The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence

Author:

Emmerson Chris1ORCID,Hollinghurst Joseph2ORCID,North Laura2,Fry Richard2ORCID,Akbari Ashley2,Humphreys Ciarán1,Gravenor Mike B3,Lyons Ronan A2

Affiliation:

1. Public Health Wales , Cardiff, UK

2. Swansea University Population Data Science and Health Data Research UK, , Swansea, UK

3. Swansea University Medical School, Swansea University , Swansea, UK

Abstract

Abstract Background dementia may increase care home residents’ risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors. Methods we created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality. Results the cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55–13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05–1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret. Discussion whilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.

Funder

Health and Care Research Wales

ADR UK

ADR Wales programme of work

HDR UK Ltd

Medical Research Council

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Aging,General Medicine

Reference35 articles.

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3. COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021;Hollinghurst;Age Ageing,2022

4. Care-home outbreaks of COVID-19 in Scotland March to May 2020: national linked data cohort analysis;Burton;Age Ageing,2021

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