EXPOSING THE REALITIES OF THE WORKFORCE IN NURSING HOMES

For decades, staffing in nursing homes has been highlighted as being inadequate and directly affecting the quality of care received by residents. The COVID-19 pandemic, occurring during the committee's deliberations, further highlighted and exacerbated the multiple workforce challenges in nursing homes. The committee's recommendations related to the nursing home workforce will be presented. Dr. Christine Mueller, a professor at University of Minnesota and with expertise in staffing and quality of care, will discuss strengthening the workforce to meet complex and varied resident needs that align with the committee's recommendations.

COVID-19 RECOVERY: LESSONS LEARNED AND POLICY ACTIONS FOR THE FUTURE

Focusing on Covid-19 recovery, this symposium will feature a selection research studies that highlight lessons learned that are applicable across the continuum of care for older adults, their families and care partners. The collection of presentations bring perspectives from local to global. Each of the presenters will highlight implications for health and aging policy.

INCREASED DEPRESSION AND ANXIETY DURING THE COVID-19 PANDEMIC REGARDLESS OF COVID-19 POSITIVITY

Background: Recent studies have reported increased rates of mood and anxiety disorders in COVID-19 patients after acute illness, possibly resulting from inflammation, which is linked to depression and childhood trauma. Increased rates of anxiety and depression have also been observed at the population level following past viral outbreaks (e.g. SARS-CoV-1, MERS) and pandemic associated stress could also impact mental health. Thus, the present study compared depression, anxiety, and perceived stress scores in university students who tested positive for COVID-19 to those who never contracted the disease, and to scores prior to the pandemic. Methods: University students completed self-report measures of depression, anxiety, and perceived stress before (N=150) and during (N=334) the COVID-19 pandemic. The pandemic sample also completed measures of COVID-19 positivity, symptoms, and recovery. One third of the sample tested positive for COVID-19 (N=109). Three x (pre-pandemic, COVID-19 positive, COVID-19 negative) x two (male, female) ANOVAs examined differences in depression, anxiety, and perceived stress. A two (COVID-19 positive, COVID-19 negative) x two (male, female) ANOVA compared PTSD severity. Results: There were significant group effects for depression (F(1,477)=3.06, p=.048, partial η2=.013), anxiety (F(1,477)=3.03, p=.049, partial η2=.013), and perceived stress (F(1,376)=5.62, p=.004, partial η2=.029). Post-hoc analyses indicated that depression and anxiety were higher in the COVID-19 positive (all p's <.034) and negative (all p's <.042) groups compared to the pre-pandemic sample, but did not differ across the pandemic samples (all p's >.584). In contrast, perceived stress was higher in the pre-pandemic group compared to those who were COVID-19 positive (p=.033) and negative (p=.011). PTSD severity did not differ between the COVID-19 positive and negative groups (p=.645). Females were more depressed (p=.036), anxious (p<.001) and stressed (p=.006) than males but did not differ in PTSD severity (p=.305). Discussion: These results suggest that rates of depression and anxiety have increased during the pandemic regardless of COVID-19 positivity. Reduced stress during the pandemic may reflect reduced extracurricular commitments due to university activity restrictions. Future research should examine if these results generalize beyond university students.

SCHIZOTYPY SYMPTOMS IN COVID-19 PATIENTS WHO FULLY RECOVERED AND THOSE WHO DEVELOPED LONG COVID

Background: The novel coronavirus (COVID-19) can cross the blood-brain barrier resulting in neuroinflammation that can cause significant damage to the peripheral and central nervous systems. Inflammation has been linked to psychotic symptoms, which have been observed following influenzas and SARS-CoV-1. Maternal influenza while in utero is also linked to later development of psychotic disorders. Some who do not develop psychosis display subclinical symptoms called schizotypy, which includes odd behavior, perceptual aberrations, and thought, speech and social impairments. The present study compared schizotypal symptoms in persons who contracted COVID-19 and recovered, to those who developed long COVID. Method: Individuals who contracted COVID-19 were recruited via social media and completed self-report measures of premorbid health, COVID-19 positivity, symptoms, and recovery, along with the schizotypal personality questionnaire (SPQ) online using Qualtrics. Results: One-third of the sample (N=88) recovered within one month of acute illness, and two-thirds (N = 153) remained symptomatic > 3 months later. A 2 (recovered, long COVID) x 2 (male, female) ANCOVA controlling for age indicated that there were no differences between those that recovered within one month and those with long COVID on SPQ scores (F(1, 154) = 3.00, p = .085). There were also no differences between the groups regarding SPQ subscales. There was an interaction effect between sex and total people that contracted COVID-19 on total SPQ scores (F(1, 154) = 12.69, p = .001). Compared to normative data, those who contracted COVID-19 scored higher in social anxiety (t(161) = 6.39, p = .001), constricted affect (t(159) = 2.54, p = .012), no close friends (t(161) = 5.03, p = .001), and ideas of reference (t(161) = - 5.26, p = .001). Discussion: Results suggest that increased social anxiety, constricted affect, lack of close friends, and ideas of reference are present in those with COVID-19, which may reflect pandemic effects on disease pathophysiology.

Autonomy of experience: time, space, path and place as blended artistic methodology in M A P, an online, interactive poetry experience

This article will discuss M A P, an interactive poetic experience facilitated on the popular media sharing application Instagram, which was developed as a research-based, cross-course collaboration. The artistic methodology applied during M A P was developed during the global pandemic of COVID-19 and was created with, and inspired by the use of blended learning approaches. Acknowledging and addressing the social disconnect and technological hyper-connect during the pandemic, M A P can be understood as a practice-as-research experimentation that investigates how digital technologies might be repurposed in blended artistic practice to allow for a more reflective and embodied experience of ourselves and others in time and place. The makers of M A P advocate the facilitation of autonomous choice-making, particularly in relation to the use of time, space, path and pace, as well as the application of slow technology and slow design considerations to develop story-telling and relational sense-making through the merging of online and real-world activities. M A P can be accessed via Instagram on @map_game_start or via https://www.themapexperience.com. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level

OBJECTIVES: Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. MATERIAL AND METHODS: Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves. RESULTS: We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79;95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70;95% CI, 0.65-0.74;P .001), the NLR (0.74;95% CI, 0.69-0.78;P = .03), or the CRP level (0.72;95% CI, 0.68-0.76;P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. CONCLUSION: PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.

Long-term follow-up of olfactory dysfunction in COVID-19 patients

Background: Olfactory dysfunction (OD) is a common symptom of COVID-19 with a prevalence of 5 to 98 percent according to geographical region and method of evaluation. Although recovery is reported within the first month in many cases, long-term observations are rare. Therefore, we aimed to assess the course of chemosensory function in COVID-19 patients within three to six months after the infection with SARS-CoV-2. Methodology: Sixty-two patients (43f and 19m;mean age/ SD: 40.513.6 years;range: 18-68 years) with SARS-CoV-2 infection and subjective OD participated in this singlecenter study. At first, patients performed questionnaires and chemosensory tests at home, and then, further psychophysical tests were performed at the clinic. Results: Three to six months after the acute infection 80% still showed some degree of OD by applying orthonasal olfactory test (“Sniffin' Sticks / TDI”). After a mean interval of 219.1 days (SD 67.6;range: 113-330) between first day of OD and follow-up testing, the mean TDI score was 26.8 points (SD 5.5;range 5.0-37.5). Furthermore, 64.5% reported improvement, 6.5% deterioration and 29% no change of OD until follow-up. Conclusions: The prevalence of persisting OD associated with SARS-CoV-2 may be higher than expected. Moreover, subjective assessment of chemosensory function seems to improve, but reconvalescence fails to appear in the majority.

Olfactory-related quality of life adjustments to smell loss during the COVID-19 pandemic

Objective: Previous studies provided the first evidence that the importance of olfaction decreases with the duration of smell loss. It is currently unknown whether the olfactoryrelated quality of life (QoL) also differs between patients with new-onset and persistent smell loss (longer than four weeks) during the coronavirus-19 (COVID-19) pandemic and patients with persistent postinfectious smell loss (PIOD) that were recruited before the pandemic. Methods: This was a retrospective study that included 149 patients with self-reported olfactory dysfunction (OD). The olfactory-related QoL was measured using the Questionnaire of Olfactory Dysfunction (QOD). The QOD measures the degree to which patients (i) adjust and cope with smell loss (QOD-PS) and (ii) suffer from OD in general (QOD-NS). Self-perceived chemosensory function, demographics, olfactory function, and duration of smell loss were evaluated. Analyses of variance were used to depict differences in QoLoutcomes between different OD groups. Results: All patients included during the COVID-19 pandemic reported an extensive loss of chemosensory functions smell, taste, and flavor perception. Retronasal testing revealed olfactory impairments in more than half of these patients. One-way analysis of variance and posthoc tests revealed that the QOD-NS was significantly higher in the new-onset OD group than the PIOD group. At the same time, the QOD-PS score was significantly higher in the PIOD and the persistent COVID-19 OD group compared to the new-onset OD group. Conclusions: We showed that patients with persistent OD experienced better olfactory-related adjustment and lower QoL-impairment than those with recent-onset OD, suggesting that the olfactory-related QoL might change as a function of time after symptom onset.

Antihypertensive medication and outcome in patients with COVID-19 compared to non-COVID respiratory infections

Background: Recent reports suggested no adverse effects of antihypertensive medication including inhibitors of the renin-angiotensin system on outcome of patients with coronavirus disease 19 (COVID-19). However, most of these studies lack adequate control groups, and regional and socio-economic differences may additionally affect clinical course and outcome of COVID-19. Methods: In the prospective observational cohort COrona VIrus surviVAl (COVIVA) study at our university hospital, we consecutively enrolled patients presenting to the emergency department with symptoms suggestive of COVID-19 between March and June 2020. Patients tested positive for COVID-19 (cases) were compared with patients tested negative, who had a respiratory infection (respiratory control). Primary outcome measure was the composite of ICU admission, 3'-day mortality or rehospitalization for respiratory symptoms. Results: The final analysis consisted of 191 patients with COVID-19 and 323 respiratory controls. Sixty cases (31.4%) and 87 (26.9%) respiratory control patients were on ACE inhibitors (ACE-I) or angiotensin II receptor blockers (ARB). In unadjusted models the hazard ratio [95% CI] for the composite outcome for patients on ACE-I/ARBs was 2.36 [1.34;4.16], p=0.003 and 2.05 [1.03;4.09], p=0.04 among patients with COVID-19 and respiratory controls, respectively. The corresponding multivariable adjusted HRs were 1.32 [0.68;2.55], p=0.41 and 1.20 [0.58;2.48], p=0.62. Furthermore, we did not observe an increased risk for the outcome when assessing ACE-Is and ARBs separately or other antihypertensive agents, both in COVID-19 patients and respiratory controls (Table). Conclusions: In a Swiss cohort of patients with COVID-19 or non-COVID respiratory controls treatment with ACE-I/ARBs or other antihypertensive medication was not associated with adverse events after accounting for comorbidities and risk factors.

Portable HEPA purifiers to eliminate airborne SARS-CoV-2: A systematic review

Introduction: Current epidemiologic predictions of COVID- 19 suggest SARS-CoV-2 mitigation strategies must be implemented long term. In-office aerosol-generating procedures (AGPs) pose a risk to staff and patients while also necessitating exam room shutdown to allow aerosol decontamination by indwelling ventilation. This review summarizes the current state of knowledge on portable high-efficiency particulate air (HEPA) purifiers' effectiveness in eliminating airborne SARSCoV- 2 from indoor environments. Method: Medline, Embase, Cochrane databases, and the World Health Organization COVID-19 Global literature on coronavirus disease were systematically searched for original English-language published studies on (“HEPA” OR “Purifier” OR “Filter” OR “Cleaner” OR 'Filtration) AND (“COVID” OR “COVID-19” OR “SARS-CoV-2” OR “Coronavirus”) indexed up to January 14, 2021. Additional relevant studies were identified by searching the reference lists of included articles. Two authors (D.T.L. and A.R.S.) independently reviewed abstracts and full-text studies. Results: Ten published studies have evaluated the effectiveness of portable HEPA purifiers in eliminating airborne SARS-CoV-2 using relevantly sized surrogate particles. Nine studies evaluated aerosols and submicron particles similar in size to SARS-CoV-2 virions, while 1 study evaluated particles with diameters up to the submillimeter range. In all studies, portable HEPA purifiers were able to significantly reduce airborne SARS-CoV-2-surrogate particles. The addition of portable HEPA purifiers augmented other decontamination strategies such as ventilation. Conclusion: Experimental studies provide evidence for portable HEPA air purifiers' potential to eliminate airborne SARS-CoV-2 and augment primary decontamination strategies such as ventilation. Based on filtration rates, additional air exchanges provided by portable HEPA purifiers may be calculated and room shutdown times after AGPs potentially reduced.

Dual diagnosis in older drinkers during the COVID-19 pandemic

Purpose: There is a dearth of literature examining the impact of the COVID-19 pandemic on older people with dual diagnosis referred to mental health services. The purpose of this study was to compare dual diagnosis before and after lockdown in people aged between 55 and 74 with alcohol use. Design/methodology/approach: Data were collected for people referred to mental health services using an anonymised database of de-identified records to identify people with both substance use disorder alone, or accompanied by co-existing mental disorders. Findings: In total, 366 older people were assessed with the Alcohol Use Disorders Identification Test (AUDIT), 185 before and 181 after lockdown. People with dual diagnosis were more likely to be referred than those without, after compared to before lockdown (13 and 6%, respectively, p < 0.05). People with any substance use disorder with and without dual diagnosis showed an even greater likelihood of referral after, compared with before, lockdown (61 and 34%, respectively, p < 0.0001). Opioid use more than once a month was more likely to be reported after, compared with before, lockdown (66 and 36%, respectively, p < 0.005). Research limitations/implications: The finding of a higher likelihood of opioid use after compared with before lockdown during the COVID-19 pandemic warrants further exploration. There is also further scope for further studies that involve older non-drinkers. Originality/value: A greater likelihood of both dual diagnosis and substance use disorder alone after, compared with before lockdown has implications for both mental health and addiction service provision during a pandemic. © 2021, Emerald Publishing Limited.