Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 399
Filter
1.
Nurs Clin North Am ; 57(2): 245-258, 2022 06.
Article in English | MEDLINE | ID: covidwho-1819287

ABSTRACT

This article highlights the critical role of advanced practice registered nurses in the care of older adults living in nursing homes. This population is one of the frailest, marginalized, and often neglected in the United States. The COVID-19 pandemic impact on nursing homes resulted in a stunning number of infections and subsequent resident deaths. This is a shameful reminder of the many challenges and gaps in the nursing home industry including inadequate staffing, high staff turnover, improper isolation technique, and lack of fundamental knowledge of how to adequately implement infection prevention and control processes. Strong advanced practice registered nurse leadership may have mitigated some of these factors.


Subject(s)
COVID-19 , Nurses , Aged , Humans , Leadership , Nursing Homes , Pandemics , United States
2.
Journal of the American Medical Directors Association ; JOUR
Article in English | ScienceDirect | ID: covidwho-2095561

ABSTRACT

Objectives COVID-19 disproportionately affected nursing home residents and people from racial and ethnic minorities in the US. Nursing homes in the Veterans Affairs (VA) system, termed Community Living Centers (CLCs), belong to a national managed care system. In the period prior to the availability of vaccines, we examined whether residents from racial and ethnic minorities experienced disparities in COVID-19 related mortality. Design Retrospective cohort study. Setting and Participants Residents at 134 VA CLCs from April 14 to December 10, 2020 Methods We used the VA’s Corporate Data Warehouse to identify VA CLC residents with a positive SARS-CoV-2 PCR test during or 2 days prior to their admission and without a prior case of COVID-19. We assessed age, self-reported race/ethnicity, frailty, chronic medical conditions, Charlson comorbidity index, the annual quarter of the infection, and all-cause 30-day mortality. We estimated odds ratios (OR) and 95% confidence intervals (CIs) of all-cause 30-day mortality using a mixed-effects multivariable logistic regression model. Results During the study period, 1133 CLC residents had an index positive SARS-CoV-2 test. Mortality at 30 days was 23% for White non-Hispanic residents, 15% for Black non-Hispanic residents, 10% for Hispanic residents, and 16% for other residents. Factors associated with increased 30-day mortality were age ≥70, Charlson comorbidity index ≥6, and a positive SARS-CoV-2 test between April 14 and June 30, 2020. Frailty, Black race, and Hispanic ethnicity were not independently associated with an increased risk of 30-day mortality. Conclusions and Implications Among a national cohort of VA CLC residents with COVID-19, neither Black race nor Hispanic ethnicity had a negative impact on survival. Further research is needed to determine factors within the VA healthcare system that mitigate the influence of systemic racism on COVID-19 outcomes in US nursing homes.

3.
SSRN;
Preprint in English | SSRN | ID: ppcovidwho-346239

ABSTRACT

Do the effects of government policy response to health crises differ for for-profit and not-for-profit organizations? We address this question through the lens of a two-sector continuous-time individual-based mean-field theoretical model that incorporates a non-random social network. Using unique data on nursing home networks in the United States, we calibrate the model and jointly quantify state-level lockdown effectiveness and preference for enforcing stringent containment strategies during the COVID-19 pandemic. We validate our estimated policy measures using external data. Simulations and regression-based analyses show significant interactions between lockdown effectiveness and the ownership status of a nursing home. In particular, differences in COVID-19 death rates between for-profit and not-for-profit nursing homes are driven by lockdown effectiveness.

4.
J Prev Med Hyg ; 63(2): E201-E207, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2081078

ABSTRACT

Introduction: The objective of the analysis is to investigate whether there is a correlation between deaths occurred within nursing homes in Lombardy Region and those related to the whole elderly population residing in the municipalities of their location at the beginning of the COVID-19 pandemic. Methods: The analysis considered a sample of 17 nursing homes belonging to the same legal entity (with a total of 2,197 beds). The changes occurred in the trend of deaths in 2020 between January the 1st and February the 20th, and between February the 21st and April the 4th, compared with the average number of deaths occurred in the same time intervals of the previous three-year period (2017-2019) were investigated. To verify the presence of a correlation between deaths occurring within nursing homes and those related to the whole elderly population residing in the municipalities of their respective locations, Pearson correlation index was calculated, distinguishing between elderly over 65 years of age and elderly over 85 years of age. Results: A statistically significant correlation was identified between the number of deaths among the overall population and the number of deaths among nursing homes residents between February the 21st and April the 20th, while no correlations were identified between January the 1st and February the 20th. Conclusions: The number of deaths occurred in the nursing homes of the sample considered shows similar trends to those of the elderly population of the municipalities in which they are located.


Subject(s)
COVID-19 , Aged , Humans , Italy/epidemiology , Nursing Homes , Pandemics
5.
J Alzheimers Dis ; 89(1): 359-366, 2022.
Article in English | MEDLINE | ID: covidwho-2065414

ABSTRACT

BACKGROUND: Disease modifying treatments (DMTs) currently under development for Alzheimer's disease, have the potential to prevent or postpone institutionalization and more expensive care and might delay institutionalization of persons with dementia. OBJECTIVE: The current study estimates costs of living in a nursing home for persons with dementia in the Netherlands to help inform economic evaluations of future DMTs. METHODS: Data were collected during semi-structured interviews with healthcare professionals and from the financial administration of a healthcare organization with several nursing homes. Personnel costs were calculated using a bottom-up approach by valuing the time estimates. Non-personnel costs were calculated using information from the financial administration of the healthcare organization. RESULTS: Total costs of a person with dementia per 24 hours, including both care staff and other healthcare providers, were € 151 for small-scale living wards and € 147 for independent living wards. Non-personnel costs were € 37 per day. CONCLUSION: This study provides Dutch estimates for total healthcare costs per day for institutionalized persons with dementia. These cost estimates can be used in cost-effectiveness analyses for future DMTs in dementia.


Subject(s)
Dementia , Dementia/epidemiology , Dementia/therapy , Health Care Costs , Humans , Institutionalization , Netherlands/epidemiology , Nursing Homes
6.
J Clin Med ; 11(19)2022 Oct 06.
Article in English | MEDLINE | ID: covidwho-2066200

ABSTRACT

The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. OBJECTIVES: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. METHODOLOGY: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann-Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. RESULTS: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. CONCLUSIONS: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making.

7.
J Am Med Dir Assoc ; 2022 Oct 06.
Article in English | MEDLINE | ID: covidwho-2061437

ABSTRACT

Despite important advances in the linkage of residents' Medicare claims and Minimum Data Set (MDS) information, the data infrastructure for long-term care remains inadequate for public health surveillance and clinical research. It is widely known that the evidence base supporting treatment decisions for older nursing home residents is scant as residents are systematically excluded from clinical trials. Electronic health records (EHRs) hold the promise to improve this population's representation in clinical research, especially with the more timely and detailed clinical information available in EHRs that are lacking in claims and MDS. The COVID-19 pandemic shined a spotlight on the data gap in nursing homes. To address this need, the National Institute on Aging funded the Long-Term Care (LTC) Data Cooperative, a collaboration among providers and stakeholders in academia, government, and the private sector. The LTC Data Cooperative assembles residents' EHRs from major specialty vendors and facilitates linkage of these data with Medicare claims to create a comprehensive, longitudinal patient record. These data serve 4 key purposes: (1) health care operations and population health analytics; (2) public health surveillance; (3) observational, comparative effectiveness research; and (4) clinical research studies, including provider and patient recruitment into Phase 3 and Phase 4 randomized trials. Federally funded researchers wanting to conduct pragmatic trials can now enroll their partnering sites in this Cooperative to more easily access the clinical data needed to close the evidence gaps in LTC. Linkage to Medicare data facilitates tracking patients' long-term outcomes after being discharged back to the community. As of August 2022, nearly 1000 nursing homes have joined, feedback reports to facilities are being piloted, algorithms for identifying infections are being tested, and proposals for use of the data have been reviewed and approved. This emerging EHR system is a substantial innovation in the richness and timeliness of the data infrastructure of the nursing home population.

8.
Clin Infect Dis ; 75(Supplement_2): S225-S230, 2022 Oct 03.
Article in English | MEDLINE | ID: covidwho-2051350

ABSTRACT

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Omicron variant has been hypothesized to exhibit faster clearance (time from peak viral concentration to clearance of acute infection), decreased sensitivity of antigen tests, and increased immune escape (the ability of the variant to evade immunity conferred by past infection or vaccination) compared to prior variants. These factors necessitate reevaluation of prevention and control strategies, particularly in high-risk, congregate settings like nursing homes that have been heavily impacted by other coronavirus disease 2019 (COVID-19) variants. We used a simple model representing individual-level viral shedding dynamics to estimate the optimal strategy for testing nursing home healthcare personnel and quantify potential reduction in transmission of COVID-19. This provides a framework for prospectively evaluating testing strategies in emerging variant scenarios when data are limited. We find that case-initiated testing prevents 38% of transmission within a facility if implemented within a day of an index case testing positive, and screening testing strategies could prevent 30% to 78% of transmission within a facility if implemented daily, depending on test sensitivity.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/diagnosis , Delivery of Health Care , Humans , Nursing Homes
9.
Medecine Palliative ; 2022.
Article in English, French | Scopus | ID: covidwho-2049653

ABSTRACT

With the arrival of the coronavirus disease 2019 (covid-19) pandemic, the French society has been deeply shaken in its overall functioning. The proliferation of patients and the increased demand for care, particularly in hospitals and intensive care units, have particularly disrupted the health and social functioning of French society. In this particular context of crisis, the latter played the role of “social analyzer” in the sense given to it by sociologists, that is to say, it shed new light on the social practices instituted normally. We have chosen for this article to examine the way in which a particular category of people “the elderly” had been treated on three registers which appeared to us to be emblematic of the social treatment of these “elderly people” during the covid-19 crisis. First there was the reactivation of what some have called “the struggle of ages” or even the war of generations. Then, this crisis has particularly highlighted the situation of elderly people residing in nursing homes: their increased mortality, their problematic confinement and their priority vaccination. Finally, this crisis raised the question of the relevance of setting up specific confinement according to age. Our conclusion is that crises are conducive to simplistic explanations and the search for scapegoats, but that they are also a formidable indicator of social dysfunctions that predate the crisis. In this sense, the crisis has brought to light an obvious fact in French society of the primacy of “life course inequalities” as a major vector of social exclusion. © 2022 Elsevier Masson SAS Avec l'arrivée de la pandémie de coronavirus disease 2019 (covid-19), la société française a été profondément ébranlée dans son fonctionnement global. La multiplication des malades et l'augmentation de la demandes de soins notamment hospitaliers et en services de réanimation ont particulièrement perturbé le fonctionnement sanitaire et social de la société française. Dans ce contexte particulier de crise, cette dernière a joué le rôle d’ « analyseur social » au sens que lui donnent les sociologues, c'est-à-dire qu'elle a été porteuse d'un éclairage nouveau sur les pratiques sociales instituées en temps normal. Nous avons choisi pour cet article d'examiner la façon dont avait été traitée une catégorie particulière de personnes « les personnes âgées » et ce sur trois registres qui nous sont apparus emblématiques du traitement social de ces « personnes âgées » pendant la crise covid-19. D'abord il y a eu la réactivation de ce que d'aucuns ont appelé « la lutte des âges » ou encore la guerre des générations. Ensuite cette crise a particulièrement mis en lumière la situation des personnes âgées résidant en EHPAD : leur mortalité accrue, leur confinement problématique et leur vaccination prioritaire. Enfin cette crise a posé la question de la pertinence d'une mise en place d'un confinement spécifique en fonction de l’âge. Notre conclusion est que les crises sont propices aux explications simplistes et à la recherche de boucs émissaires, mais qu'elles sont aussi un formidable révélateur des dysfonctionnements sociaux antérieurs à la crise. En ce sens la crise a remis en lumière une évidence, dans la société française, la primauté des « inégalités de parcours de vie » comme vecteur majeur de l'exclusion sociale. © 2022 Elsevier Masson SAS

10.
Aten Primaria ; 54(10): 102463, 2022 10.
Article in English | MEDLINE | ID: covidwho-2048911

ABSTRACT

OBJECTIVE: The aim of this paper was to analyse the association of demographic, clinical and pharmacological risk factors with the presence of SARS-COV-2 virus infection, as well as to know the variables related to mortality from COVID-19 in nursing home (NH) residents. DESIGN: Retrospective case-control study. The study variables of those residents who acquired the infection (case) were compared with those of the residents who did not acquire it (control). A subgroup analysis was carried out to study those variables related to mortality. SITE: Nursing homes in the region of Guipúzcoa (Spain). PARTICIPANTS AND INTERVENTIONS: 4 NHs with outbreaks of SARS-CoV-2 between March and December 2020 participated in the study. The infectivity and, secondary, mortality was studied, as well as demographic, clinical and pharmacological variables associated with them. Data were collected from the computerised clinical records. MAIN MEASUREMENTS: Infection and mortality rate. Risk factors associated with infection and mortality. RESULTS: 436 residents were studied (median age 87 years (IQR 11)), 173 acquired SARS-CoV-2 (39.7%). People with dementia and Global Deterioration Scale ≥6 were less likely to be infected by SARS-CoV-2 virus [OR=0.65 (95% CI 0.43-0.97; p<.05)]. Overall case fatality rate was 10.3% (a mortality of 26% among those who acquired the infection). COVID-19 mortality was significantly associated with a Global Deterioration Scale ≥6 (OR=4.9 (95% CI 1.5-16.1)), COPD diagnosis (OR=7.8 (95% CI 1.9-31.3)) and antipsychotic use (OR=3.1 (95% CI 1.0-9.0)). CONCLUSIONS: Advanced dementia has been associated with less risk of SARS-CoV-2 infection but higher risk of COVID-19 mortality. COPD and chronic use of antipsychotics have also been associated with mortality. These results highlight the importance of determining the stage of diseases such as dementia as well as maintaining some caution in the use of some drugs such as antipsychotics.


Subject(s)
Antipsychotic Agents , COVID-19 , Dementia , Pulmonary Disease, Chronic Obstructive , Aged, 80 and over , Case-Control Studies , Dementia/epidemiology , Humans , Nursing Homes , Retrospective Studies , Risk Factors , SARS-CoV-2
11.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(11-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-2046490

ABSTRACT

The research project utilized an explorative, descriptive method that required the administration of a Pre-COVID Employee Wellness Questionnaire, a Present Employee Wellness Questionnaire to assess the health care workers feelings before and during the COVID-19 pandemic. At the same time, the Administration Questionnaire measured each facility's challenges from a financial, work environment, and staffing perspective. The use of the Patient Health Questionnaire Depression Scale (PHQ8), the Insomnia Severity Index (ISI), and the Generalize Anxiety Disorder Screener (GAD-7) assessed symptoms of depression, insomnia, and anxiety in health care workers that have treated COVID-19 patients in a nursing home settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

12.
Generations ; 46(1), 2022.
Article in English | Scopus | ID: covidwho-2045891

ABSTRACT

This article examines how elder care providers across the world handled the COVID-19 vaccine rollout. Its focus is on residential settings - nursing homes, group homes, and assisted living residences - though it also has information from providers on the experience of community-dwelling elders who receive home- and community-based care. The article shares challenges and opportunities faced by providers in 12 countries when rolling out COVID-19 vaccines, focused on acceptance, type, and uptake percentage among providers. It also shares lessons learned and suggested action items to achieve high levels of vaccine uptake. © 2022 American Society on Aging. All rights reserved.

13.
Int J Environ Res Public Health ; 19(19)2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2043729

ABSTRACT

During the first COVID-19 pandemic wave in Spain, 50% of deaths occurred in nursing homes, making it necessary for some hospitals to support these facilities with the care of infected patients. This study compares origin, characteristics, and mortality of patients admitted with COVID-19 during six pandemic waves in the Hospital Central de la Cruz Roja in Madrid. It is a retrospective observational study of patients ≥80 years old, admitted with an acute SARS-CoV-2 infection, with a total of 546 patients included, whose final outcome was death or discharge. During the first wave, those from nursing homes had a higher risk of death than those from home; during the two successive waves, the risk was higher for those from home; and in the last two waves, the risk equalized and decreased exponentially in both groups. Men had 72% higher risk of death than women. For each year of age, the risk increased by 4% (p = 0.036). For each Charlson index point, the risk increased by 14% (p = 0.019). Individuals in nursing homes, despite being older with higher comorbidity, did not show a higher overall lethality. The mortality decreased progressively in each successive wave due to high vaccination rates and COVID-19 control measures in this population.


Subject(s)
COVID-19 , Pandemics , Aged, 80 and over , COVID-19/epidemiology , Female , Hospitalization , Humans , Male , Nursing Homes , SARS-CoV-2
14.
Risk Manag Healthc Policy ; 15: 1795-1808, 2022.
Article in English | MEDLINE | ID: covidwho-2043255

ABSTRACT

Purpose: To identify interventions implemented during the first, second and third waves of the Coronavirus disease 2019 (COVID-19) among Italian Nursing Homes (NHs). Patients and Methods: A descriptive qualitative design according to COnsolidated criteria for REporting Qualitative (COREQ) guideline. A purposeful sample of five public NHs, located in the north-east of Italy, equipped with from 60 to 151 beds, participated. Six nurse managers, four clinical nurses and one NH director were interviewed in depth at the end of 2021. These interviews were audio-recorded and then transcribed verbatim. A qualitative content analysis was performed to identify effective interventions as perceived by participants to protect facilities and residents from the pandemic. Results: Three main sets of interventions have been applied, at the environmental, nurse staff and at the resident levels. Some have been enacted in all facilities, others in a few but in a homogeneous fashion, while other interventions have been implemented in some NHs also in contrast with available national or local recommendations. Conclusion: Despite their documented frailty and precarious system, NHs implemented several interventions to protect their residents from the COVID-19. All interventions have been designed and implemented during the event, suggesting the need to increase the NHs' preparedness to face future disasters. Regarding those interventions enacted in contrast to the recommendations or not homogeneously across NHs, future investigations are suggested to assess their actual effectiveness and accumulate evidence for the future.

15.
Jpn J Nurs Sci ; : e12510, 2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2038066

ABSTRACT

AIM: To describe the experience of relatives of residents with dementia residing in locked-down nursing homes during the first outbreak of the COVID-19 pandemic, concerning their relationships with nurses and the nursing care applied. METHODS: A qualitative descriptive study was carried out and purposive sampling was applied. Participants were first- and second-degree relatives of residents with dementia, who lived permanently in a nursing home and who were admitted prior to the COVID-19 pandemic. Sixteen participants, of which 10 were women (mean age 57.1 years), participated in the study. Data were collected through in-depth interviews and reflective notes, using a digital platform. An inductive thematic analysis was carried out. This study was approved by the University Research Ethics Committee and followed the COREQ guidelines. The Guba and Lincoln criteria (credibility, transferability, dependability, and confirmability) were applied for quality control. RESULTS: Families' relationships with nurses before the first wave relied on closeness and involvement in care. Families had difficulty maintaining a close relationship with nurses due to turnover and lack of time. The nursing care applied in the first wave resulted in limited family access to the nursing home, limited contact time with residents, and limited close physical contact. CONCLUSIONS: The first outbreak has affected the relationships among relatives and nurses in nursing homes. Changes should be made in the organization of care within nursing homes in order to adapt to restrictions due to the pandemic.

16.
Am J Infect Control ; 50(10): 1110-1117, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2035669

ABSTRACT

BACKGROUND: The Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive--conducted prior to identified cases--or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps. METHODS: Data from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type. RESULTS: DSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009). CONCLUSIONS: Increased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.


Subject(s)
COVID-19 , Disinfectants , Hand Sanitizers , COVID-19/prevention & control , Humans , Infection Control , Iron-Dextran Complex , Long-Term Care , Nursing Homes , Pandemics/prevention & control , SARS-CoV-2 , Skilled Nursing Facilities , Soaps , Texas/epidemiology , Water
17.
Aging Clin Exp Res ; 34(10): 2577-2584, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2035473

ABSTRACT

BACKGROUND: Nursing home (NH) residents suffered the greatest impact of the COVID-19 pandemic. Limited data are available on vaccine-induced immunity and on the protection ensured by a prior infection in this population. AIMS: The present study aims to monitor antibody levels and their persistence over a 6-month period in NH residents according to the history of prior SARS-CoV-2 infection. METHODS: We measured anti-trimeric Spike IgG antibody levels in a sample of 395 residents from 25 NHs in 6 Italian Regions at study enrolment (prior to the first dose of vaccine, T0) and then after 2 (T1) and 6 months (T2) following the first vaccine dose. All participants received mRNA vaccines (BNT162b2 or mRNA-1273). Analyses were performed using log-transformed values of antibody concentrations and geometric means (GM) were calculated. RESULTS: Superior humoral immunity was induced in NH residents with previous SARS-CoV-2 infection. (T0: GM 186.6 vs. 6.1 BAU/ml, p < 0.001; T1: GM 5264.1 vs. 944.4 BAU/ml, p < 0.001; T2: GM 1473.6 vs. 128.7 BAU/ml, p < 0.001). Residents with prior SARS-CoV-2 infection receiving two vaccine doses presented significantly higher antibody concentration at T1 and T2. A longer interval between previous infection and vaccination was associated with a better antibody response over time. DISCUSSION: In a frail sample of NH residents, prior SARS-CoV-2 infection was associated with a higher humoral response to vaccination. Number of vaccine doses and the interval between infection and vaccination are relevant parameters in determining humoral immunity. CONCLUSIONS: These findings provide important information to plan future immunization policies and disease prevention strategies in a highly vulnerable population.


Subject(s)
COVID-19 , Viral Vaccines , Humans , COVID-19 Vaccines , Immunity, Humoral , SARS-CoV-2 , COVID-19/prevention & control , RNA, Messenger , BNT162 Vaccine , Pandemics , Nursing Homes
18.
Tijdschrift voor Gerontologie en Geriatrie ; 53(2), 2022.
Article in Dutch | Scopus | ID: covidwho-2026685

ABSTRACT

The measures taken in Dutch nursing homes during the first wave of the COVID-19 pandemic resulted in both an increase and a decrease of challenging behavior in nursing home residents. Staff undertook various initiatives to reduce the negative effects. For example, video calling between residents and their relatives was facilitated. In addition, initiatives in digital care (telehealth) were deployed. The aim of this study was to explore nursing home practitioners’ experiences with online communication between residents and relatives, working remotely in general and the remote treatment of challenging behavior in particular. One hundred and seventy-five nursing home professionals (psychologists, elderly care specialists, nursing specialists, daytime activities coordinators) completed an online questionnaire at the end of 2020/start of 2021. Open and closed questions showed that face-to-face contacts are preferred over online communication. Online communication was mainly seen as a (meaningful) addition. Although professionals wanted to continue some of their work remotely, and found this efficient and workload-reducing, they felt that this could impair their job satisfaction and the quality of care. For remote work and remote treatment, each task needs to be evaluated on whether it can be performed properly and whether that results in good care. More research into online communication, remote working and digital care in nursing homes is needed. © 2022, Vilans. All rights reserved.

19.
Telehealth and Medicine Today ; 6(1), 2021.
Article in English | ProQuest Central | ID: covidwho-2026462

ABSTRACT

Background: During the COVID-19 pandemic, measures were taken to decrease viral spread by transitioning health care appointments to virtual mediums. This study evaluates the use of telemedicine within the Divisions of Colon and Rectal Surgery and Otolaryngology-Neurotology at a single academic institution during the COVID-19 pandemic. Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) was administered to gauge patient’s experience with Electronic Medical Record-based telemedicine visits. Results: Participants noticed several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. A total of 36% at least somewhat agreed that the quality of care was hindered by the lack of a physical examination;61.7% participants at least somewhat agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7) and 95.8% would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort with the in-office control, the telemedicine patients noticed an improved ability to communicate with their physician in five out of eight domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth can provide satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

20.
JMIR Aging ; 5(3): e37482, 2022 Aug 23.
Article in English | MEDLINE | ID: covidwho-2022370

ABSTRACT

BACKGROUND: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. OBJECTIVE: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. METHODS: NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. RESULTS: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. CONCLUSIONS: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.

SELECTION OF CITATIONS
SEARCH DETAIL