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4.
J Alzheimers Dis ; 83(4): 1841-1848, 2021.
Article in English | MEDLINE | ID: covidwho-1369637

ABSTRACT

BACKGROUND: In a previous study, we assessed burnout in geriatric healthcare workers during the first lockdown that lasted from March to May 2020 in France, in response to the COVID-19 crisis. OBJECTIVE: We carried out a follow-up study to assess burnout in the same population during the second lockdown that was implemented at the end of October 2020. METHODS: We used an online survey to assess burnout in terms of exhaustion and disengagement in a sample of 58 geriatric healthcare workers. RESULTS: We found higher levels of exhaustion, disengagement, and burnout among geriatric healthcare workers during the second than during the first lockdown. We also found high levels of exhaustion but moderate disengagement and burnout during the second lockdown. CONCLUSION: The increased exhaustion, disengagement, and burnout during the second lockdown can be attributed to the increased workload in geriatric facilities throughout this crisis and during the second lockdown due to shortage in staff and increased number of shifts and allocated duties. The high levels of exhaustion reported among geriatric healthcare workers during the second lockdown can reflect their physical fatigue, as well as their feelings of being emotionally overextended and exhausted by their workload.


Subject(s)
Burnout, Professional , COVID-19 , Caregiver Burden , Health Personnel/psychology , Health Services for the Aged , Work Engagement , Adult , Burnout, Professional/diagnosis , Burnout, Professional/epidemiology , Burnout, Professional/etiology , Burnout, Professional/psychology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Caregiver Burden/epidemiology , Caregiver Burden/psychology , Communicable Disease Control/methods , Female , Follow-Up Studies , France/epidemiology , Health Services Needs and Demand , Health Services for the Aged/organization & administration , Health Services for the Aged/statistics & numerical data , Humans , Male , SARS-CoV-2 , Surveys and Questionnaires
5.
J Am Geriatr Soc ; 69(10): 2708-2715, 2021 10.
Article in English | MEDLINE | ID: covidwho-1301523

ABSTRACT

COVID-19 has exacted a disproportionate toll on the health of persons living in nursing homes. Healthcare providers and other decision-makers in those settings must refer to multiple evolving sources of guidance to coordinate care delivery in such a way as to minimize the introduction and spread of the causal virus, SARS-CoV-2. It is essential that guidance be presented in an accessible and usable format to facilitate its translation into evidence-based best practice. In this article, we propose the Haddon matrix as a tool well-suited to this task. The Haddon matrix is a conceptual model that organizes influencing factors into pre-event, event, and post-event phases, and into host, agent, and environment domains akin to the components of the epidemiologic triad. The Haddon matrix has previously been applied to topics relevant to the care of older persons, such as fall prevention, as well as to pandemic planning and response. Presented here is a novel application of the Haddon matrix to pandemic response in nursing homes, with practical applications for nursing home decision-makers in their efforts to prevent and contain COVID-19.


Subject(s)
COVID-19 , Civil Defense/organization & administration , Evidence-Based Practice , Homes for the Aged/organization & administration , Infection Control , Models, Organizational , Nursing Homes/organization & administration , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Evidence-Based Practice/methods , Evidence-Based Practice/trends , Health Services for the Aged/organization & administration , Health Services for the Aged/standards , Health Services for the Aged/trends , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Organizational Innovation , SARS-CoV-2 , United States
6.
Can J Aging ; 39(3): 333-343, 2020 09.
Article in English | MEDLINE | ID: covidwho-1261985

ABSTRACT

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.


Subject(s)
Aging , Communicable Disease Control/methods , Coronavirus Infections , Health Services for the Aged/organization & administration , Pandemics , Patient Care Management , Patient Care Team , Pneumonia, Viral , Aged , Aging/physiology , Aging/psychology , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Interdisciplinary Communication , Mental Health , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Patient Care Team/organization & administration , Patient Care Team/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Quality Improvement , SARS-CoV-2
9.
Emerg Med J ; 38(5): 371-372, 2021 May.
Article in English | MEDLINE | ID: covidwho-1197268

ABSTRACT

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people's services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.


Subject(s)
COVID-19/epidemiology , Community Health Services/organization & administration , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Health Services for the Aged/organization & administration , Humans , Neoplasms/therapy , Palliative Care/organization & administration , Pandemics , Patient Discharge , SARS-CoV-2
10.
BMC Med ; 19(1): 71, 2021 03 05.
Article in English | MEDLINE | ID: covidwho-1119426

ABSTRACT

BACKGROUND: To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS: Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS: Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS: To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.


Subject(s)
COVID-19 , Health Services for the Aged , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Quality of Health Care , Residential Facilities/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/prevention & control , COVID-19/therapy , Cohort Studies , England/epidemiology , Female , Health Services Needs and Demand , Health Services for the Aged/organization & administration , Health Services for the Aged/standards , Humans , Male , Mortality , SARS-CoV-2
11.
Rural Remote Health ; 21(1): 6122, 2021 01.
Article in English | MEDLINE | ID: covidwho-1068209

ABSTRACT

INTRODUCTION: Older adults, especially those aged 85 years or older, remain at significantly higher risk for COVID-19. This group, along with those with pre-existing heart and lung disease and diabetes, have accounted for 80% of hospitalizations and an even higher percentage of COVID-19 related deaths in the USA. West Virginia, the only state in the USA located completely within Appalachia, has a higher percentage of elderly than all but two states in the nation. Rural seniors are hesitant to use hospital emergency departments and attend routine care visits for fear of exposure to the virus. Restricted cell phone and internet service may limit effective technological outreach to more isolated rural older adults. More information is needed to develop effective, safe, and acceptable approaches to care for rural, isolated older adults. METHODS: Telephone interviews were conducted with 124 community-dwelling residents in four counties in rural Appalachia between 1 and 22 April 2020. Participants were aged 75 years or older. Descriptive statistics were calculated and Fisher's Exact Test was used to examine for associations among variables. RESULTS: Participants consisted of 86 (69.4%) women and 38 (30.6%) men with an average age of 82.5 years. Telephone contact was the preferred method of contact among all but four participants (96.8%). Seventeen calls (13.7%) resulted in some form of intervention, including arranging for emergent home repairs, treatment of severe hypertension, scheduling urgent laboratory testing, arranging for terminal care, treating acute conditions, and providing durable medical equipment. The 17 participants requiring intervention were significantly more likely to be aged 85 years or older (p=0.004), and report two or more chronic conditions (p<0.001). Those describing themselves as 'lonely' were significantly more likely to live alone (p=0.009) and describe themselves as 'anxious' or 'depressed' (p<0.001). CONCLUSION: A telephone call appears to be the most effective means of communication with patients in these rural Appalachian counties. Patients aged 85 years or older and those living alone should be given highest priority for regular outreach by healthcare providers. In this population, systematically calling rural elderly patients during the COVID-19 epidemic and its aftermath represents an effective strategy for providers who care for elderly rural patients.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility/organization & administration , Health Services Needs and Demand/statistics & numerical data , Rural Population/statistics & numerical data , Aged , Aged, 80 and over , Appalachian Region , COVID-19/epidemiology , Female , Health Services for the Aged/organization & administration , Humans , Male , West Virginia
12.
Res Aging ; 43(3-4): 123-126, 2021.
Article in English | MEDLINE | ID: covidwho-1061209

ABSTRACT

This special issue covers several important topics related to long-term care (LTC) systems and policy development in China. It provides a good contextual background on the development of the LTC system in China as well as the needs and preferences of LTC from family and older adults' perspectives. In addition, this issue covers the topic of evaluation of a recently developed long-term care nursing insurance and provides an example of family caregiving for persons with dementia within the Chinese context. The authors in this special issue also provided insights into the impact of the COVID-19 pandemic on older adults' life and LTC quality, and explored potential strategies to handle the challenges during and post-pandemic.


Subject(s)
COVID-19 , Health Policy , Health Services for the Aged/organization & administration , Health Services for the Aged/standards , Long-Term Care/organization & administration , Long-Term Care/standards , Quality Improvement , China , Humans
13.
Ciênc. Saúde Colet ; 26(1): 159-168, jan. 2021. tab
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1060978

ABSTRACT

Resumen Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.


Abstract The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus , Homes for the Aged/legislation & jurisprudence , Homes for the Aged/organization & administration , Homes for the Aged/statistics & numerical data , Nursing Homes/legislation & jurisprudence , Nursing Homes/organization & administration , Nursing Homes/statistics & numerical data , Spain/epidemiology , Sex Distribution , Coronavirus Infections/mortality , Age Distribution , Patient-Centered Care , Qualitative Research , Employment , Health Services for the Aged/organization & administration
17.
Br J Community Nurs ; 26(1): 6-12, 2021 Jan 02.
Article in English | MEDLINE | ID: covidwho-1000637

ABSTRACT

Rapid response services provide opportunities for older people living with frailty to remain in their own homes during an episode of deteriorating health. The government has announced additional funding to increase capacity and responsiveness for these services through the Ageing Well programme as part of the NHS Long Term Plan. Older people living with frailty are particularly at risk of the adverse effects of a hospital admission and evidence is emerging of the benefits of enhanced healthcare support to allow them to remain in their own home. The Hospital at Home model offers short-term, targeted interventions at acute hospital level care that can provide a truly person-centred experience within the home. This article describes a Rapid Response and Treatment service for older people living in care homes in Berkshire West and shares Sid's story to demonstrate how such a service is delivered. The COVID-19 pandemic has presented additional challenges and opportunities that highlight the ongoing need for the development of services that will support older people to prioritise what matters to them most.


Subject(s)
COVID-19 , Frail Elderly , Health Services for the Aged/organization & administration , Home Health Nursing/organization & administration , Hospital Rapid Response Team/organization & administration , Advance Care Planning , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , COVID-19/epidemiology , Catheter-Related Infections/diagnosis , Catheter-Related Infections/drug therapy , Humans , Independent Living , Male , Pandemics , Patient-Centered Care , SARS-CoV-2
18.
Semergen ; 47(2): 122-130, 2021 Mar.
Article in Spanish | MEDLINE | ID: covidwho-997527

ABSTRACT

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Subject(s)
COVID-19/prevention & control , Health Care Rationing/ethics , Health Services Accessibility/ethics , Infection Control/methods , Primary Health Care/ethics , Telemedicine/ethics , COVID-19/epidemiology , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Health Services for the Aged/ethics , Health Services for the Aged/organization & administration , Humans , Infection Control/instrumentation , Infection Control/organization & administration , Pandemics , Personal Protective Equipment/supply & distribution , Primary Health Care/methods , Primary Health Care/organization & administration , Quality of Health Care/ethics , Quality of Health Care/organization & administration , Spain/epidemiology , Telemedicine/methods , Telemedicine/organization & administration
19.
Pan Afr Med J ; 35(Suppl 2): 99, 2020.
Article in English | MEDLINE | ID: covidwho-963762

ABSTRACT

The ongoing Coronavirus disease (COVID-19) pandemic has markedly changed health care provisions and arrangements for patient care. Older adults are most susceptible to worse outcomes. The public health impact of the disease in terms of morbidity and mortality has necessitated the evolution of management protocols for effective care of older persons. This review describes our experience during this period attending to the healthcare needs of both the acutely ill and clinically stable patients at the first purpose-built facility for the care of older persons in Nigeria, the Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan. A major strategy recommended by the World Health Organization was a lockdown with restricted movements and laid down rules for engagement. As such, the CTAGC also embarked on steps to ensure patient safety as well as effective care. Prior to the lockdown, targeted activities included fumigation of the centre as well as health education and promotional activities. Measures were put in place to care for up to 95% of our patients at home. Thus, a "Care in Place" approach was adopted to enable them to take ownership of their care. Ambulatory older patients were seen on an out-patient basis following scheduled appointments after a telephone consultation through the hospital's designated lines. Clients were managed for their routine health conditions which were mostly non-communicable diseases (NCDs). Also, acutely ill older patients were admitted for acute exacerbation and/or complications of their chronic morbidities. Importantly, 60% of admitted patients presented with COVID like symptoms but they all tested negative for COVID 19. Based on our experience at the CTAGC, older persons can be successfully managed through a "Care in place" approach in a resource-poor setting during pandemics with high infectivity rates such as COVID 19. The information hereby generated is beneficial for future practice.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Health Services for the Aged/organization & administration , Public Health , Ambulatory Care/organization & administration , Humans , Nigeria , Referral and Consultation , Specialization , Telephone , Tertiary Care Centers/organization & administration
20.
Aust Health Rev ; 44(6): 829-830, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-952438

ABSTRACT

The COVID-19 pandemic has highlighted an aged care system struggling to meet the needs of vulnerable Australians. Staffing levels and skill mix in aged care have declined, whereas the health and social needs of an older and more clinically complex population have risen. Increasing staff and improving personal care workers' skills and education are essential steps to quality aged care in Australia, but it will not be possible without funding models that foster secure employment, development opportunities and long-term career pathways.


Subject(s)
COVID-19/therapy , Geriatric Nursing/education , Geriatric Nursing/organization & administration , Health Personnel/organization & administration , Health Services for the Aged/organization & administration , Health Workforce/organization & administration , Personnel Staffing and Scheduling/organization & administration , Adult , Aged , Aged, 80 and over , Australia , Female , Health Policy , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
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