Class II/III Obesity Prevalence in Residents of US Nursing Homes: Cross-sectional Study and Forecasting 2030 with COVID-19 Perspective.

OBJECTIVES: This study aimed to better understand Class II/III obesity prevalence trends among older adults residing in nursing homes (NH) nationwide. METHODS: Our retrospective cross-sectional study evaluated Class II/III obesity (BMI ≥35 kg/m²) prevalence among NH residents in two independent national NH cohorts. We used databases from Veterans Administration NHs called Community Living Centers (CLCs) covering 7 years to 2022, and Rhode Island Medicare data covering 20 years ending in 2020. We also performed forecasting regression analysis of obesity trends. RESULTS: While VA CLC resident obesity prevalence was less overall and dipped during the COVID-19 pandemic, obesity prevalence increased in NH residents in both cohorts over the last decade and is predicted to do so through 2030. CONCLUSION: Obesity prevalence in NHs is on the rise. It will be important to understand clinical, functional, and financial implications for NHs, particularly if predictions on increases materialize.

Comorbidity and Management of Concurrent Psychiatric and Medical Disorders.

Aging increases susceptibility to medical and psychiatric comorbidity via interrelated biological, psychological, and social mechanisms. Mental status changes or other psychiatric symptoms occurring in older adults with medical disorders most often result from delirium, depression, or the onset of Alzheimer's disease and related dementias (ADRD). Clinicians can use evidence-based tools to evaluate such symptoms including the 4A's Test for delirium, the Saint Louis University Mental Status Exam, and the Geriatric Depression Scale. Innovative models such as collaborative care can improve the outcome of care of older adults with medical disorders requiring treatment for depression or ADRD..

Can we use temperature measurements to identify pre-symptomatic SARS-CoV-2 infection in nursing home residents?

BACKGROUND: COVID-19 has had a severe impact on morbidity and mortality among nursing home (NH) residents. Earlier detection of SARS-CoV-2 may position us to better mitigate the risk of spread. Both asymptomatic and pre-symptomatic transmission are common in outbreaks, and threshold temperatures, such as 38C, for screening for infection could miss timely detection in the majority of residents. We hypothesized that in long-term care residents, temperature trends with SARS-CoV-2 infection could identify infection in pre-symptomatic individuals earlier than standard screening. METHODS: We conducted a retrospective cohort study using electronic health records in 6176 residents of the VA NHs who underwent SARS-CoV-2 testing triggered by symptoms. We collected information about age and other demographics, baseline temperature, and specific comorbidities. We created standardized definitions, and a hypothetical model to test measures of temperature variation and compare outcomes to the VA standard of care. RESULTS: We showed that a change from baseline of 0.4C identified 47% of NH residents who became SARS-CoV-2 positive, earlier than standard testing by an average of 42.2 h. Temperature variability of 0.5C over 3 days when paired with a 37.2C temperature cutoff identified 55% of NH residents who became SARS-CoV-2 positive earlier than the standard of care testing by an average of 44.4 h. A change from baseline temperature of 0.4C when combined with temperature variability of 0.7C over 3 days identified 52% of NH residents who became SARS-CoV-2 positive, earlier than standard testing by an average of 40 h, and by more than 3 days in 22% of the residents. This earlier detection comes at the expense of triggering 57,793 tests, as compared to the number of trigger tests ordered in the VA system of 40,691. CONCLUSIONS: Our model suggests that early temperature trends with SARS-CoV-2 infection may identify infection in pre-symptomatic long-term care residents.

Dementia prevalence, a contextual factor associated with SARS-CoV-2 in veterans affairs community living centers.

BACKGROUND: Alzheimer's disease and related dementias (ADRD) impact the diagnosis and infection control of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in nursing homes (NH) by influencing the behavior of residents and their caregivers. Health system data show an association between ADRD and SARS-CoV-2. Whether this association is present in NH populations remains unknown. How increased SARS-CoV-2 risk among residents with ADRD impacts the greater NH population also remains unknown. METHODS: This retrospective cohort study used electronic health record data on Veterans residing in 133 Veterans Affairs Community Living Centers (CLC) and 15 spinal cord injury units from March 1, 2020 to December 13, 2020. We measured ADRD using diagnostic codes 12 months before an index SARS-CoV-2 test date for each resident. We used Poisson regression to determine the relative risk of SARS-CoV-2 for the highest quartile of facility ADRD prevalence versus the lowest, stratifying by individual ADRD status, and adjusting for covariates, with and without a random intercept to account for facility clustering. RESULTS: Across the study period, 15,043 residents resided in CLCs, 1952 (13.0%) had SARS-CoV-2, and 8067 (53.6%) had ADRD. There was an estimated 60% increased risk of SARS-CoV-2 in facilities with highest dementia prevalence versus lowest (relative risk, 1.6 [95% confidence interval 0.95, 2.7]). CONCLUSIONS: CLC residents had a greater likelihood of SARS-CoV-2 infection in facilities with greater ADRD prevalence. Facility characteristics other than ADRD prevalence may account for this association.

Achilles' tendon rupture dancing the 'Jerusalema' - A case series.

INTRODUCTION AND IMPORTANCE: The weekend warrior has long been prey to musculoskeletal injuries as a result of intermittent, high intensity activity. The Achilles tendon is known to be particularly vulnerable in this population cohort but during the COVID-19 lockdowns in Ireland and all over the world there has been a certain level of detraining and deconditioning among all age groups and populations. Throughout the worldwide restrictions, viral internet challenges and dances have encapsulated the spirit of a global community with the 'Jerusalema' dance being no exception. The rise of this particular viral sensation was at the detriment of the Achilles tendons of three middle aged gentlemen on who we base our case series. PRESENTATION OF CASES: Over the space of ten days three cases of Achilles tendon rupture repair presented to the emergency department in Midlands Regional Hospital Tullamore (MRHT) with the mechanism of tendon rupture being through the 'Jerusalema' dance. These patients were surgically managed in line with local institution practice and postoperative outcomes were good with no complications noted. Follow up is ongoing. CLINICAL DISCUSSION: This retrospective case series is based on the impact of the 'Jerusalema Dance' on presentations of Achilles tendon rupture to the Emergency Department in a single regional hospital from January to March 2021. We used these cases in conjunction with a review of current literature to highlight the benefit of an integrated Achilles Tendon rehabilitation programme in this at-risk patient cohort. CONCLUSION: This paper highlights the dangers inherent when well intentioned, but physically deconditioned individuals endeavour to perform a physical exercise which is deceptively demanding. Going forward, viral challenges such as the 'Jerusalema' may contribute to new and interesting mechanisms of injuries in our 'weekend warrior' cohort. In addition to this, given the global deconditioning seen due to the COVID 19 pandemic and subsequent lockdowns we may see a higher rate of Achilles tendon injuries in the near future across a multitude of patient cohorts. Level one evidence suggests that conservative treatment is just as effective as surgical treatments in the majority of patients with an Achilles tendon rupture, as long as a protocol of rehabilitation with early weightbearing is performed. Our accelerated rehabilitation programme in MRHT is in line with others however internal audit and new literature in the future may enable us to refine it further.

COVID-19 and Long-Term Care Healthcare Worker Mental Health in Rhode Island

Introduction Healthcare workers in long-term care settings and group homes for the disabled are at signi?cant risk of contracting COVID-19 and subsequently infecting the residents, fellow co-workers, and their family. In addition, lower paying long-term care healthcare workers maybe working multiple jobs which increases the risk of exposure. In April 2020, 27% of all deaths in the population was among residents in long-term care. The elderly population has the greatest risk for mortality from COVID-19 (Liu et al. 2020) and are disproportionality a?ected by social distance and self-isolation. Most long-term care settings have implemented lockdowns preventing families from visiting and limiting interactions among residents. Social isolation of the elderly is considered a serious public health concern. Social disconnection is a risk factor for increased depression and anxiety among the elderly. It is hypothesized that elderly persons are at high risk for poor mental health outcomes from the COVID-19 pandemic. The Alzheimer's Disease International suggest that those with dementia “may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak”. These factors potentially may increase stress on healthcare workers in long-term care settings beyond the fears of exposure and transmitting COVID-19 to their families. There are few studies to date that examine the mental health impact of COVID-19 on healthcare workers in long-term care. The United Nations has highlighted the mental health risk to workers in long-term care. “First responders and front line workers, particularly workers in health and long-term care play a crucial role in ?ghting the outbreak and saving lives. However, they are under exceptional stress, being faced with extreme workloads, di?cult decisions, risks of becoming infected and spreading infection to families and communities, and witnessing deaths of patients.” Methods Healthcare workers in long-term care facilities, and assisted living facilities in Rhode Island were given questionnaires to complete that examined mental health and risk factors associated with COVID-19. The questionnaire includes items on the healthcare worker's experience with COVID-19. Resilience is measured using The Brief Resilience Scale assessing the individual's ability to bounce back or recover from stress. Subjective incompetence is de?ned as the perceived incapacity to perform tasks and express feelings deemed appropriate in a stressful situation. Increasing distress and subjective incompetence may convert a normal reaction to stress into mental disorder requiring intervention. Demoralization is measured using the Demoralization Scale-II. Depression and anxiety is measured using two of the most commonly used screens in clinical care, the PHQ-9 for depression and the GAD-7 for generalized anxiety. Family functioning during and before the COVID-19 pandemic is measured using the three-item Brief Assessment of Family Functioning. Social support is measured during and before the COVID-19 pandemic using the emotional-informational support subscale of the Brief Social Support Scale derived from the Medical Outcomes Study Social Support Survey. Coronavirus Anxiety Scale is a mental health screener designed to aid in the identi?cation of probable cases of dysfunctional anxiety associated with the COVID-19 pandemic. The fear of Coronavirus-19 Scale was used to measure this construct. The ?ve-item Primary Care PTSD Screen was adapted to COVID-19 as a traumatic event. Items measuring healthcare worker workplace stress was developed based on a items from a number of existing scales. A 15-item health care workers attitudes toward the management of COVID-19 in the long-term care facility was developed by the research team that focuses on training of sta?, safety, and resident care. Results Preliminary data will be presented. Data collection is currently underway. There are 65 assisted living facilities and 85 nursing homes in Rhode Island. Approximately 10% of the facilities are currently participating with the aim to recruit nearly all facilities in the state. Conclusions The hypotheses to be tested is that healthcare workers in long-term care settings have mental health issues including demoralization, depression and anxiety due to the COVID-19 pandemic disaster. That those who are in facilities with COVID-19 residents have increased stress. Those facilities that have placed increased demands on healthcare workers will have employees that are having more difficulty in dealing with the COVID-19 pandemic. This study examines how healthcare workers in long-term care facilities have coped during the COVID-19 pandemic and the impact on their mental health;factors that protect or place the healthcare worker at risk for poorer mental health outcomes (depression, anxiety, demoralization, post-traumatic stress);and factors during COVID-19 that place the healthcare worker for poorer mental health outcomes during COVID-19 pandemic. Funding Department of Psychiatry of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Lifespan