Dying from COVID-19 in nursing homes-sex differences in symptom occurrence

Lisa Martinsson, Peter Strang, Jonas Bergström, Staffan Lundström, Lisa Martinsson, Peter Strang, Jonas Bergström, Staffan Lundström

Abstract

Background: Coronavirus disease 2019 (COVID-19), is a disease with diverse presentation. Several studies have shown different occurrence of symptoms for women and men, but no studies have been found examining sex differences in clinical presentation for nursing home residents dying from COVID-19. The objective of this study was to describe sex and age differences and the impact of a dementia diagnosis on symptom occurrence during the last week in life for persons dying from COVID-19 in nursing homes.

Methods: This is a population-based retrospective study based on data from the Swedish Register of Palliative Care. A total of 1994 residents aged 65 or older who died from COVID-19 in nursing homes were identified. The impact of sex, age and a dementia diagnosis on six different symptoms was analysed using chi2-test and multivariate logistic regression.

Results: Residents dying from COVID-19 were more often men (p < .002). Men more often had dyspnoea and death rattles (p < .001). Nausea was more common in women (p < .001). No sex differences in the occurrence of pain, anxiety or confusion were seen. Dyspnoea and nausea were less commonly reported in residents with dementia (p < .001).

Conclusions: We found sex differences in symptom presentation for fatal COVID-19 in nursing home settings which remained after adjusting for age. Residents with a dementia diagnosis had fewer symptoms reported before death compared to those without dementia. Clinical presentation of fatal COVID-19 differs between women and men in nursing homes. Residents with fatal COVID-19 present with more unspecific and less prominent symptoms when also suffering from dementia.

Keywords: COVID-19; Dementia; End-of-life care; Hospitals; Nursing homes; Palliative care.

Conflict of interest statement

The authors report no competing interests.

References

    1. Iser BPM, Sliva I, Raymundo VT, Poleto MB, Schuelter-Trevisol F, Bobinski F. Suspected COVID-19 case definition: a narrative review of the most frequent signs and symptoms among confirmed cases. Epidemiol Serv Saude. 2020;29(3):e2020233. doi: 10.5123/S1679-49742020000300018.
    1. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115(5):766–73. 10.14309/ajg.0000000000000620.
    1. Rozenberg S, Vandromme J, Martin C. Are we equal in adversity? Does Covid-19 affect women and men differently? Maturitas. 2020;138:62–68. doi: 10.1016/j.maturitas.2020.05.009.
    1. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology. Head Neck Surg. 2020;277(8):2251–2261.
    1. Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S, Ormianer Z. Olfactory and Oral manifestations of COVID-19: sex-related symptoms-a potential pathway to early diagnosis. Otolaryngol-Head Neck Surg. 2020:194599820934380.
    1. Gao YJ, Ye L, Zhang JS, Yin YX, Liu M, Yu HB, et al. Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 2020;20(1):564. 10.1186/s12879-020-05274-2.
    1. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical presentation of COVID19 in dementia patients. J Nutr Health Aging. 2020;24(6):560–2. 10.1007/s12603-020-1389-1.
    1. Poloni TE, Carlos AF, Cairati M, Cutaia C, Medici V, Marelli E, et al. Prevalence and prognostic value of delirium as the initial presentation of COVID-19 in the elderly with dementia: an Italian retrospective study. EClinicalMedicine. 2020:100490.
    1. Martín-Sánchez FJ, Del Toro E, Cardassay E, Valls Carbó A, Cuesta F, Vigara M, et al. Clinical presentation and outcome across age categories among patients with COVID-19 admitted to a Spanish emergency department. Eur Geriatr Med. 2020:1–13.
    1. Martinsson L, Lundström S, Sundelöf J. Better quality of end-of-life care for persons with advanced dementia in nursing homes compared to hospitals: a Swedish national register study. BMC Palliat Care. 2020;19(1):135. doi: 10.1186/s12904-020-00639-5.
    1. Socialstyrelsen [National Board of Health and Welfare]. Care for the elderly: Report on the current situation 2020 [Vård och omsorg om äldre: Lägesrapport 2020] (Swe). Socialstyrelsen 2020.
    1. Smedbäck J, Öhlén J, Årestedt K, Alvariza A, Fürst CJ, Håkanson C. Palliative care during the final week of life of older people in nursing homes: A register-based study. Palliat Support Care. 2017;15(4):417–424. doi: 10.1017/S1478951516000948.
    1. Socialstyrelsen [National Board of Health and Welfare]. Statistics describing number of deaths from COVID-19 [Statistik över antal avlidna i covid-19] (Swe). Socialstyrelsen 2020. . Accessed 5th November 2020.
    1. Andersson S, Årestedt K, Lindqvist O, Fürst CJ, Brännström M. Factors associated with symptom relief in end-of-life Care in Residential Care Homes: a National Register-Based Study. J Pain Symptom Manag. 2018;55(5):1304–12.
    1. Strang P, Bergström J, Lundström S. Symptom relief is possible in elderly dying COVID-19 patients: a National Register Study. J Palliat Med. 2021;24(4):514--9.
    1. Strang P, Martinsson L, Bergström J, Lundström S. COVID-19: symptoms in dying residents of nursing homes and in those admitted to hospitals. J Palliat Med. 2021. 10.1089/jpm.2020.0688 Epub ahead of print.
    1. Lundström S, Axelsson B, Heedman PA, Fransson G, Fürst CJ. Developing a national quality register in end-of-life care: the Swedish experience. Palliat Med. 2012;26(4):313–321. doi: 10.1177/0269216311414758.
    1. Martinsson L, Heedman PA, Lundström S, Fransson G, Axelsson B. Validation study of an end-of-life questionnaire from the Swedish Register of Palliative Care. Acta Oncol (Stockholm, Sweden) 2011;50(5):642–647. doi: 10.3109/0284186X.2011.554434.
    1. Martinsson L, Heedman PA, Lundström S, Axelsson B. Improved data validity in the Swedish register of palliative care. PLoS One. 2017;12(10):e0186804. doi: 10.1371/journal.pone.0186804.
    1. Löfdahl K, Ström K. Increasing morbidity and mortality in women with COPD. Lakartidningen. 2007;104(13):1040–1042.
    1. Arslanian-Engoren C, Engoren M. Physiological and anatomical bases for sex differences in pain and nausea as presenting symptoms of acute coronary syndromes. Heart Lung. 2010;39(5):386–393. doi: 10.1016/j.hrtlng.2009.10.013.
    1. Arslanian-Engoren C, Patel A, Fang J, Armstrong D, Kline-Rogers E, Duvernoy CS, et al. Symptoms of men and women presenting with acute coronary syndromes. Am J Cardiol. 2006;98(9):1177–81. 10.1016/j.amjcard.2006.05.049.
    1. DeVon HA, Ryan CJ, Ochs AL, Shapiro M. Symptoms across the continuum of acute coronary syndromes: differences between women and men. Am J Crit Care. 2008;17(1):14–24. doi: 10.4037/ajcc2008.17.1.14.
    1. Esra YE, Aziz Y, Zeki U, Gülsah G, Mert B, Yesim E, et al. Is chemotherapy-induced nausea and vomiting lower in smokers? Int J Clin Pharmacol Ther. 2011;49(12):709–712.
    1. Olden AM, Holloway R, Ladwig S, Quill TE, van Wijngaarden E. Palliative care needs and symptom patterns of hospitalized elders referred for consultation. J Pain Symptom Manag. 2011;42(3):410–8.
    1. Comas-Herrera A, Zalakaín J, Lemmon E, Henderson D, Litwin C, Hsu AT, Schmidt AE, Arling G, Kruse F and Fernández J-L (2020) Mortality associated with COVID-19 in care homes: international evidence. Article in , international long-term care policy network, CPEC-LSE, 1st February 2021.
    1. Strang P, Bergström J, Martinsson L, Lundström S. Dying from COVID-19: loneliness, end-of-life discussions, and support for patients and their families in nursing homes and hospitals. A National Register Study. J Pain Symptom Manag. 2020;60(4):e2–e13. 10.1016/j.jpainsymman.2020.07.020 Epub 2020 Jul 25.

Source: PubMed

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