A Europe-wide randomized controlled trial of hearing and vision rehabilitation in dementia: Results from the SENSE-Cog trial

Background: Hearing and vision impairments are highly prevalent in people with dementia (PwD) and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimize sensory function improve these outcomes. The SENSE-cog Trial evaluated whether a home-based multi-part 'sensory support' intervention (SSI) is effective in improving quality of life and other key outcomes in PwD (including hearing and/or vision problems), and their care partners. Method(s): This was a pan-European, multi-centre, observer blind, randomized controlled trial (RCT), of PwD with hearing and/or vision impairment and their companions. We compared 'care as usual' (CAU) to a multi-part complex intervention of hearing and vision rehabilitation (SSI) tailored to each participant dyad. The SSI included: assessment and correction of hearing and/or vision impairments;home-based, therapist-delivered sensory support (i.e., adherence with devices;improving the sensory environment, communication training, and signposting to other support agencies). Outcomes were collected at baseline, intervention end (18 weeks) and post-intervention (36 weeks - the primary endpoint) and included: quality of life, sensory and cognitive functional ability, relationship satisfaction, neuropsychiatric symptoms, and mental well-being. Health resource utilization was measured to estimate cost-effectiveness of the intervention. Result(s): Across 7 European centers (UK, France, Cyprus, Greece), 252 participants with dementia (median age 80 years, 53% female, 59% hearing impairment only, 4% visual impairment only and 37% both impairments) were randomized from May 2018 to May 2021 to receive either CAU or SSI (10 visits over 18 weeks). Mitigating strategies to adapt study procedures to the COVID-19 pandemic were implemented. Over 75% of participants completed the primary outcome, the DEM-QoL scale, at 36 weeks. An initial feasibility study yielded positive results for this outcome revealing an average improvement in the DEM-QoL of 4.9 points (> minimum important clinical change). Conclusion(s): Hearing and vision support in PwD is a potentially important and cost-effective means of improving the lived experience of dementia, representing a critical step in the diagnostic and care pathway. Main RCT results will be available in May 2022. Trial registration: ISRCTN17056211. Copyright © 2022 the Alzheimer's Association.

SARS-COV-2 INFECTION AND VACCINATION PATTERNS DETERMINE LONG-TERM ANTIBODY RESPONSES IN NURSING HOME RESIDENTS: DATA FROM NH-COVAIR

Background: Older Nursing Home Residents (NHRs) are at greatest risk of morbidity and mortality from SARS-CoV-2, particularly in the context of both waning vaccine efficacy and the emergence of Variants-of-Concern (VOCs). However, the determinants of long-term vaccine-induced protective antibody responses are yet to be determined in this group. Methods: NH-COVAIR recruited older NHRs for comprehensive clinical and frailty (NH-FRAIL) assessment. Blood samples were obtained pre-vaccination, at 6-weeks and 6-months following primary vaccination and 6-months following booster vaccination. Antibody titres were measured using both an electrochemiluminescence assay and a custom bead-based array (Luminex™) to measure antibody titre and avidity for Wuhan strain/major VOC antigens. Stepwise adjusted linear regression (log-transformed) assessed longitudinal determinants of vaccine-induced antibody responses. Results: Of 86 participants (81.1 ± 10.8 years;65% female), just under half (45.4%) had evidence of previous SARS-CoV-2 infection. All NHRs mounted a significant antibody-response to vaccination at 5 weeks followed by a significant decrease in antibody titre by 6 months. Previous SARS-CoV-2 infection was the strongest predictor of antibody waning at all timepoints (β: 3.59;2.89, 4.28;P < 0.001 for 6-months). Independent of infection history, both age (β: –0.05;–0.08, –0.02;p<0.001) and frailty (β: –0.22;–0.33, –0.11;p<0.001) were associated with faster antibody waning at 6-months. Cross-reactivity and avidity were significantly lower for Beta (B.1.351) and Gamma (P.1) VOC strains (all p<0.001). Additionally, there was faster antibody waning and significantly reduced antibody avidity to Beta and Gamma VOCs in SARS-CoV-2 naïve NHRs. Conclusion: Older NHRs are capable of mounting protective antibody responses to SARS-CoV-2 vaccination. Responses were more durable, with a greater cross-reactivity to and avidity for VOCs in those with previous SARS-CoV-2 infection. Increasing age and greater frailty in NHRs was associated with faster antibody waning. Our findings support ongoing serological surveillance and use of additional vaccine doses in older NHRs, particularly in those without previous SARS-CoV-2 exposure.

BUILT ENVIRONMENT OF NURSING HOMES AND INFECTION CONTROL AND PANDEMIC PREPAREDNESS

Background The disproportionately high death rate of nursing home (NH) residents from COVID-19 in many countries, including Ireland, has focussed attention on infection prevention and control, including the built environment, in nursing homes. This has been a poorly researched topic to date, and we undertook a systematic review of evidence for architectural design measures which support infection control and pandemic preparedness. Methods Databases were screened for keywords related to NHs, built environment, infection prevention and control, and COVID-19;relevant papers were uploaded onto Covidence and screened for relevance. Data extracted from included articles was tabulated under 8 specific aspects of the built environment. Results Of 17 papers included in the final analysis, four studies found that larger nursing homes carried an increased risk of COVID-19 infection. Crowding in NHs was also a risk factor for infection, with a high crowding index associated with COVID-19 infection in five studies. Green House care homes, which are based on small clusters of domestic dwellings, fared better than traditional NHs. Two papers found an association between the location of NHs and the risk of COVID-19 infection, with urban NHs and those in areas of high prevalence being more at risk. Two papers identified internal fittings as a target for infection prevention and control. Seven papers highlighted the role of adequate ventilation in NHs in the prevention of spread of COVID-19. Only one paper described easy access to the outdoors as beneficial to infection control. Conclusion Residents of NHs are amongst the most vulnerable to COVID-19 infection. When designing and building NHs, the role of the built environment in controlling the spread of the virus should not be underestimated. This research supported by Science Foundation Ireland.

Intensity and frequency of physician interventions to nursing home residents before and during the COVID-19 pandemic

Introduction The COVID-19 pandemic has disproportionately affected nursing home residents internationally, with 62% of COVID-19 related deaths in Ireland occurring in residential care facilities. The increased care needs of nursing home residents with COVID-19 has stimulated discussions related to transfer to hospitals for higher intensities of care. However little focus has been given to calculating physician care needs of residents who remain in the nursing home, an ethical imperative for advance care planning which ensures adequate medical care for those not transferring. This study profiled the frequency and intensity of medical intervention. Methods Retrospective review of 51 residents’ healthcare records from January-May 2020. We assessed the frequency and intensity of medical intervention, compared pre-pandemic and pandemic periods. Results Of 51 residents (31 women, mean age 84.1+8.2), 19 (37%) acquired COVID-19. Most residents were maximum dependency (n=32, (55%)) with over half diagnosed with dementia (n=31, 51%) and 29 (47%) with stroke. The average number of medical interventions per month for all residents almost doubled, from 89 during the pre-pandemic period to 176 during the 3-month pandemic period: Chi-squared test: p=0.02. Average monthly night-time and week-end interventions increased by 189% (28 vs 81). Conclusion The total frequency of physician interventions for nursing home residents increased significantly during the COVID-19 pandemic. This highlights the importance of ensuring increased access to physicians, including night-time and weekends, in pandemic planning for nursing home residents.

Hospitalised older people with covid-19: One month outcomes

Aims COVID-19 disproportionately affects older people, with those aged ≥65 years representing a significant proportion of hospital admissions and deaths. Our aim was to examine characteristics, inpatient course and one-month outcomes of older patients with COVID-19 managed in an Irish urban tertiary hospital. Methods A retrospective cohort study of patients aged ≥65 diagnosed with laboratory-confirmed-COVID-19 over one-month and managed as inpatients in an Irish tertiary referral hospital. Electronic and paper medical records were reviewed. Results Eighty-six inpatients aged ≥65 years (mean age 77) with laboratory-confirmed-COVID-19 were included. Participants were frail (Median Clinical Frailty Scale:5) with multiple comorbidities (Median Charlson Comorbidity Index:5). One month after diagnosis, 44.2% (38/86) were discharged, 33.7% (29/86) had died and 14.0% (12/86) were awaiting rehabilitation or long-term care(LTC). The remainder were medically recovering. Discussion COVID-19 had a significant impact on older people admitted to hospital with high case-fatality rates. The proportion awaiting rehabilitation or LTC at four weeks demonstrates a significant functional impact on this cohort.

Responding to needs of residents in long term care in ireland

Residents in nursing home care have borne a disproprtionate morbidity and mortality in the COVID-19 pandemic in comparison to the general population. Although the high rate of infection, morbidity and mortality in older people living in nursing homes may be attributable to increased levels of frailty and comorbidity in residents, the physical infrastructure and governance structures within nursing homes is also likely to be highly significant. The authors present, on behalf of Irish Society of Physicians in Geriatric Medicine, a position paper on changes that should be implemented to enhance the safety and quality of care for nursing home residents in Ireland.