Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid
MD Rafael Bielza, MD Juan Sanz, MD Francisco Zambrana, MD Estefanía Arias, MD Eduardo Malmierca, MD Laura Portillo, MD Israel J Thuissard, MD Ana Lung, MD Marta Neira, María Moral, PhD a, b , María Moral MD g Cristina Andreu-Vázquez, MD h Ana Esteban, MD i Marcela Irma Ramírez, MD j Laura González, MD k Guillermo Carretero, Ricardo Vicente Moreno, MD l Pilar Martínez, MD Javier López, Mar Esteban-Ortega, MD Isabel García, María Antonia Vaquero, MD Ana Linares, MD Ana Gómez-Santana, Jorge Gómez Cerezo
Journal of the American Medical Directors Association, doi:10.1016/j.jamda.2020.12.003
Objectives: 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. 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: A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs. Methods: 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 logrank Mantel-Cox test. Results: The diagnosis of COVID-19 was mainly made by clinical compatibility (N ¼ 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 ¼ 332) and altered level of consciousness (n ¼ 301). According to multiple logistic regression, male sex (P ¼ .019), the Clinical
References
Abrams, Loomer, Gandhi, Grabowski, Characteristics of U.S. nursing homes with COVID-19 cases, J Am Geriatr Soc
Bernabeu-Wittel, Vega, Díaz-Jiménez, Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks, Arch Gerontol Geriatr
Bonanad, García-Blas, Tarazona-Santabalbina, The effect of age on mortality in patients with COVID-19: A meta-analysis with 611,583 subjects, J Am Med Dir Assoc
Borobia, Carcas, Arnalich, A cohort of patients with COVID-19 in a major teaching hospital in Europe, J Clin Med
Chen, Zhou, Dong, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study, Lancet
Cid-Ruzafa, Moreno, Valoración de la discapacidad física: el indice de Barthel, Rev Esp Salud Publica
Comas-Herrera, Zalakaín, Litwin, Mortality associated with COVID-19 outbreaks in care homes: early international evidence
Ellis, Wan, Yeung, Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results, CMAJ
Farrell, Francis, Brown, Rationing limited healthcare resources in the COVID-19 era and beyond: Ethical considerations regarding older adults, J Am Geriatr Soc
Gordon, Goodman, Achterberg, Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery, Age Ageing
Guan, Ni, Hu, Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med
Hewitt, Carter, Vilches-Moraga, The effect of frailty on survival in patients with COVID-19 (COPE): A multicentre, European, observational cohort study, Lancet Public Health
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Lau-Ng, Caruso, Perls, COVID-19 deaths in long-term care facilities: A critical piece of the pandemic puzzle, J Am Geriatr Soc
Lithander, Neumann, Tenison, COVID-19 in older people: A rapid clinical review, Age Ageing
Liu, Chen, Lin, Han, Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients, J Infect
Liu, Fang, Deng, Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province, Chin Med J (Engl)
Martinez-Peromingo, Serra-Rexach, Long-term care facilities and the COVID-19 pandemic: Lessons learned in Madrid, J Am Geriatr Soc
Mitchell, Maynard, Lyons, The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic, Palliat Med
Norman, Stall, Sinha, Typically atypical: COVID-19 presenting as a fall in an older adult, J Am Geriatr Soc
Poloni, Carlos, Cairati, Prevalence and prognostic value of delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study, EClinicalMedicine
Reisberg, Ferris, Leon, Crook, The global deterioration scale for assessment of primary degenerative dementia, Am J Psychiatry
Renom-Guiteras, Uhrenfeldt, Meyer, Mann, Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: A systematic review, BMC Geriatr
Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area, JAMA
Smet, Mellaerts, Vandewinckele, Frailty and mortality in hospitalized older adults with COVID-19: Retrospective observational study, J Am Med Dir Assoc
Sun, Ning, Tao, Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, China: A retrospective study, J Am Geriatr Soc
Wang, He, Yu, Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up, J Infect
Wu, Mcgoogan, Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention, JAMA
Zhao, Huang, Huang, Mortality in older patients with Covid-19, J Am Geriatr Soc
{ 'indexed': {'date-parts': [[2024, 2, 28]], 'date-time': '2024-02-28T16:23:00Z', 'timestamp': 1709137380515},
'reference-count': 30,
'publisher': 'Elsevier BV',
'issue': '2',
'license': [ { 'start': { 'date-parts': [[2021, 2, 1]],
'date-time': '2021-02-01T00:00:00Z',
'timestamp': 1612137600000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'}],
'content-domain': { 'domain': [ 'clinicalkey.fr', 'clinicalkey.jp', 'clinicalkey.es', 'clinicalkey.com.au',
'clinicalkey.com', 'jamda.com', 'elsevier.com', 'sciencedirect.com'],
'crossmark-restriction': True},
'published-print': {'date-parts': [[2021, 2]]},
'DOI': '10.1016/j.jamda.2020.12.003',
'type': 'journal-article',
'created': { 'date-parts': [[2020, 12, 12]],
'date-time': '2020-12-12T00:14:00Z',
'timestamp': 1607732040000},
'page': '245-252.e2',
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 49,
'title': 'Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of '
'a Region of Madrid',
'prefix': '10.1016',
'volume': '22',
'author': [ { 'ORCID': 'http://orcid.org/0000-0001-5655-6516',
'authenticated-orcid': False,
'given': 'Rafael',
'family': 'Bielza',
'sequence': 'first',
'affiliation': []},
{'given': 'Juan', 'family': 'Sanz', 'sequence': 'additional', 'affiliation': []},
{'given': 'Francisco', 'family': 'Zambrana', 'sequence': 'additional', 'affiliation': []},
{'given': 'Estefanía', 'family': 'Arias', 'sequence': 'additional', 'affiliation': []},
{'given': 'Eduardo', 'family': 'Malmierca', 'sequence': 'additional', 'affiliation': []},
{'given': 'Laura', 'family': 'Portillo', 'sequence': 'additional', 'affiliation': []},
{'given': 'Israel J.', 'family': 'Thuissard', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ana', 'family': 'Lung', 'sequence': 'additional', 'affiliation': []},
{'given': 'Marta', 'family': 'Neira', 'sequence': 'additional', 'affiliation': []},
{'given': 'María', 'family': 'Moral', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-7558-4325',
'authenticated-orcid': False,
'given': 'Cristina',
'family': 'Andreu-Vázquez',
'sequence': 'additional',
'affiliation': []},
{'given': 'Ana', 'family': 'Esteban', 'sequence': 'additional', 'affiliation': []},
{'given': 'Marcela Irma', 'family': 'Ramírez', 'sequence': 'additional', 'affiliation': []},
{'given': 'Laura', 'family': 'González', 'sequence': 'additional', 'affiliation': []},
{'given': 'Guillermo', 'family': 'Carretero', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ricardo Vicente', 'family': 'Moreno', 'sequence': 'additional', 'affiliation': []},
{'given': 'Pilar', 'family': 'Martínez', 'sequence': 'additional', 'affiliation': []},
{'given': 'Javier', 'family': 'López', 'sequence': 'additional', 'affiliation': []},
{'given': 'Mar', 'family': 'Esteban-Ortega', 'sequence': 'additional', 'affiliation': []},
{'given': 'Isabel', 'family': 'García', 'sequence': 'additional', 'affiliation': []},
{'given': 'María Antonia', 'family': 'Vaquero', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ana', 'family': 'Linares', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ana', 'family': 'Gómez-Santana', 'sequence': 'additional', 'affiliation': []},
{'given': 'Jorge', 'family': 'Gómez Cerezo', 'sequence': 'additional', 'affiliation': []}],
'member': '78',
'reference': [ { 'key': '10.1016/j.jamda.2020.12.003_bib1',
'doi-asserted-by': 'crossref',
'first-page': '497',
'DOI': '10.1016/S0140-6736(20)30183-5',
'article-title': 'Clinical features of patients infected with 2019 novel coronavirus in '
'Wuhan, China',
'volume': '395',
'author': 'Huang',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib2',
'doi-asserted-by': 'crossref',
'first-page': '1025',
'DOI': '10.1097/CM9.0000000000000744',
'article-title': 'Clinical characteristics of novel coronavirus cases in tertiary '
'hospitals in Hubei Province',
'volume': '133',
'author': 'Liu',
'year': '2020',
'journal-title': 'Chin Med J (Engl)'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib3',
'doi-asserted-by': 'crossref',
'first-page': '507',
'DOI': '10.1016/S0140-6736(20)30211-7',
'article-title': 'Epidemiological and clinical characteristics of 99 cases of 2019 novel '
'coronavirus pneumonia in Wuhan, China: A descriptive study',
'volume': '395',
'author': 'Chen',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib4',
'doi-asserted-by': 'crossref',
'first-page': '1708',
'DOI': '10.1056/NEJMoa2002032',
'article-title': 'Clinical characteristics of coronavirus disease 2019 in China',
'volume': '382',
'author': 'Guan',
'year': '2020',
'journal-title': 'N\xa0Engl J Med'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib5',
'first-page': 'e14',
'article-title': 'Clinical features of COVID-19 in elderly patients: A comparison with '
'young and middle-aged patients',
'volume': '80',
'author': 'Liu',
'year': '2020',
'journal-title': 'J\xa0Infect'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib6',
'doi-asserted-by': 'crossref',
'first-page': '1685',
'DOI': '10.1111/jgs.16649',
'article-title': 'Mortality in older patients with Covid-19',
'volume': '68',
'author': 'Zhao',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib7',
'doi-asserted-by': 'crossref',
'first-page': 'E19',
'DOI': '10.1111/jgs.16533',
'article-title': 'Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, '
'China: A retrospective study',
'volume': '68',
'author': 'Sun',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib8',
'doi-asserted-by': 'crossref',
'first-page': '915',
'DOI': '10.1016/j.jamda.2020.05.045',
'article-title': 'The effect of age on mortality in patients with COVID-19: A '
'meta-analysis with 611,583 subjects',
'volume': '21',
'author': 'Bonanad',
'year': '2020',
'journal-title': 'J\xa0Am Med Dir Assoc'},
{'key': '10.1016/j.jamda.2020.12.003_bib9', 'author': 'Comas-Herrera'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib10',
'doi-asserted-by': 'crossref',
'first-page': '1653',
'DOI': '10.1111/jgs.16661',
'article-title': 'Characteristics of U.S. nursing homes with COVID-19 cases',
'volume': '68',
'author': 'Abrams',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib11',
'doi-asserted-by': 'crossref',
'first-page': '501',
'DOI': '10.1093/ageing/afaa093',
'article-title': 'COVID-19 in older people: A rapid clinical review',
'volume': '49',
'author': 'Lithander',
'year': '2020',
'journal-title': 'Age Ageing'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib12',
'first-page': '639',
'article-title': 'Coronavirus disease 2019 in elderly patients: Characteristics and '
'prognostic factors based on 4-week follow-up',
'volume': '80',
'author': 'Wang',
'year': '2020',
'journal-title': 'J\xa0Infect'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib13',
'series-title': 'Clinical management of severe acute respiratory infection (SARI) when '
'COVID-19 disease is suspected: interim guidance, 13\xa0March 2020',
'first-page': '1',
'year': '2020'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib14',
'doi-asserted-by': 'crossref',
'first-page': '1239',
'DOI': '10.1001/jama.2020.2648',
'article-title': 'Characteristics of and important lessons from the Coronavirus Disease '
'2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases '
'from the Chinese Center for Disease Control and Prevention',
'volume': '323',
'author': 'Wu',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib15',
'doi-asserted-by': 'crossref',
'first-page': '127',
'DOI': '10.1590/S1135-57271997000200004',
'article-title': 'Valoración de la discapacidad física: el indice de Barthel',
'volume': '71',
'author': 'Cid-Ruzafa',
'year': '1997',
'journal-title': 'Rev Esp Salud Publica'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib16',
'doi-asserted-by': 'crossref',
'first-page': '1136',
'DOI': '10.1176/ajp.139.9.1136',
'article-title': 'The global deterioration scale for assessment of primary degenerative '
'dementia',
'volume': '139',
'author': 'Reisberg',
'year': '1982',
'journal-title': 'Am J Psychiatry'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib17',
'doi-asserted-by': 'crossref',
'first-page': 'E3',
'DOI': '10.1503/cmaj.190952',
'article-title': 'Complementing chronic frailty assessment at hospital admission with an '
'electronic frailty index (FI-Laboratory) comprising routine blood test '
'results',
'volume': '192',
'author': 'Ellis',
'year': '2020',
'journal-title': 'CMAJ'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib18',
'doi-asserted-by': 'crossref',
'first-page': '1895',
'DOI': '10.1111/jgs.16669',
'article-title': 'COVID-19 deaths in long-term care facilities: A\xa0critical piece of '
'the pandemic puzzle',
'volume': '68',
'author': 'Lau-Ng',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib19',
'doi-asserted-by': 'crossref',
'first-page': '1920',
'DOI': '10.1111/jgs.16665',
'article-title': 'Long-term care facilities and the COVID-19 pandemic: Lessons learned in '
'Madrid',
'volume': '68',
'author': 'Martinez-Peromingo',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib20',
'doi-asserted-by': 'crossref',
'first-page': '2052',
'DOI': '10.1001/jama.2020.6775',
'article-title': 'Presenting characteristics, comorbidities, and outcomes among 5700 '
'patients hospitalized with COVID-19 in the New York City Area',
'volume': '323',
'author': 'Richardson',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib21',
'first-page': '1689',
'article-title': 'A\xa0cohort of patients with COVID-19 in a major teaching hospital in '
'Europe. J Clin Med',
'volume': '53',
'author': 'Borobia',
'year': '2020'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib22',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.archger.2020.104240',
'article-title': 'Death risk stratification in elderly patients with covid-19. A '
'comparative cohort study in nursing homes outbreaks',
'volume': '91',
'author': 'Bernabeu-Wittel',
'year': '2020',
'journal-title': 'Arch Gerontol Geriatr'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib24',
'doi-asserted-by': 'crossref',
'DOI': '10.1016/j.eclinm.2020.100490',
'article-title': 'Prevalence and prognostic value of delirium as the initial presentation '
'of COVID-19 in the elderly with dementia: An Italian retrospective '
'study',
'volume': '26',
'author': 'Poloni',
'year': '2020',
'journal-title': 'EClinicalMedicine'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib25',
'doi-asserted-by': 'crossref',
'first-page': 'E36',
'DOI': '10.1111/jgs.16526',
'article-title': 'Typically atypical: COVID-19 presenting as a fall in an older adult',
'volume': '68',
'author': 'Norman',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib26',
'doi-asserted-by': 'crossref',
'first-page': '928',
'DOI': '10.1016/j.jamda.2020.06.008',
'article-title': 'Frailty and mortality in hospitalized older adults with COVID-19: '
'Retrospective observational study',
'volume': '21',
'author': 'De Smet',
'year': '2020',
'journal-title': 'J\xa0Am Med Dir Assoc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib27',
'doi-asserted-by': 'crossref',
'first-page': 'e444',
'DOI': '10.1016/S2468-2667(20)30146-8',
'article-title': 'The effect of frailty on survival in patients with COVID-19 (COPE): A '
'multicentre, European, observational cohort study',
'volume': '5',
'author': 'Hewitt',
'year': '2020',
'journal-title': 'Lancet Public Health'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib28',
'doi-asserted-by': 'crossref',
'first-page': '80',
'DOI': '10.1186/1471-2318-14-80',
'article-title': 'Assessment tools for\xa0determining appropriateness of admission to '
'acute care of persons transferred from long-term care facilities: A '
'systematic review',
'volume': '14',
'author': 'Renom-Guiteras',
'year': '2014',
'journal-title': 'BMC Geriatr'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib29',
'doi-asserted-by': 'crossref',
'first-page': '1143',
'DOI': '10.1111/jgs.16539',
'article-title': 'Rationing limited healthcare resources in the COVID-19 era and beyond: '
'Ethical considerations regarding older adults',
'volume': '68',
'author': 'Farrell',
'year': '2020',
'journal-title': 'J\xa0Am Geriatr Soc'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib30',
'doi-asserted-by': 'crossref',
'first-page': '701',
'DOI': '10.1093/ageing/afaa113',
'article-title': 'Commentary: COVID in care homes-challenges and dilemmas in healthcare '
'delivery',
'volume': '49',
'author': 'Gordon',
'year': '2020',
'journal-title': 'Age Ageing'},
{ 'key': '10.1016/j.jamda.2020.12.003_bib31',
'doi-asserted-by': 'crossref',
'first-page': '1182',
'DOI': '10.1177/0269216320947623',
'article-title': 'The role and response of primary healthcare services in the delivery of '
'palliative care in epidemics and pandemics: A rapid review to inform '
'practice and service delivery during the COVID-19 pandemic',
'volume': '34',
'author': 'Mitchell',
'year': '2020',
'journal-title': 'Palliat Med'}],
'container-title': 'Journal of the American Medical Directors Association',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S1525861020310525?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S1525861020310525?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2022, 7, 13]],
'date-time': '2022-07-13T06:20:37Z',
'timestamp': 1657693237000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S1525861020310525'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 2]]},
'references-count': 30,
'journal-issue': {'issue': '2', 'published-print': {'date-parts': [[2021, 2]]}},
'alternative-id': ['S1525861020310525'],
'URL': 'http://dx.doi.org/10.1016/j.jamda.2020.12.003',
'relation': {},
'ISSN': ['1525-8610'],
'subject': ['Health Policy', 'General Medicine', 'General Nursing', 'Geriatrics and Gerontology'],
'container-title-short': 'Journal of the American Medical Directors Association',
'published': {'date-parts': [[2021, 2]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in '
'Nursing Homes of a Region of Madrid',
'name': 'articletitle',
'label': 'Article Title'},
{ 'value': 'Journal of the American Medical Directors Association',
'name': 'journaltitle',
'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.jamda.2020.12.003',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for '
'Post-Acute and Long-Term Care Medicine.',
'name': 'copyright',
'label': 'Copyright'}]}