Clinical characteristics, frailty and mortality of residents with COVID-19 in nursing homes of a region of Madrid

ABSTRACT Objectives To describe the clinical characteristics, 30-day mortality and associated factors of patients living in nursing homes (NH) with COVID-19, from 20th March to 1st June, 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: 630 patients aged 70 and older with COVID-19 living in 55 NHs. Methods A logistic regression was performed to analyse 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 female and 45.9% were transferred to be cared 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 dyspnoea (N=332) and altered level of consciousness (N=301). According to multiple logistic regression, male sex (p=0.019), the Clinical Frailty Score (CFS)≥6 (p=0.004), dementia (p=0.012), dyspnoea (p Conclusions and Implications Mortality of the residents living in NHs with COVID-19 was almost forty-five percent. 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 them, was associated with mortality, apart from the male sex, CFS≥6, dementia, and dyspnoea, 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.