Abstract
Background: This mixed methods systemic review synthesizes the evidence about nursing home risks for
COVID-19 infections. Methods: Four electronic databases (PubMed, Web of Science, Scopus, and Sage Journals
Online) were searched between January 2020 and October 2022. Inclusion criteria were studies reported on
nursing home COVID-19 infection risks by geography, demography, type of nursing home, staffing and resident’s
health, and COVID-19 vaccination status. The Mixed Methods Appraisal Tool (MMAT) was used to assess the
levels of evidence for quality, and a narrative synthesis for reporting the findings by theme. Results: Of 579
initial articles, 48 were included in the review. Findings suggest that highly populated counties and urban locations
had a higher likelihood of COVID-19 infections. Larger nursing homes with a low percentage of fully vaccinated
residents also had increased risks for COVID-19 infections than smaller nursing homes. Residents with advanced
age, of racial minority, and those with chronic illnesses were at higher risk for COVID-19 infections. Discussion
and implications: Findings suggest that along with known risk factors for COVID-19 infections, geographic and
resident demographics are also important preventive care considerations. Access to COVID-19 vaccinations for
vulnerable residents should be a priority.