Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid.
Rafael Bielza, Juan Sanz, Francisco Zambrana and 21 others
PMID 33417840WHAT IT FOUND
282 of 630 older residents with COVID-19 attended by a hospital geriatric team died within 30 days.
Male sex, dementia, breathlessness, severe illness, and frailty score 6 or higher were associated with death. Age and hospital versus nursing home care were not.
Key findings
01282 of 630 included residents died within 30 days of first care by the geriatric team.
02In adjusted analysis, male sex, dementia, dyspnea, severe illness, and Clinical Frailty Scale score 6 or higher were associated with mortality.
03Mortality did not differ significantly between residents cared for in nursing homes and those cared for in hospital.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Retrospective records, and many diagnoses were based on clinical compatibility rather than PCR. Only patients with enough electronic health record data were included, and milder cases managed by nursing home physicians may not have entered the registry. Treatment was not randomly assigned, and patients received antibiotics, fluid therapy, enoxaparin, hydroxychloroquine, paracetamol, and inhalers together, so no single treatment effect can be separated. Nursing home and hospital comparisons are not causal; residents who remained in nursing homes were older, frailer, more often had dementia, and had lower Barthel Index scores, while hospital patients were more often PCR-confirmed. The availability of palliative medicines and corticoids did not allow monitoring of the end-of-life scenario in nursing homes. The study reports associations with mortality, not whether any intervention changed mortality.
The easy way to misread this
Do not conclude that the treatment package or hospital transfer reduced mortality. This was an observational study without randomised treatment assignment, patients received antibiotics, fluid therapy, enoxaparin, hydroxychloroquine, paracetamol, and inhalers together, and mortality did not differ between nursing home and hospital care.