gms | German Medical Science

Background: While numerous studies have examined risk factors for COVID-19 infection in the overall population, only few studies have comprehensively analyzed risk factors for COVID-19 infection in the older general population, despite older people being among the most affected by the pandemic. Hence, this is one aim of the population-representative study on the health of older people in Germany (Gesundheit 65+).

Methods: Data on COVID-19 infections and possibly related factors was collected from 3,164 participants aged 65 years and older (weighted mean 75.6 years (95% confidence interval 75.5-76)), form which 55.9% (95% confidence interval 54.3-57.5) were women) between October 2021 and August 2022 in the study Gesundheit 65+. COVID-19 infection status was ascertained as self-reported confirmed infection by a PCR-test or no infection according to self-report. We considered sociodemographic variables (age, sex, education, household income), health risk factors (obesity, smoking status, COVID-19 vaccination, chronic diseases), and indicators of regular face-to-face contacts (e.g., needing help to perform the basic activities of daily living (ADL-help), living in an assisted living facility, or meeting family or friends). We estimated the weighted prevalences and conducted univariable and multivariable logistic regressions to explore associated risk factors for infection.

Results: Out of all participants, 6.8% (95% confidence interval 5.6-8.2) had a self-reported PCR-confirmed SARS-CoV-2 infection, 87.3% (85.4-89.0) explicitly stated that they had not been infected, and 5.9% (4.7-7.4) had missing information on infection. Subsequent analyses were restricted to the sample of 2,976 participants (unweighted number) with infection status data of which 3.1% (2.3-4.1) lived in assisted living facilities, and 14.0% (12.3-15.9) received ADL-help. Compared to the respective reference group, prevalences of infection were significantly higher among residents of assisted living facilities (24.7% vs. 6.7%), people who received help to perform ADL (10.8% vs. 6.8%), individuals who had not been vaccinated against COVID-19 (25.2% vs. 6.9%), individuals who did not meet family or friends (12.7% vs. 6.7%), and non-smokers (7.8% vs. 2.6%). None of the other variables were significantly related to COVID-19 infection. In multivariable analysis, living in an assisted living facility (odds ratio, OR 3.6; 95%CI 1.8-7.2), not having been vaccinated against COVID-19 (OR 4.6; 95%CI 1.5-14.1), and being a non-smoker (OR 1.6; 95%CI 1.1-2.6) were independently associated to a higher chance of COVID-19 infection.

Conclusion: The preliminary results of this study reflect the prevalence of COVID-19 infection found in previous contemporary studies. The protective effect of the vaccine is noticeable. Even though the participants living in assisted living facilities are not representative of this specific part of the population, we can see the pandemic's important effect on this group. This highlights the need to improve quality and infection preventive measures in nursing homes. Older people, in general, have been very vulnerable to the effects of the pandemic. Our findings on risk factors of the older population fill an important evidence gap and highlight the need for pandemic preparedness that considers the specific daily living situation of the older population and their need not only for medical help but also for ADL-help.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.