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Cognitive impairment among factors linked to elevated death rates in nursing home residents with COVID-19

Cognitive impairment, along with age, gender, chronic medical conditions, and physical limitations, is linked to a higher risk of death among nursing home residents with COVID-19, according to a study supported in part by NIA. By helping to identify residents at the highest risk, the findings, published Jan. 4, 2021, in JAMA Internal Medicine, could lead to improved outcomes for this highly vulnerable group.

COVID-19 outbreaks have had a significant impact on nursing homes, with residents bearing a disproportionate share of deaths from the illness in the United States and internationally. Factors like communal living, confined settings, and caregivers moving from room to room likely contribute to these high death rates, but the effects of resident-specific features such as age, gender, or medical problems have not been fully investigated. To address this knowledge gap, a team led by scientists at Brown University analyzed the medical records of 5,256 nursing home residents in 25 states who developed COVID-19 in a six-month period starting in March 2020. The researchers analyzed the relationship between resident-specific characteristics and death in the first 30 days after testing positive for COVID-19.

The results revealed that nursing home residents with COVID-19 and moderate and severe cognitive limitations were more likely to die than those with no cognitive impairment. The analysis also showed that physical impairment is linked to higher fatality rates, but to a lesser extent than cognitive impairment. These findings are consistent with those from a European study that showed a connection between a person’s frailty score, a measure of physical and cognitive ability, and death in hospitalized patients with COVID-19. More research is needed to fully understand why high fatality rates are associated with characteristics of advanced frailty.

Consistent with findings in the general population, the study also showed that men and older residents have a higher risk of dying, as do those with symptoms of serious disease such as shortness of breath and low blood oxygen. Nursing home residents with chronic illnesses like diabetes or chronic kidney disease were also at higher risk, mirroring results from other studies and in other population groups. Overall, 21% of study participants died within 30 days of COVID-19 diagnosis, underscoring the toll the illness is taking on nursing home residents.

This work has uncovered a number of factors associated with elevated death rates in nursing home residents with COVID-19. By helping to identify those in the highest risk groups, the findings may lead to a recalibration of prevention practices and possibly provide insight on ways to reduce fatality rates in this susceptible population.

This research was supported in part by NIA grant P01AG027296-11S1.

Reference: Panagiotou OA, et al. Risk factors associated with all-cause 30-day mortality in nursing home residents with COVID-19. JAMA Internal Medicine. 2021. ePub Jan. 4. doi: 10.1001/jamainternmed.2020.7968.