Most nursing home residents with COVID-19 were symptomatic for more than three weeks, which prolonged their recovery from the disease, according to a new study conducted by Indiana University researchers.

Kathleen Unroe, M.D., MHA

“For many nursing home residents who survive COVID-19, the duration of symptoms is long and arduous; most will survive the disease but may not get back to baseline,” senior author Kathleen Unroe, M.D., said of the findings. “The effect of COVID on nursing home residents goes beyond the mortality numbers we saw.“

The analysis, which was conducted by the Regenstrief Institute using the electronic medical records of 74 Indiana nursing home residents with COVID, also found that for seniors most infection cases called into four disease trajectory categories: 

  • 32 residents survived but experienced significant symptoms, 
  • 20 residents died after a prolonged course with significant symptom burden 
  • 17 residents had minimal to no symptoms; and 
  • 5 residents died after a rapidly progressive course of less than seven days

The most common types of symptoms were fever, hypoxia, anorexia and fatigue. Hypertension was the most common comorbidity among residents, followed by dementia, diabetes and non-dementia mental illness. 

“This is a population that by their very need to reside in a nursing home, has complex medical conditions and is at high risk,” Unroe explained. “When the COVID outbreak occurred, we [physicians who care for nursing home residents] didn’t know, because we weren’t armed with knowledge or clinical experience, what to expect — who would do well and who wouldn’t.” 

Researchers added that the findings point to the need for more adequate support for nursing homes to help them manage and care for residents in similar situations in the future. 

“Without adequate staff to encourage hydration, monitor frequent vitals, and administer other supportive treatments, residents will need to be transferred to the hospital,” the investigators concluded. “Older adults, especially those in the shared space environment of nursing homes, will continue to be susceptible to novel infections. Thus, it is imperative that future pandemic preparation include expertise in geriatrics and gerontology, including nursing home care.”