The statistics are grim. A survey of 12,000 US nursing homes finds over 56,000 COVID related deaths as of July 2020. This number represents ten percent of all cases in the US, or forty-four percent of all deaths in the United States.
A recent online publication by JAMA Intern Med describes a cohort (group) study of 5,256 US residents of nursing homes who have been diagnosed with COVID-19.
The researchers noted several independent risk factors relating to thirty-day mortality, such as impaired physical and cognitive function, age, and gender. These findings indicate that characteristics such as comorbidities (other diseases), sociodemographic characteristics, and cognitive and physical impairments can greatly affect residents of nursing homes who are COVID-19 patients.
Residents of Nursing Homes Are at Risk
There is no doubt that the COVID-19 pandemic has had a severe impact on nursing home residents, resulting in a disproportionate number of deaths worldwide.
Most nursing homes lack proper protection against infections or even measures to prevent transmission. These issues are obviously compounded by a high-touch environment and communal living.
Once the resident becomes infected with the virus due to factors discussed previously, these elderly patients are at an increased risk of death over and above the norm.
Lack of Data Means More Risk
The researchers only found a few studies that included data from a small number of facilities. They were surprised to find scant data comparing the general population against residents of nursing homes in order to explain the increased COVID-19 mortality.
It is well known that advanced age is one of the major factors affecting COVID-19 patients. But there is an urgent need to go beyond age in order to identify residents who are high mortality risks. Especially since there is scant evidence about the primary factors that put residents of nursing homes at greater risk of infection from SARS.
It is therefore a priority to thoroughly understand the risks and identify the risk factors.
About the Study
From March to September 2020, polymerase chain reaction tests were performed on 5,256 residents of nursing homes who had COVID-19 infections called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). A total of 351 nursing homes were represented in the cohort study.
Testing usually occurred after exposure or even suspicion of SARS-CoV-2.
The endpoint of the study was to investigate the reason for death from any cause within thirty days of a positive SARS-CoV-2 test result.
The Researchers’ Methods of Investigation
The team examined electronic medical and clinical data from a sample of nursing homes throughout the nation. Records of patients’ conditions are kept by nurses electronically. All facilities must keep infection logs and testing dates in connection with SARS-CoV-2.
Resident assessments are conducted upon admission, at intervals while at the nursing home, and again at discharge. Any substantive changes must be recorded as well.
The team was investigating the causes of mortality of patients who were symptomatic. For this reason, all residents who evidenced positive test results up to fourteen days after testing were included in the study.
Partial Study Results
Residents were evaluated according to age. The mortality rate for residents 80 to 84 years of age was 1.46 times higher than for residents who were 75 to 79 years old. The rate was 1.59 times higher if the residents were 85 to 89 years old and 2.14 times more for residents 90 years old or older.
Diabetes and chronic kidney disease were generally associated with mortality.
Data were also collected from a provider of post-acute and long-term care facility that has twenty-five units in the US. It maintains a daily record of all residents. For those needing nursing assessments, residents will have vital signs checked several times each day in an effort to screen for COVID-19.
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Brown University’s review board approved this study.
