Greater Excess Mortality Observed Among LTC Residents Without Personal Contact During Pandemic

New data demonstrates a correlation between increased mortality rates and access to personal contact with friends and family in the early days of the COVID-19 pandemic, according to research published in the Journal of the American Medical Directors Association.

According to authors of the study, an interrupted time series analysis was conducted in order to evaluate changes in all-cause mortality rates of long-term care (LTC) residents with and without contact with family or friends in Ontario, Canada, from January 1, 2017, to September 30, 2020, and residents were identified using the Continuing Care Reporting System database.

“Although pandemic-related restrictions in LTC (eg, visitor bans, suspension of congregate dining) led to widespread social isolation of residents, most remained in contact with family/friends virtually or by phone,” stated authors of the study.

March, 14, 2020, was used as the defining date of prepandemic and pandemic periods. Based on preCOVID-19 trends, excess mortality in the pandemic period was calculated in each group as absolute and relative differences for observed and expected mortality, according to authors of the study.

“During the pandemic period, there was a 57.8% relative increase (absolute change, 12.6 excess deaths per 1000) in mortality in residents without family or friend contact and a 17.1% increase (4.8 deaths per 1000) in residents with family or friend contact, representing 34.8% greater excess mortality in residents without personal contact with family or friends (difference-in-difference, 7.8 deaths per 1,000),” said authors.

Patterns were consistent for residents aged 85 years or older as well as in men and women. Results of the study showed that excess mortality was highest in April, but by June and July had returned to preCOVID-19 levels when community transmission was low.

According to the findings, 9.5% of deaths occurred in residents without family or friend contact with confirmed COVID-19 compared to 13.4% of deaths in residents with family or friend contact. While rates were similar in March, in April and May results show that residents without family or friend contact had lower hospital transfer rates prior to death.

“These residents may have experienced reduced access and/or other deficiencies in care (eg, delayed treatment decisions) if stripped of the extra care typically provided by staff, and with no family/friends to advocate for needed care,” stated authors of the study. “They may have also been less resilient to pandemic-related stressors because of their isolation; loneliness and social isolation have been shown to increase the risk for premature mortality.”

Further research is still needed in order to understand underlying mechanisms to minimize further harm to socially vulnerable residents, concluded authors of the study.

Reference:
Savage RD, Rochon PA, Na Y, et al. Excess mortality in long-term care residents with and without personal contact with family or friends during the COVID-19 pandemic [published online ahead of print December 17, 2021]. J Am Med Dir Assoc. doi: 10.1016/j.jamda.2021. 12.015.