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1.
BMJ Supportive and Palliative Care ; 11:A53-A54, 2021.
Article in English | EMBASE | ID: covidwho-2032500

ABSTRACT

Background Nottinghamshire Hospice's day therapy unit closed its doors to patients during the COVID-19 pandemic. Government advice was supporting discharge from hospital wherever possible (NHS England and NHS Improvement, 2020). When asked, more than four in five people say they would prefer to die at home (Hoare, Morris, Kelly, et al., 2015). Patients receiving care from specialist palliative care teams tend to do better than those without (Higginson & Evans, 2010). Aims To expedite the discharge of patients at end-of-life from hospital and prevent unnecessary hospital admission for those in the community so that more people achieve their preferred place of death (PPD) with the provision of a dedicated palliative care service. Methods March-May 2020: consultations with fast track continuing care (FTCC), model planning, internal consultation, workforce transformation. May-July 2020: recruitment, service launch. July-March 2021: continuous service provision. We worked closely alongside FTCC to support patients either in hospital that wished to come home but needed a package of care or, patients that were deteriorating at home and required end-of-life care. An initial assessment by a registered nurse from the Hospice Outreach Discharge Support (HODS) team meant more timely referral into extended palliative community services including provision of specialist equipment and access to other hospice services e.g. bereavement support. It also focuses on the completion of EPaCCS and ReSPECT forms identifying PPD. Results Number of patients treated by HODS May 20 - March 21 = 195. 64% (124) died at home. 23% (44) remained well enough to be discharged to domiciliary care agency. 10% (20) admitted to hospital. 3% (6) admitted to nursing home. Average length of stay on HODS = 10 days PPD achieved = 95.87% [4] Conclusion The creation of HODS allows more people at end-of-life to remain in their PPD and with greater access to support services preventing carer burnout and unnecessary admission to hospital.

2.
Am J Infect Control ; 2022.
Article in English | ScienceDirect | ID: covidwho-2031084

ABSTRACT

BACKGROUND: Outbreaks of coronavirus disease 2019 (COVID-19) in long-term care facilities are difficult to control and are associated with mortality, although vaccination have contributed to improvements. This study reports clinical impacts of a COVID-19 outbreak in a nursing home for elderly individuals in Kyoto City, Japan. METHODS: We performed epidemiologic and molecular investigations of the outbreak and characterized outcomes of the nursing home residents. RESULTS: During the outbreak period, a total of 31 residents (39.2%) and 26 staff members (49.1%) were infected with COVID-19. All residents and staff received two doses of a vaccine approximately 7 months prior. Only four residents were admitted to hospitals, and 10 residents with severe hypoxemia could not be transferred to a hospital due to a shortage of beds for COVID-19 patients. Within 90 days of the onset of the outbreak, 8 residents with COVID-19 (25.8%) and 3 uninfected residents (6.2%) died. A total of 48.4% of residents with COVID-19 and 8.3% of uninfected residents developed one or more comorbidities. Viral genome analysis showed that the outbreak was caused by the Omicron BA.1.1.2 variant. CONCLUSIONS: Despite vaccination, high mortality and morbidity were observed in the COVID-19 outbreak due to the Omicron variant. Limiting medical care for residents with COVID-19 in facilities that experience ongoing outbreaks may be needed to reduce the risk of mortality among nursing home residents.

3.
The journal of nutrition, health & aging ; 2022.
Article in English | Web of Science | ID: covidwho-2031044

ABSTRACT

Objectives Among patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia. Design and Setting This case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls. Results 132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039);prior fall (OR=2.08, p=0.012);malnutrition (OR=1.97, p=0.018);length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049). Conclusion COVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population.

4.
Healthcare ; 10(8):1544, 2022.
Article in English | ProQuest Central | ID: covidwho-2023400

ABSTRACT

Delirium is an important component of the geriatric syndromes and has been recognized to negatively influence the prognosis of older people in hospital and in a post-acute setting. About 2–5% of older people world-wide live in nursing homes and are characterized by functional impairment, cognitive decline, dementia, comorbidities, and polypharmacotherapy, all factors which influence the development of delirium. However, in this setting, delirium remains often understudied. Therefore, in this narrative review, we aimed to describe the latest evidence regarding delirium screening tools, epidemiology characteristics, outcomes, risk factors, and preventions strategies in nursing homes.

5.
Journal of the American Geriatrics Society ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-2019449

ABSTRACT

Background Methods Results Conclusions Care aides (certified nursing assistants, personal support workers) are the largest workforce in long‐term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well‐being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID‐19 on care aides working in LTC homes during the first year of the pandemic.We conducted semi‐structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis.Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full‐time in LTC homes, and 37% worked multiple positions before “one worksite policies” were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID‐19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes.These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID‐19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well‐being and adequately resource this workforce. We recommend improved policy guidelines and interventions. [ FROM AUTHOR] Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

6.
Oncology Times ; 44(16):15-15, 2022.
Article in English | CINAHL | ID: covidwho-2018115
7.
Journal of Advanced Nursing ; 78(8):2495-2506, 2022.
Article in English | APA PsycInfo | ID: covidwho-2011569

ABSTRACT

The objective of this study was to assess burdens placed on and consequences of the COVID-19 pandemic on nursing home staff. Design: We conducted a qualitative descriptive interview study. Methods: We interviewed 18 nurses, nursing aides and care aides from five different nursing homes by using a semi-structured interview guideline between June and September 2020. Data were analysed with a qualitative content analysis method by combining an inductive and deductive coding frame. Results: Results show that the qualitative work load and work organization were major concerns. Regarding the qualitative work load, participants stated that they were required to perform additional tasks to care for residents, because the pandemic interventions placed the residents under stress and dealing with relatives presented significant challenges. Nursing home staff reported that psychological consequences such as uncertainty, fear and stress represented major effects of the COVID-19 situation. Conclusion: We could show that qualitative workloads were assessed and perceived differently. Most nursing home care staff members experienced the changes in working conditions as both physically and psychologically challenging. Impact: We highly recommend that nursing home staff receive support in such pandemics by being allowed, for example personal protective equipment breaks. Individually tailored programs need to be established to enhance wellbeing and decrease psychological stress and fear in such challenging times. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009540

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in delayed medical care that may have led to increased death rates in 2020 among people with medical conditions such as cancer. This study examined changes in cancer-related mortality between 2019 and 2020. Methods: We used the US 2019-2020 Multiple Cause of Death database from the CDC WONDER to identify cancer-related deaths, defined as decedents with invasive or noninvasive cancer as a contributing cause of death (ICD-10 codes: C00-C97 and D00-D09). We compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020 (pandemic) versus January-December 2019 (pre-pandemic) overall and stratified by rurality and place of death. We calculated the 2020 excess death by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rate from 2015 to 2019. Results: The number of cancer-related deaths was 686 054 in 2020, up from 664 888 in 2019, with an annual increase of 3.2%. Compared to the number of projected deaths for 2020 (666 286), the number of cancer-related excess deaths was 19 768 in 2020. Annual age-standardized cancer-related mortality rate (per 100,000 person-years) continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020 (2020 vs 2019 rate ratio (RR): 1.013, 95% confidence interval (CI): 1.009 - 1.016). The cancer-related monthly mortality rate was higher in April 2020 (RR: 1.032, 95% CI: 1.020 - 1.044) when healthcare capacity was most challenged by the pandemic, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019. In large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020, coinciding with the time-spatial pattern of COVID-19 incidence in the country. Compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in decedent's homes. Conclusions: The COVID-19 pandemic led to significant increases in cancer-related deaths in 2020 versus 2019. Ongoing evaluation of the spatialtemporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.

9.
Clin Nurs Res ; : 10547738221121028, 2022.
Article in English | PMC | ID: covidwho-2009289

ABSTRACT

Nursing home residents comprise a disproportionate share of coronavirus-related deaths in the United States. Additionally, lockdown restrictions disrupted residents' relationships with their family members to an unknown extent. This study explored family members' perceived family role and interactions with nursing home residents and staff during the COVID-19 pandemic. Using a qualitative descriptive approach, 10 family members were interviewed using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, and data were analyzed using Braun and Clarke's Reflexive Thematic analysis. Themes and subthemes indicated that family members accounted for residents' care in new ways, found existing relationships becoming amplified under stress, maintained connections through creative alternatives, and also felt powerless to provide care, despite their knowledge and experience. Family members increasingly relied on staff to meet residents' care needs and provide updates, and often desired to provide assistance and companionship beyond what policy permitted, representing a major opportunity for improving experiences.

10.
International Journal of Health Governance ; 26(4):446-453, 2021.
Article in English | EMBASE | ID: covidwho-1577427

ABSTRACT

Using historic institutionalism to evaluate healthcare governance in Vietnam and the Philippines during COVID-19

11.
The Lancet Infectious Diseases ; 22(9):1291, 2022.
Article in English | EMBASE | ID: covidwho-2008210
12.
Journal of Public Health in Africa ; 13:36-37, 2022.
Article in English | EMBASE | ID: covidwho-2006779

ABSTRACT

Introduction/ Background: Long-term care facilities (LTCFs) experienced a large burden of SARS-CoV-2 due the COVID-19 pandemic. The purpose of this study was to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff testing positive for SARS-CoV-2 in LTCFs across South Africa. Methods: We implemented a retrospective cohort analysis of SARS-CoV-2 positive cases in LTCFs across South Africa from 5 March 2020- 31 July 2021. We analysed 45 LTCFs from the DATCOV sentinel surveillance system in South Africa. Outbreaks in LTCFs were defined as large if more than one third of residents and staff had been infected or there were more than 20 cases that were epidemiologically linked. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents. Results: Total of 2,324 SARS-CoV-2 cases were reported;1,504 (65%) were residents and 820 (35%) staff. Ten (26%) reported one outbreak and 29 (74%) reported more than one outbreak, while 15 (38%) reported small outbreaks and 24 (62%) large outbreaks. There were 1,259 cases during the first COVID-19 wave, 362 during wave two, and 299 during wave three. Among residents, 9% died and among staff 0.5% died. Factors associated with mortality among residents were age 40-59 years, 60-79 years and ≥80 years compared to <40 years. Compared to pre-wave 1, there was a lower risk of mortality across waves. Impact: There is currently very little literature on the impact of COVID-19 in LTCFs in low- and middle-income countries (LMIC). This study will impact by adding knowledge to SARS-CoV-2 in LTCFs in a LMIC. Conclusion: Sentinel LTCFs in South Africa shows an encouraging trend of decreasing numbers of outbreaks, cases, and risk for mortality since the first wave. LTCFs have likely learnt from international experience and adopted national protocols, including improved measures to limit transmission and early and appropriate clinical care.

13.
Journal of the American Medical Directors Association ; 2022.
Article in English | ScienceDirect | ID: covidwho-2004189

ABSTRACT

Objectives In the first months of 2021 the Dutch COVID-19 vaccination campaign was disturbed by reports of death in Norwegian nursing homes (NHs) after vaccination. Reports predominantly concerned persons >65 years of age with one or more comorbidities. Also in the Netherlands adverse events were reported after COVID-19 vaccination in this vulnerable group. Yet, it was unclear whether a causal link between vaccination and death existed. Therefore, we investigated the risk of death after COVID-19 vaccination in Dutch NH residents compared with the risk of death in NH residents prior to the COVID-pandemic. Design Population-based longitudinal cohort study with electronic health record data. Setting and Participants We studied Dutch NH residents from 73 NHs who received one or two COVID-19 vaccination(s) between January 13 and April 16, 2021 (n=21.762). As historical comparison group we included Dutch NH residents who were registered in the same period in 2019 (n=27.591). Methods Data on vaccination status, age, gender, type of care, comorbidities, and date of NH entry and (if applicable) discharge or date of death were extracted from electronic health records. Risk of death after 30 days was evaluated and compared between vaccinated residents and historical comparison subjects with Kaplan-Meier and Cox regression analyses. Regression analyses were adjusted for age, gender, comorbidities and length of stay. Results Risk of death in NH residents after one COVID-19 vaccination (regardless of whether a second vaccination was given) was decreased compared to historical comparison subjects from 2019 (adjusted HR 0.77 (95%CI 0.69-0.86)). The risk of death further decreased after two vaccinations compared with the historical comparison group (adjusted HR 0.57 (0.50-0.64)). Conclusions and Implications We found no indication that risk of death in NH residents is increased after COVID-19 vaccination. These results indicate that COVID-19 vaccination in NH residents is safe, and could reduce fear and resistance towards vaccination.

14.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003117

ABSTRACT

Background: Children are frequently victims of disasters, however significant gaps remain in pediatric disaster preparedness planning. There is a significant gap in resources for disaster planning for pediatric residents in long-term care facilities. The New York City (NYC) Pediatric Disaster Coalition (PDC) is funded by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) to improve NYC's pediatric disaster preparedness and response. After creating resources for disaster planning in pediatric hospital departments, pediatric and neonatal intensive care units, obstetric/newborn services within NYC hospitals and outpatient and urgent care centers, the NYC PDC partnered with leaders and experts in pediatric disaster management and the care of pediatric residents in longterm care facilities and created the Pediatric Long-Term Care Planning Committee (PLTCPC). Methods: The PLTCPC included physicians, nurses, administrators and emergency planning experts who have had experience working in long-term care settings. The PLTCPC's goal was to create guidelines and templates for use in disaster planning for pediatric residents at long term care facilities. The committee met bi-weekly over 3 months and shared facility plans to create tools that meet the specific pediatric challenges presented by this population. Results: Utilizing an iterative process that included a literature review, participant presentations and discussions, review and improvement of the working documents, the final guidelines and templates for surge and evacuation of pediatric residents in long-term care facilities were created. Due to the onset of the COVID-19 pandemic the NYC PDC reconvened the PLTCPC to focus on surge planning for pandemics at pediatric long-term care facilities. Two pediatric infectious disease clinicians were added to the committee to contribute their subject matter expertise (SME). Utilizing the same process delineated above, a detailed pandemic specific annex was created to the existing plans based on clinical pediatric experience gained throughout the COVID-19 pandemic. Conclusion: To our knowledge these are the first pediatric specific resources for long term care disaster planning. They address the importance of matching available resources to the unique needs of PLTC facilities in regard to space, equipment, staffing and training. Pediatric long term care facilities present special needs during pandemics and this approach can be utilized as a model for other facilities nationwide.

16.
Journal of General Internal Medicine ; 37:S600-S601, 2022.
Article in English | EMBASE | ID: covidwho-1995851

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: When hospitals and skilled nursing facilities (SNF) were impacted during the COVID surge, what healthcare delivery model can be used to increase hospital bed capacity while maintaining quality care for marginalized patients with no access to a SNF? DESCRIPTION OF PROGRAM/INTERVENTION: Background - Santa Clara Valley Medical Center is the second largest public safety net healthcare system in California. During the COVID surge, our hospitals experienced a significant demand for hospital beds. At this time, SNFs were impacted and did not accept patients with barriers in discharge planning. Problem: How to safely discharge non-acute patients with no accepting SNF to increase hospital bed capacity. Intervention: Develop a post-acute care team (PACT) for marginalized, non-acute patients. These patients were initially hospitalized for severe medical conditions but could not be safely discharged once stabilized. During the COVID surge, Santa Clara County operationalized a 36-bed, lowacuity hospital called DePaul Health Center (DPHC) through an emergency state-issued alternative care license. DPHC implemented a novel healthcare model for post-acute transitions of vulnerable, non-acute patients during a resource-constrained time period. Of the 131 admissions to DPHC, 42% had unstable housing, 29% had active substance use, and 100% had no accepting SNFs. The operationalization involved: - Training volunteer outpatient providers to work in an inpatient setting with COVID-positive patients. - Building a referral model to include all hospitals in our county. - Transition of care services including: direct transition to drug treatment programs, linkage to medical respites, COVID vaccinations, specialty care followup, and medication delivery/teaching at bedside. MEASURES OF SUCCESS: - Number of hospital bed days saved. - Number of additional potential hospital admissions. - Implementation of high-quality inpatient services for non-acute patients. FINDINGS TO DATE: Over six months, DPHC admitted 127 patients across three county hospitals. DPHC allowed for a potential 446 additional hospital admissions (based on 2232 potential bed days saved and an average hospital LOS of 5 days per hospital admission). KEY LESSONS FOR DISSEMINATION: - Establishing a post-acute care team addresses structural inequities prevalent in our healthcare system for marginalized patients. - Incorporating a post-acute care team improves access to SNF for marginalized patients.

17.
Int J Older People Nurs ; : e12498, 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1992882

ABSTRACT

BACKGROUND: NHs have been severely exposed during the COVID-19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID-19 pandemic. METHODS: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis. RESULTS: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work. CONCLUSION AND IMPLICATION FOR PRACTICE: During the first wave of the COVID-19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs.

18.
Influenza Other Respir Viruses ; 2022 Aug 12.
Article in English | MEDLINE | ID: covidwho-1992829

ABSTRACT

BACKGROUND: Infection control during COVID-19 outbreaks in nursing facilities is a critical public health issue. Antibody responses before and after the third (booster) dose of SARS-CoV-2 vaccination in nursing home residents have not been fully characterized. METHODS: This study included 117 individuals: 54 nursing home residents (mean age, 83.8 years; 39 SARS-CoV-2-naive and 15 previously infected) and 63 healthcare workers (mean age, 45.8 years; 32 SARS-CoV-2-naive and 31 previously infected). Anti-spike (receptor-binding domain [RBD]) and anti-nucleocapsid antibody responses to BNT162b2 mRNA vaccination and their related factors were evaluated using pre- (shortly and 6 months after the second dose) and post-booster vaccination samples. RESULTS: The median anti-spike (RBD) IgG level in SARS-CoV-2-naive residents 6 months after the second dose was the lowest among the four groups, with a decreasing rate of over 90%. The median rate of increase before and after the third dose in SARS-CoV-2-naive residents was significantly higher than that in SARS-CoV-2-naive healthcare workers (64.1- vs. 37.0-fold, P = 0.003), with the highest level among the groups. The IgG ratio of SARS-CoV-2-naive residents to healthcare workers after the second and third doses changed from one-fifth (20%) to one-half (50%). The rate of increase after the third dose in previously infected individuals was three- to fourfold, regardless of residents or healthcare workers. CONCLUSIONS: Advanced aged nursing home residents, poor responders in the initial SARS-CoV-2 vaccine series, could obtain sufficient antibody responses with the additional booster dose, despite more than 6 months after the second.

19.
Health Soc Care Community ; 2022 Aug 13.
Article in English | MEDLINE | ID: covidwho-1992807

ABSTRACT

COVID-19 had a devastating impact on older people living in care homes. This study explored the clinical trajectory and management of COVID-19, as well as recovery of older people following infection during the early stages of the pandemic (May to August 2020). A two-phase exploratory qualitative study was used. Frontline staff with experience of caring for older people with COVID-19 were recruited to Phase 1, and senior care home operational and quality managers were recruited to Phase 2. During Phase 1 remote semi-structured interviews (n = 35) were carried out with staff working in care homes, hospital and community settings in England. During Phase 2, a remote consultation event was carried out with senior care home operational and quality managers (n = 11) to share Phase 1 findings and check resonance, relevance and gaps. Data were analysed using Framework Analysis. Older people with COVID-19 presented with wide ranging symptoms, and an unpredictable illness trajectory. The wide range of COVID-19 symptoms required timely testing and supportive interventions. Staff used different interventions to manage symptoms and reported uncertainties of how individuals would respond. In care home settings, health and social care staff needed to work together when administering interventions such as subcutaneous fluids or oxygen therapy. Alongside symptom management, supportive care focused on nutrition and hydration, social interaction, and maintaining physical activity to meet both physical and emotional needs. The effects of prolonged periods of social isolation and inactivity on the health and well-being of older people means rehabilitation is essential to enhance physical and emotional recovery, and to minimise impacts on cognition and function. The pandemic highlighted important areas for care of this population.

20.
Aging and Disease ; : 12, 2022.
Article in English | Web of Science | ID: covidwho-1988575

ABSTRACT

Older people in nursing homes (NH) have been hit particularly hard by the COVID-19 pandemic. We conducted a retrospective study of three outbreaks of COVID-19, occurring during the waves of the initial pre-Alpha, Delta and Omicron SARS-CoV-2 variants, in one NH in suburban Belgrade, Serbia. All staff and 95% residents were vaccinated in February 2021, mostly with BBIBP-CorV, and two thirds were boosted with a third dose in August 2021. COVID-19 was diagnosed by positive PCR and/or antigen test. After the first outbreak, 80 affected individuals were tested for SARS-CoV-2 specific antibodies. The first outbreak involved 64/126 (50.8%) residents and 45/64 (70.3%) staff, the second 22/75 (29.3%) residents and 3/40 (7.5%) staff, and the third involved 36/110 (32.7%) residents and 19/56 (33.9%) staff. Clinical presentation ranged from asymptomatic to severe, with severe cases referred to hospital ICUs. Deaths occurred only in residents, and the case fatality rate was 31.2%, 9.1% and 0%, respectively in outbreaks 1, 2 and 3. Specific IgG antibodies were detected in all 35 residents and 44 of the 45 staff, and higher IgG levels were detected in the residents (417.3 +/- 273.5) than in the staff (201.9 +/- 192.9, p<0.0001) despite a double difference in age (79.0 +/- 7.4 vs. 40.1 +/- 11.5 years). Outbreaks 2 and 3 involved four and 23 breakthrough infections, respectively. Older individuals mounted a good immunological response to SARS-CoV2 infection and vaccination, which prevented significant mortality and severe morbidity in the subsequent outbreaks, despite a significant number of breakthrough infections.

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