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Introduction: There was an increase in antipsychotic prescribing for people with dementia during the COVID-19 pandemic (1). To explain this increase, the current study was conducted to explore the views of staff working in care homes for the elderly during the pandemic on the use of antipsychotics for residents with Behavioural and Psychological Symptoms of Dementia (BPSD). Aim(s): The aim was to explore the use of antipsychotics for people with BPSD during the COVID-19 pandemic by interviewing staff in care homes about their experiences during that time. Method(s): Semi-structured interviews were conducted online with staff working in ten UK elderly care settings using convenience sampling. Participants mainly onsite care home staff were recruited through online networks, for example, Twitter, and support groups such as CHAIN and NIHR clinical research network. Interviews were conducted between May 2021-March 2022, were audio recorded, transcribed verbatim, and analysed inductively using thematic analysis in NVivo version 12. Result(s): Ten interviews were completed with managers (n=2), care staff (n=6) and nurses (n=2) in nursing homes (n=7) and residential homes (n=3) (all were female). The first theme 'Challenges experienced in care provision' entails challenges experienced in the care environment;residents were confined to their rooms, activities were suspended, staff were absent and stressed, and family visits were barred. The reduced human contact affected residents' sense of self, mental and physical wellbeing, and in turn, their behaviours. The second theme 'Prescribing process' refers to doctors prescribing medicines in response to staff raising concerns. The third theme 'Attitude toward antipsychotics' denotes participants' positive and negative beliefs about antipsychotics. The positive beliefs included antipsychotics being the right choice and beneficial, an increased need and continued use of antipsychotics, use of a combination of medications and weighing the risks and benefits of antipsychotics. The negative beliefs included reports of adverse effects and short-term benefits of antipsychotics, antipsychotics not always beneficial, benefits in deprescribing, dislike for antipsychotics and belief antipsychotics are the last resort. Some expressed the need for antipsychotics had not increased but been driven by health professionals involved. The fourth theme 'Other psychotropic medication' alluded to other commonly used psychotropic medications and associated risks and benefits. The fifth theme 'Measures implemented within care settings' represented strategies implemented to avert the initiation or bolster antipsychotic deprescribing such as non-pharmacological approaches, nurses' assessment of residents before requesting antipsychotics, multidisciplinary consultation, and medication review. Conclusion(s): This is the first study that reports care home staff views on antipsychotic use for residents with dementia during the pandemic. The limitations include that only views of female respondents were obtained and the limited sample size. Care homes faced enormous challenges in the provision of care services to residents with dementia during the pandemic. The multitude of difficulties experienced in care homes due to lack of preparedness may have influenced staff to have positive views of antipsychotics and their use as an option during the pandemic. It's important to acknowledge and address these difficulties for example through education and training interventions to help with future preparedness.
ABSTRACT
Long COVID is a poorly understood condition, with a wide spectrum of effects on multiple body systems and variable presentation in different individuals. Long COVID is of particular concern among older people (ie, aged 65 years or older), who are at greater risk than younger people of persisting symptoms associated with COVID-19. In addition, COVID-19 might trigger or exacerbate chronic conditions that occur commonly in older people, such as cardiovascular diseases, respiratory diseases, neurodegenerative conditions, and functional decline. In addition, the disruptive effects of COVID-19 for older people should not be underestimated;lockdowns and other restrictions might have reduced the social interactions of older people, and they are also likely to have lost a spouse or loved one during the pandemic, which can contribute to mental and physical decline. COVID-19 vaccination appears to reduce the effects of long COVID, and older people, especially those living in aged care facilities, should remain up-to-date with their COVID-19 vaccinations. Health-care staff should also consider long COVID in the differential diagnosis of relevant symptoms in older people, rather than assume increasing frailty, and should pursue early multidisciplinary assessment and management of persisting symptoms. Addressing physical, psychological, and functional sequelae will mitigate the effect of long COVID and improve the health and quality of life of older people.Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ABSTRACT
Background/Purpose: Due to the pandemic of COVID-19 and the need to pay attention to the older adults as one of the most vulnerable groups, this study aimed to determine the effects of educational programs based on the Protection Motivation Theory (PMT) as non-pharmaceutical intervention in promoting protective behaviors against COVID-19 among the older adults in Hamadan. Method(s): The present study was a randomized controlled trial performed in 2021 on 80 older adults visiting retirement centers in Hamadan. Participants were randomly assigned to experimental (n=40) and control groups (n=40). The data collection tool was a researcher-made questionnaire including demographic variables and constructs of PMT which were completed before and two months after the intervention. The intervention consisted of four sessions implemented for the experimental group. The collected data was analyzed in SPSS-16 using Chi-square, Mann-Whitney, and Wilcoxon tests. Result(s): There was no significant difference between the two groups in terms of all demographic variables and theoretical constructs before the educational intervention. After the educational intervention, there was a significant difference in the constructs of perceived severity (P=0.012), perceived response efficiency (P=0.009), perceived self-efficacy (P=0.021), and perceived response cost (P <0.001) after the intervention. No significant changes were reported in the control group (P >0.05). Also, results showed that there was no significant difference in the mean of COVID-19 preventive behaviors between the two groups after the educational intervention (P >0.05). Conclusion(s): The results showed that the use of educational intervention as non-pharmaceutical intervention based on the PMT was an effective approach to perform preventive behaviors against infectious diseases such as COVID-19. Copyright © 2022, Full Universe Integrated Marketing Limited. All rights reserved.
ABSTRACT
Introduction: COVID-19 is a global pandemic causing a major reorganization of health systems and a significant impact on many people's daily activities by lockdown mandates. The aim of our study is to compare the characteristics of the autopsies performed during the complete French lockdown in 2020 to the same period the preceding year. Material and methods: We analysed all the medico-legal autopsies performed in Toulouse and Grenoble, two French forensic institutes from March 17 to May 11 in 2020 (period of the complete French Lockdown) compared to the same period of 2019. The main objective was to evaluate to difference in the number of autopsies performed. The secondary aims were to compare the characteristics of these autopsies: violent death, types of violent death, scene examination report, putrefied body, place of death, age, and sex. Results: In total, 200 medico-legal autopsies were performed in 2019, 95 in 2020 during the reporting period. Weekly number of autopsies was 25 (SD = 6.8) in 2019 and 12.5 (SD = 3.5) in 2020 (P < 0.001). No significant difference was found concerning the secondary aims except for two criteria with very low population (deaths in retirement homes and attacks). Conclusion: Number of autopsies was divided by two during the lockdown compared to the control period year without modification of the other characteristics of the autopsies. These results do not allow evaluating a modification of the cause of death by the lockdown or defining some characteristics of the death appearing to be more important during lockdown.
ABSTRACT
Purpose: Visual impairment has a significant negative impact on quality of life, independence and ability to work. This study quantifies the prevalence of undiagnosed visual impairment detected at pop-up community screening clinics in the Waikato region of New Zealand. Locations were selected to target vulnerable populations including elderly Māori that may not otherwise attend vision assessments elsewhere. Methods: Pop-up screening clinics were completed at two locations: regional marae performing COVID-19 vaccinations and at a local retirement home. Best corrected visual acuity (BCVA) and autorefraction was measured. Individuals were flagged for community follow-up if BCVA was better than 6/12 or hospital follow-up if BCVA was worse than 6/12 bilaterally or 6/15 in either eye. All individuals 40 years or older were invited to participate in the vision screening. Results: In total 64 individuals were screened with 59% females. Ethnicities included Māori (44%), New Zealand-European (34%) and undeclared (22%). Average age was 69.74 years. Based on BCVA, 59% were flagged for community follow-up and 41% for hospital follow-up. Of the 26 referred for hospital follow-up, 69% have been reviewed. Diagnosed pathology included: cataract (55%), age-related macular degeneration (17%), other (17%), and refractive error (11%). Conclusion: This pilot study reports high rates of undiagnosed ocular pathology. Obtaining accurate prevalence data on visual impairment in vulnerable populations is important for developing service delivery models to provide timely treatment for these populations. This pilot highlights barriers to access public funded ophthalmic care for vulnerable populations using the existing models of healthcare delivery.