Canada’s long-term care facilities experienced the worst international record for COVID-19 deaths during the first six months of the pandemic. A new study has found the top factors tied to this outsized mortality rate, and revealed the treatment linked to lower mortality among very ill residents in those early days.

Investigators examined LTC data from a cohort of 1,197 residents. They found that a severe shortage of licensed practical nurses and larger facility size were associated with 30-day mortality. Individual factors tied to higher mortality included later time until diagnosis, older age, functional impairment, male sex, diagnosis of congestive heart failure and neurocognitive disorders.

Anticoagulants make a difference

In severe COVID-19 cases, the use of anticoagulant drugs was associated with survival, likely because of its protection against thromboembolic complications, according to Kate Zinszer, PhD, of the University of Montreal, and colleagues. Anticoagulation may hold promise as an essential therapeutic modality for severe cases, but clinical trials are needed, they wrote. 

In addition, LPN shortages appear to be specifically problematic during the pandemic, perhaps decreased direct contact with residents and delayed detection of clinical deterioration, they theorized. 

“Finding solutions to staff shortages, especially for LPNs, appears to be a crucial step to prevent COVID-19 mortality, and may also improve the overall quality of care, the authors wrote.

Meanwhile, larger facility size has been shown in many pandemic studies to be a risk factor for COVID-19 deaths, likely due to increased viral exposure and less personalized care, they added.

“Interventions and policies aiming to mitigate staff shortages and facility size, as well as the use of anticoagulation among severe cases, may help protect LTCF residents in the event of future COVID-19 outbreaks,” the authors concluded.

Full findings were published in the Journal of the American Geriatrics Society.

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