 vs 82.1 岁），大多数为女性（61.6% vs 43.2%），功能依赖性更严重（47.0% vs 7.8%），合并症更多（Charlson 合并症指数：6 分 vs 5 分），更常患有痴呆症（59.1% vs 14.4%），症状持续时间更短（中位数：3 天 vs 6 天）（均 P<.001）。LTCF 居民的死亡风险因素包括严重的功能依赖性（调整后的优势比[aOR]：1.79；95%置信区间[CI]：1.13-2.83；P=.012）、呼吸困难（1.66；1.16-2.39；P=.004）、SatO2 < 94%（1.73；1.27-2.37；P=.001）、体温≥37.8°C（1.62；1.11-2.38；P=.013）、qSOFA 指数≥2（1.62；1.11-2.38；P=.013）、双侧浸润影（1.98；1.24-2.98；P<.001）和高 C 反应蛋白（1.005；1.003-1.007；P<.001）。LTCF 居民的住院死亡率最初较高（43.3% vs 39.7%），但在调整性别、年龄、功能依赖性和合并症后较低（aOR：0.74，95%CI：0.62-0.87；P<.001）。
基础功能状态和 COVID-19 严重程度是 LTCF 居民死亡的风险因素。LTCF 居民调整后死亡率较低的原因可能是 COVID-19 的早期识别、治疗和住院。
