Abstract: European Geriatric Medicine (2021) 12:601–607 https://doi.org/10.1007/s41999-020-00432-w RESEARCH PAPER COVID‑19 mortality risk factors in older people in a long‑term care center Eva Heras1 · Pablo Garibaldi1 · Maite Boix1 · Oliver Valero2 · Jorge Castillo1 · Yurisan Curbelo1 · Elso Gonzalez1 · Obilagilio Mendoza1 · Maria Anglada1 · Joan Carles Miralles1 · Petra Llull1 · Ricard Llovera1 · Josep M. Piqué1 Received: 18 August 2020 / Accepted: 11 November 2020 / Published online: 27 November 2020 © European Geriatric Medicine Society 2020 Key summary points Aim COVID-19 mortality risk factors in older people from a long term care center. Findings Male gender, low Barthel index, no pharmacological treatment and lymphocytopenia are independent mortality risk factors. Message The independent prognostic factors identified in the present study can help to adjust the healthcare resources in this population in case of new outbreaks of the COVID-19 pandemic. Abstract Purpose Despite high rates of COVID-19 infection and increased related mortality have been reported among older adults admitted in long-term care facilities, a limited amount of information is available about the natural course of this pandemic and prognostic factors in such population. In the current study, we aimed to investigate the epidemiologic, demographics, clinical, or therapeutic factors that may predict the prognosis in a cohort of COVID-19 infected institutionalized older in a nursing home. Methods We conducted a retrospective analysis of all COVID-19 confirmed institutionalized older in a nursing home from March 15 to June 5, 2020. Epidemiological, demographic, and frailty status before infection, and clinical, laboratory, treatment, and outcome data during infection were collected. We used bivariate analysis and multivariate logistic regression to identify risk factors for mortality. Results The analysis comprised all 100 COVID-19 confirmed cases during the study period. The median age was 85 years; 62% were female. The case fatality rate was 20%. In the bivariate analysis, male gender, fever, respiratory symptoms, severe cognitive decline, a low Barthel index, and lymphocytopenia were significantly associated with mortality. Patients treated with hydroxychloroquine plus azithromycin were related to a higher chance of survival than those without pharmacological treatment. Multivariate logistic regression analysis identified male gender, low Barthel index, no pharmacological treatment, and lymphocytopenia as independent risk factors associated with mortality. Conclusions Male gender, low Barthel index, and lymphocytopenia are independent risk factors for COVID-19 mortality in institutionalized older patients in long-term care nursing homes. Treatment with hydroxychloroquine and azithromycin was associated with lower mortality in these patients.