{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:09:28Z","timestamp":1787936968573,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005227","name":"Centers for Medicare and Medicaid Services","doi-asserted-by":"publisher","award":["1E1CMS331488"],"award-info":[{"award-number":["1E1CMS331488"]}],"id":[{"id":"10.13039\/100005227","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG062797"],"award-info":[{"award-number":["K23AG062797"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Older adults are at greater risk of both infection with and mortality from COVID\u201019. Many U.S. nursing homes have been devastated by the COVID\u201019 pandemic, yet little has been described regarding the typical disease course in this population. The objective of this study is to describe and identify patterns in the disease course of nursing home residents infected with COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Methods<\/jats:title>\n                    <jats:p>This is a case series of 74 residents with COVID\u201019 infection in a nursing home in central Indiana between March 28 and June 17, 2020. Data were extracted from the electronic medical record and from nursing home medical director tracking notes from the time of the index infection through August 31, 2020. The clinical authorship team reviewed the data to identify patterns in the disease course of the residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The most common symptoms were fever, hypoxia, anorexia, and fatigue\/malaise. The duration of symptoms was extended, with an average of over 3\u2009weeks. Of those infected 25 died; 23 of the deaths were considered related to COVID\u201019 infection. A subset of residents with COVID\u201019 infection experienced a rapidly progressive, fatal course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion\/Conclusions<\/jats:title>\n                    <jats:p>Nursing home residents infected with COVID\u201019 from the facility we studied experienced a prolonged disease course regardless of the severity of their symptoms, with implications for the resources needed to care for and support of these residents during active infection and post\u2010disease. Future studies should combine data from nursing home residents across the country to identify the risk factors for disease trajectories identified in this case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.17308","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T15:16:15Z","timestamp":1622474175000},"page":"2412-2418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["<scp>COVID<\/scp>\n                    \u201019 disease trajectories among nursing home residents"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-4735","authenticated-orcid":false,"given":"Jennifer L.","family":"Carnahan","sequence":"first","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"},{"name":"Regenstrief Institute, IU Center for Aging Research  Indianapolis Indiana USA"},{"name":"Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi M.","family":"Lieb","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"},{"name":"Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Albert","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Wagle","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"},{"name":"Roudebush VA Medical Center  Indianapolis Indiana USA"},{"name":"Community Medicine Indiana University Health Physicians  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Kaehr","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"},{"name":"Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen T.","family":"Unroe","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics  Indianapolis Indiana USA"},{"name":"Regenstrief Institute, IU Center for Aging Research  Indianapolis Indiana USA"},{"name":"Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"HJKF Foundation.State Data and Policy Actions to Address Coronavirus.KFF.https:\/\/www.kff.org\/health\u2010costs\/issue\u2010brief\/state\u2010data\u2010and\u2010policy\u2010actions\u2010to\u2010address\u2010coronavirus\/?utm_source=web&utm_medium=trending&utm_campaign=covid\u201019. Accessed 2020."},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1111\/jgs.16669","article-title":"COVID\u201019 deaths in long\u2010term care facilities: a critical piece of the pandemic puzzle","volume":"68","author":"Lau\u2010Ng R","year":"2020","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1086\/595683","article-title":"Clinical practice guideline for the evaluation of fever and infection in older adult residents of long\u2010term care facilities: 2008 update by the Infectious Diseases Society of America","volume":"48","author":"High KP","year":"2009","journal-title":"Clin Infect Dis"},{"issue":"1","key":"e_1_2_12_5_1","first-page":"4","article-title":"A systematic review of body temperature variations in older people","volume":"19","author":"Lu SH","year":"2010","journal-title":"J Clin Nurs"},{"issue":"1","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1086\/313896","article-title":"Fever in the elderly","volume":"31","author":"Norman DC","year":"2000","journal-title":"Clin Infect Dis"},{"issue":"21","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1056\/NEJMoa2005412","article-title":"Epidemiology of Covid\u201019 in a long\u2010term care facility in King County, Washington","volume":"382","author":"McMichael TM","year":"2020","journal-title":"N Engl J Med"},{"issue":"13","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.15585\/mmwr.mm6913e1","article-title":"Asymptomatic and presymptomatic SARS\u2010CoV\u20102 infections in residents of a long\u2010term care skilled nursing facility \u2013 King County, Washington, March 2020","volume":"69","author":"Kimball A","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1007\/s12603-020-1389-1","article-title":"Clinical presentation of COVID19 in dementia patients","volume":"24","author":"Bianchetti A","year":"2020","journal-title":"J Nutr Health Aging"},{"issue":"10","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.3201\/eid2610.202694","article-title":"High proportion of asymptomatic SARS\u2010CoV\u20102 infections in 9 long\u2010term care facilities, Pasadena, California, USA, April 2020","volume":"26","author":"Feaster M","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"7","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.jamda.2020.05.040","article-title":"Asymptomatic spread of COVID\u201019 in 97 patients at a skilled nursing facility","volume":"21","author":"Goldberg SA","year":"2020","journal-title":"J Am Med Dir Assoc"},{"issue":"6","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.jinf.2020.03.019","article-title":"Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4\u2010week follow\u2010up","volume":"80","author":"Wang L","year":"2020","journal-title":"J Infect"},{"issue":"1","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12916-020-01665-z","article-title":"COVID\u201019: a retrospective cohort study with focus on the over\u201080s and hospital\u2010onset disease","volume":"18","author":"Brill SE","year":"2020","journal-title":"BMC Med"},{"issue":"9","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/S2213-2600(20)30316-7","article-title":"Case characteristics, resource use, and outcomes of 10\u2008021 patients with COVID\u201019 admitted to 920 German hospitals: an observational study","volume":"8","author":"Karagiannidis C","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"9","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1097\/MLR.0000000000000334","article-title":"The minimum data set 3.0 cognitive function scale","volume":"55","author":"Thomas KS","year":"2017","journal-title":"Med Care"},{"issue":"1","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1001\/jamainternmed.2016.7031","article-title":"Effect of the goals of care intervention for advanced dementia: a randomized clinical trial","volume":"177","author":"Hanson LC","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"9","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s12603-020-1497-y","article-title":"Editorial: COVID\u201019 \u2013 the long road to recovery","volume":"24","author":"Morley JE","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"e_1_2_12_18_1","unstructured":"Statistics NCfH.Guidance for certifying deaths due to COVID\u201019.2020."},{"issue":"7836","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/d41586-020-03360-8","article-title":"Could COVID delirium bring on dementia?","volume":"588","author":"Arnold C","year":"2020","journal-title":"Nature"},{"issue":"10","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.ajic.2020.07.028","article-title":"Lessons learned \u2013 outbreaks of COVID\u201019 in nursing homes","volume":"48","author":"Kim JJ","year":"2020","journal-title":"Am J Infect Control"},{"issue":"12","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1111\/jgs.16894","article-title":"COVID\u201019 in older adults: a series of 76 patients aged 85\u2009years and older with COVID\u201019","volume":"68","author":"Vrillon A","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1007\/s11606-020-05885-0","article-title":"Pneumonia management in nursing homes: findings from a CMS demonstration project","volume":"36","author":"Carnahan JL","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"9","key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.jamda.2009.07.001","article-title":"Reducing potentially avoidable hospitalizations of nursing home residents: results of a pilot quality improvement project","volume":"10","author":"Ouslander JG","year":"2009","journal-title":"J Am Med Dir Assoc"},{"issue":"11","key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1001\/jama.2020.14984","article-title":"Point prevalence testing of residents for SARS\u2010CoV\u20102 in a subset of Connecticut nursing homes","volume":"324","author":"Parikh S","year":"2020","journal-title":"JAMA"},{"key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jamda.2021.03.010","article-title":"The adverse effects of the COVID\u201019 pandemic on nursing home resident well\u2010being","volume":"22","author":"Levere M","year":"2021","journal-title":"J Am Med Dir Assoc"},{"issue":"7844","key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/d41586-021-00268-9","article-title":"Novavax offers first evidence that COVID vaccines protect people against variants","volume":"590","author":"Callaway E","year":"2021","journal-title":"Nature"},{"key":"e_1_2_12_27_1","doi-asserted-by":"crossref","unstructured":"JangraS YeC RathnasingheR et al.The E484K mutation in the SARS\u2010CoV\u20102 spike protein reduces but does not abolish neutralizing activity of human convalescent and post\u2010vaccination sera.medRxiv.2021.","DOI":"10.1101\/2021.01.26.21250543"},{"issue":"3","key":"e_1_2_12_28_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1056\/NEJMoa2029849","article-title":"SARS\u2010CoV\u20102 neutralizing antibody LY\u2010CoV555 in outpatients with Covid\u201019","volume":"384","author":"Chen P","year":"2021","journal-title":"N Engl J Med"},{"key":"e_1_2_12_29_1","doi-asserted-by":"crossref","unstructured":"LiuH ZhangQ WeiP et al.The basis of a more contagious 501Y.V1 variant of SARS\u2010COV\u20102.bioRxiv.2021.","DOI":"10.1101\/2021.02.02.428884"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.17308","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.17308","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.17308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:04:57Z","timestamp":1762182297000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.17308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,7]]},"references-count":28,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1111\/jgs.17308"],"URL":"https:\/\/doi.org\/10.1111\/jgs.17308","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,7]]},"assertion":[{"value":"2021-03-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}