Long-Term Care Facility Residents with Dementia: Their COVID-19 Infection Hospitalization Outcomes
Authors:   , Yin Cheng 
Published: October 2024

Long-term care facilities (LTCF) were impacted disproportionately by the coronavirus (COVID-19), suggesting their high risk for community-spread pandemics. This three-article dissertation with publications aims to a) aggregate the emerging research evidence of factors for nursing home residents' COVID-19 infections; b) explore hospitalizations due to COVID-19 among emergency admissions and length of hospital stays for long-term care facility (LTCF) residents with dementia; and c). investigate how comorbidity index score mediates the relationship between COVID-19 hospitalization and discharge outcomes among LTCF residents with dementia. This dissertation consists of a three-article format: a mixed-methods systematic review and two retrospective cohort studies. The first study is a systematic review to summarize major factors of nursing home residents' COVID-19 infections over the pandemic period (January 1, 2020, to October 31, 2022) in the United States providing a context for the two empirical studies on COVID-19 hospitalization outcomes for LTCF residents with dementia. The second study is a cross-sectional study and utilizes Texas Inpatient Public Use Data File (PUDF) to compare COVID-19 hospitalization outcomes for LTCF residents with dementia aged over 60 years (n = 1,413) and those without dementia (n = 1,674) during period January 2020 to October 2022. Logistic regression is used to predict emergency admissions and length of hospital stay, with pre-existing conditions mediating the relationship. The third is a cross-sectional study and uses the same dataset and criterion from the second study. Logistic regression, mediation analysis, and moderation analysis are used to investigate the effect of comorbidity index score and health insurance status on the association between dementia status and place of live discharge, while controlling for sociodemographic factors such as age cohort, race, and gender. Findings from the mix-method systematic review of 48 articles yielded evidence to suggest risk factors associated with COVID-19 infections among nursing home residents in the USA by geography, demography, type of nursing home, staffing, resident's status, and COVID-19 vaccination status through 48 articles. The second study found that with COVID-19 hospitalization, a diagnosis of dementia and preexisting conditions was significantly associated with emergency admission (OR = 1.70; 95%CI = 1.40-2.06) and shorter hospital stays (OR = 0.64; 95%CI = 0.55-0.74) when considering, adjusting for confounders such as demographics, health insurance, and lifestyle. In the third study, dementia diagnosis with COVID-19 hospitalization increased the likelihood of discharge to hospice care (OR = 1.44, 95% CI = 1.16-1.80), followed by LTCF (OR = 1.42, 95% CI = 1.23-1.65), but decreased the likelihood of discharge to recovery hospitals (OR = 0.70, 95% CI = 0.52-0.94). The findings highlight the increased risk of COVID-19 hospitalization disparities among individuals with dementia. Targeted health support programs for LTCF residents with dementia would enhance their COVID-19 hospitalization outcomes. Discharge plans for COVID-19 patients with dementia should be customized to their care needs, including hospice care, to minimize healthcare disparities compared to other residents. Further study is needed as to why recovery hospitals are less preferred for live discharge of COVID-19 patients with dementia diagnosis.