Postacute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A case–control study

Background: Postacute sequelae of SARS-CoV-2 (PASC) include fatigue, dyspnea, anxiety, and cognitive impairment. Few studies have explored the prevalence or presentation of PASC among nursing home (NH) residents. Method: A case–control study was conducted at 1 NH in Michigan in December 2021. Cases were defined as residents with SARS-CoV-2 infection between November 2, 2020, and October 8, 2021. Controls lived at the same NH during this interval and never tested positive for SARS CoV-2. Patient characteristics were compared between cases and controls using the Fisher exact test and Wilcoxon rank-sum test. Primary outcomes were functional decline, cognition, and adverse health outcomes. Outcomes were assessed by comparing measures on last observation to observations before COVID-19 diagnosis (cases) or to earliest observation (controls). Multivariable logistic regression assessed correlation between COVID-19 diagnosis and outcomes. Results: In total, 152 residents were identified for inclusion (147 included in final analyses, 76 cases, 71 controls);5 were excluded due to insufficient data. We collected the following resident characteristics: 66% were aged ≥80 years;73% were female;95% were non-Hispanic white;82% were long-stay residents;median of 3 comorbidities (IQR, 2–4). The mean number of follow-up observations was 2.60 (SD, 1.25). No significant differences in population characteristics were detected between cases and controls. Moreover, 106 patients (46 cases and 60 controls) had at least 1 follow-up visit and were thus included in the analyses to evaluate long-term outcomes. Among them, cases experienced significant declines in completing transfers (OR 5.65, p Conclusions: Nursing home residents with COVID-19 are more likely to enter hospice and have a higher mortality rate in the year following infection. Survivors experience significant functional decline in basic activities of daily living, specifically in the ability to transfer and dress. Larger studies are needed to further characterize our findings and to design interventions that can help overcome these long-term sequelae from COVID-19.Funding: NoneDisclosures: None

Environmental Contamination with SARS-CoV-2 in Nursing Homes

Background The COVID-19 pandemic has disproportionately affected nursing home (NH) patients, accounting for 5% of all cases and 32% of all COVID-19 deaths nationwide. Little is known about the frequency and persistence of SARS-CoV-2 environmental contamination in NHs. We characterize SARS-CoV-2 contamination in the rooms of COVID-19 patients and common areas in and around COVID-19 units. Methods A prospective cohort study was conducted at four NHs in Michigan between October 2020 and January 2021. Clinical research personnel obtained swab specimens from high-touch room surfaces of COVID-19 infected patients, up to three times per patient. Weekly swab specimens from six high-touch surfaces in common areas were also obtained. Demographic and clinical data were collected from patient clinical records. Our primary outcome of interest was the probability of SARS-CoV-2 detection from specific environmental surfaces in COVID-19 patient rooms. Results One hundred four patients with COVID-19 were enrolled and followed for 241 visits. Patient characteristics included: 61.5% over the age of 80;67.3% female;89.4% non-Hispanic white;50.1% short-stay. The study population had significant disabilities in activities of daily living (ADL;81.7% dependent in four or more ADLs) and comorbidities including dementia (55.8%), diabetes (40.4%) and heart failure (32.7) (Table 1). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient room surfaces, 191 common area swabs). Figure 1 shows contamination rates at sites proximate and distant to the patient bed. SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Over the course of follow-up, 89.4% (93/104) of patients had SARS-CoV-2 contamination in their room at least once (Figure 2). Environmental contamination detected on enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. Table 1. Clinical and Demographic Characteristics of the Study Population Including Short- and Long-stay Patients Figure 1. Contamination of Environmental Surfaces Relative to Distance from Patient Bed Figure 2. SARS-CoV-2 on Swab Specimens Collected – Patient-level, Visit-level, and Swab-level Conclusion We conclude that environmental contamination of surfaces in the rooms of COVID-19 patients is nearly universal and persistent. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment. Disclosures All Authors: No reported disclosures

Environmental contamination with SARS-CoV-2 in nursing homes.

BACKGROUND: SARS-CoV-2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID-19) units within NHs to care for affected patients. Frequency and persistence of SARS-CoV-2 environmental contamination in these units have not been studied. METHODS: A prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high-touch surfaces in COVID-19-infected patient rooms were obtained at enrollment and follow-up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS-CoV-2 RNA detection from specific environmental surfaces in COVID-19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS-CoV-2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site-specific environmental detection upon enrollment and during follow-up. RESULTS: One hundred and four patients with COVID-19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non-Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient rooms, 191 common areas). SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS-CoV-2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. CONCLUSIONS: Environmental detection of viral RNA from surfaces in the rooms of COVID-19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.

Behaviours of older adults and caregivers preparing for elective surgery: a virtually conducted mixed-methods research protocol to improve surgical outcomes.

INTRODUCTION: Older adults (age ≥65 years) are pursuing increasingly complex, elective surgeries; and, are at higher risk for intraoperative and postoperative complications. Patients and their caregivers frequently struggle with the postoperative recovery process at home, which may contribute to complications. We aim to identify opportunities to intervene during the preoperative period to improve postoperative outcomes by understanding the preparatory behaviours of older adults and their caregivers before a complex, elective surgery. METHODS AND ANALYSIS: As a result of the COVID-19 pandemic, we will conduct this study via telephone and videoconferencing. Using a multiphase mixed-methods research design, we will collect data on 10-15 patient-caregiver dyads from a pool of older adults (across a spectrum of cognitive abilities) scheduled for an elective colorectal surgery between 1 July 2020 and 30 May 2021. We will collect quantitative and qualitative data before (T1, T2) and after (T3, T4) surgery. Preoperatively, participants will each complete a cognitive assessment and a semi-structured qualitative interview that focuses on their preparatory behaviours (T1). They will then answer questionnaires about mood, self-efficacy and home environment (T2). Three weeks following hospital discharge, participants will complete another qualitative interview focusing on a comparison of preoperative and postoperative preparedness (T3). Researchers will also collect information about the patient's medical conditions, the postoperative complications and healthcare utilisation from the patient's chart 30 days following discharge (T4). We will code and conduct thematic analysis of the qualitative data to identify salient themes. Quantitative data will be analysed using basic descriptive statistics to characterise the participants. We will integrate the qualitative and quantitative findings using results from the quantitative scales to group participants and with use of joint display analysis. ETHICS AND DISSEMINATION: Ethics approval was obtained from the University of Michigan IRB. Study findings will be disseminated through peer-reviewed journals and presentations at conferences.

Geriatric Education on Telehealth (GET) Access: A medical student volunteer program to increase access to geriatric telehealth services at the onset of COVID-19.

The coronavirus disease 2019 pandemic placed an unprecedented demand on health systems to rapidly shift ambulatory in-person care to virtual care. Geriatric patients face more challenges with video visit access compared to younger patients due to discomfort with technology and less access to devices and internet. Medical students at the University of Michigan created an initiative to improve access to and comfort with video visits for geriatric patients. The program's goals were to (a) explore options for the delivery of personalized training to older adults, (b) create materials for volunteers to successfully navigate conversations with patients and caregivers, (c) provide patients one-to-one remote guidance while identifying and overcoming barriers-with practice sessions to increase comfort, (d) share with the larger health system, and (e) ensure program sustainability. Over a 10-week evaluation period, providers whose patients worked with our geriatric education on telehealth access volunteers had a video visit rate of 43% compared to 19.2% prior to participation in the program (adjusted odds ratio = 3.38, 95% confidence interval = 2.49, 4.59), ultimately providing a platform for geriatric patients to foster stronger connections with their providers, while increasing Michigan Medicine's overall proportion of video telehealth visits.

GET Access: Geriatric Education on Telehealth. Increasing Video Access for Geriatric Psychiatry Patients at the Onset of the COVID Pandemic and Beyond

Introduction The start of the Covid-19 pandemic placed an unprecedented demand on health systems to rapidly shift ambulatory in-person care to virtual care. Geriatric patients, at increased risk of morbidly and mortality from Covid-19 infection, face more challenges with video visit access compared to younger patients due to discomfort with technology and less access to necessary devices and broadband internet. Thus, it is a priority to enhance remote connections between geriatric patients and their providers. Methods The aim of this project was to facilitate the transition to video telemedicine for the geriatric population by creating a well-organized training program for volunteers to guide patients and caregivers to make the conversion from phone to video visits. A 28-page volunteer manual was created that included a structured process for how to call patients, including our three-call model, a walk-through of the video modalities, an algorithm for choosing which modality is best for each patient (Figure 1), and troubleshooting resources. Virtual training sessions oriented volunteers to the process and connected them with the faculty they would work with for the duration of the project. Volunteers provided patients with one-to-one remote guidance, identifying and overcoming barriers, with practice sessions to increase comfort with the technology. Initial volunteer work began in the Michigan Medicine Geriatric Psychiatry Clinic. With expansion of our team to 26 total individuals we also began servicing the Michigan Medicine Geriatric General Medicine Clinics. Quantitatively, we measured the proportion of video visits before and after intervention with the program. Qualitatively, we solicited feedback from providers, patients, and volunteers. Results The GET Access Program volunteers were successful in teaching and converting many visits to video that the schedulers were unable to do on a first pass. Of 95 contacted patients, 80 agreed to participate, and 71 switched from a phone visit to video visit, representing a conversion rate of 88.75% from phone to video visits. During a 10-week evaluation period of the two clinics GET Access serviced, 1942 patients had 2865 visits. Of 59 providers within the clinics studied, 12 providers with the lowest video visit rates received help from GET Access. Averaged over the evaluation period, visits after participation in the program were associated with video format 43% compared to 19.2% for visits prior to participation (adjusted OR 3.38 [95% CI 2.49, 4.59]) and visit by non-participating providers (32.1%, adjusted OR 1.65 [1.31, 2.08]) as shown in Figure 2. Conclusions A program dedicated to personalized virtual technological instruction and practice helped geriatric patients transition from phone to video visits, to provide a platform for stronger connection with their providers. Sustainability of the program beyond the immediate need of it due to Covid-19 was achieved with creation of a robust leadership structure. We are currently working with the telehealth administration at Michigan Medicine to expand GET Access to more clinics at Michigan Medicine. This expansion will allow our program to service more patients at Michigan Medicine, and results of the extension are expected to be available in March 2021.