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Impaired Function, Older Age Increase Risk of COVID-19 Mortality in NH Residents

January 11, 2021

Older age, male sex, and impaired cognitive and physical function are independent risk factors for all-cause 30-day mortality in nursing home residents with COVID-19, according to a study published online in JAMA Internal Medicine. 

“Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population,” researchers wrote. 

The study included 5256 nursing home residents with COVID-19 from 351 US facilities.  Researchers looked at deaths from any cause within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. 

The study found an all-cause 30-day death rate of 21%.

Compared with residents aged 75 to 79 years, the odds of death were 1.46 times higher for those aged 80 to 84 years, 1.59 times higher for those aged 85 to 89 years, and 2.14 times higher for those 90 years or older, researchers reported.  

Meanwhile, residents with moderate cognitive impairment had 2.09 times higher odds of death and residents with severe cognitive impairment had 2.79 higher odds compared with residents with no cognitive impairment. Residents with moderate impairment in physical function had 1.49 times higher odds of death, and residents with severe impairment in physical function had 1.64 higher odds of death, compared with residents with no or limited physical impairment, according to the study.  

Diabetes and chronic kidney disease were associated with mortality risk, as were COVID-19 symptoms of fever, shortness of breath, tachycardia, and hypoxia. Women had a lower mortality risk than men.  

“When considered jointly, these factors improve estimation in this population beyond what is achieved when considering them individually,” researchers wrote. “More important, the associations of these factors with mortality were not accounted for by variations in nursing home quality.” 

Jolynn Tumolo


Panagiotou OA, Kosar CM, White EM, et al. Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19 [published online ahead of print, 2021 Jan 4]. JAMA Intern Med. 2021;10.1001/jamainternmed.2020.7968. doi:10.1001/jamainternmed.2020.7968

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