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1.
rev. cuid. (Bucaramanga. 2010) ; 12(1): e1380, ene-2021.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1811618

ABSTRACT

Objetivo: Enumerar las pautas y recomendaciones para la prevención y el control de COVID-19 en instituciones de atención a larga estancia para ancianos. Método: Esta es una carta al editor que resume las principales pautas sobre la prevención y el control de COVID-19 en instituciones de atención a larga estancia para ancianos que se encuentran disponibles en documentos de agencias federales brasileñas. Resultados: Se recomienda en todas las instituciones realizar el diagnóstico situacional, la suspensión de visitas externas, la evaluación multidimensional de los residentes y la adopción de prácticas preventivas de salud como el ejercicio físico y la alimentación saludable con la distancia mínima entre los ancianos. Además, se destacan las medidas individuales, colectivas, ambientales y de higiene de los materiales y alimentos, con vigilancia y detección temprana de signos y síntomas sugestivos de la enfermedad, con el ingreso hospitalario justificado en presencia de signos clínicos de gravedad. Además, se refuerza la importancia de involucrar a los residentes y familiares en la detección de los riesgos de propagación de la enfermedad y en las estrategias de prevención, con el objetivo de optimizar la cultura de seguridad y capacitar a los residentes y miembros de la familia para garantizar una atención segura y de calidad. Conclusión: La difusión de información y directivas seguras es esencial para prevenir la difusión de Covid-19 en instituciones a larga estancia para mantener la salud y el bienestar de los ancianos y sus cuidadores.


Subject(s)
Humans , Aged , Communicable Disease Control/methods , COVID-19/prevention & control , Homes for the Aged
2.
J Infect Dis ; 225(4): 555-556, 2022 02 15.
Article in English | MEDLINE | ID: covidwho-1684703
3.
BMJ Open ; 12(2): e055457, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-1677397

ABSTRACT

OBJECTIVES: Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake. DESIGN: Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed. SETTING: Residential care. PARTICIPANTS: 27 invited researcher and provider experts. RESULTS: Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals). CONCLUSIONS: COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.


Subject(s)
COVID-19 , Aged , Drinking , Homes for the Aged , Humans , Nursing Homes , SARS-CoV-2
5.
PLoS One ; 17(1): e0261523, 2022.
Article in English | MEDLINE | ID: covidwho-1643245

ABSTRACT

BACKGROUND: The COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic. METHODS: An observational retrospective cohort analysis of deaths recorded among >80 years in three Italian cities has been carried out to compare death rate of the general population and "Long Live the Elderly!" (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model. RESULTS: The total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8‰ (9,718 deaths out of 279,249 individuals; CI95%: 34.1-35.5) and 28.9‰ (166 deaths out of 5,727 individuals; CI95%:24.7-33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71-0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001). CONCLUSIONS: LLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients' adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19.


Subject(s)
COVID-19/epidemiology , Community Health Services/organization & administration , Homes for the Aged/organization & administration , Monitoring, Physiologic/methods , Nursing Homes/organization & administration , SARS-CoV-2/pathogenicity , Aged, 80 and over , COVID-19/mortality , COVID-19/psychology , Cities , Community Health Services/ethics , Female , Homes for the Aged/ethics , Humans , Incidence , Italy/epidemiology , Male , Nursing Homes/ethics , Physical Distancing , Retrospective Studies , Social Isolation/psychology , Survival Analysis
8.
Public Health Rep ; 137(1): 137-148, 2022.
Article in English | MEDLINE | ID: covidwho-1523161

ABSTRACT

OBJECTIVES: Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home-associated COVID-19 infection rates and county-level and nursing home attributes. METHODS: We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. RESULTS: Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates. CONCLUSIONS: Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.


Subject(s)
COVID-19/ethnology , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Social Determinants of Health/ethnology , Humans , Ownership , SARS-CoV-2 , United States/epidemiology
11.
Gerontologist ; 60(3): e200-e217, 2020 04 02.
Article in English | MEDLINE | ID: covidwho-1455299

ABSTRACT

BACKGROUND AND OBJECTIVES: In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS: A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS: The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS: Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.


Subject(s)
Homes for the Aged/standards , Nursing Homes/standards , Nursing Staff/statistics & numerical data , Personnel Staffing and Scheduling/statistics & numerical data , Quality of Health Care , Aged , Delivery of Health Care/standards , Humans , Long-Term Care , Workforce
12.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434765

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
18.
JAMA Netw Open ; 4(3): e216315, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1384067

ABSTRACT

Importance: Nursing home residents account for approximately 40% of deaths from SARS-CoV-2. Objective: To identify risk factors for SARS-CoV-2 incidence, hospitalization, and mortality among nursing home residents in the US. Design, Setting, and Participants: This retrospective longitudinal cohort study was conducted in long-stay residents aged 65 years or older with fee-for-service Medicare residing in 15 038 US nursing homes from April 1, 2020, to September 30, 2020. Data were analyzed from November 22, 2020, to February 10, 2021. Main Outcomes and Measures: The main outcome was risk of diagnosis with SARS-CoV-2 (per International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) by September 30 and hospitalization or death within 30 days after diagnosis. Three-level (resident, facility, and county) logistic regression models and competing risk models conditioned on nursing home facility were used to determine association of patient characteristics with outcomes. Results: Among 482 323 long-stay residents included, the mean (SD) age was 82.7 (9.2) years, with 326 861 (67.8%) women, and 383 838 residents (79.6%) identifying as White. Among 137 119 residents (28.4%) diagnosed with SARS-CoV-2 during follow up, 29 204 residents (21.3%) were hospitalized, and 26 384 residents (19.2%) died within 30 days. Nursing homes explained 37.2% of the variation in risk of infection, while county explained 23.4%. Risk of infection increased with increasing body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) (eg, BMI>45 vs BMI 18.5-25: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.15-1.24) but varied little by other resident characteristics. Risk of hospitalization after SARS-CoV-2 increased with increasing BMI (eg, BMI>45 vs BMI 18.5-25: aHR, 1.40; 95% CI, 1.28-1.52); male sex (aHR, 1.32; 95% CI, 1.29-1.35); Black (aHR, 1.28; 95% CI, 1.24-1.32), Hispanic (aHR, 1.20; 95% CI, 1.15-1.26), or Asian (aHR, 1.46; 95% CI, 1.36-1.57) race/ethnicity; impaired functional status (eg, severely impaired vs not impaired: aHR, 1.15; 95% CI, 1.10-1.22); and increasing comorbidities, such as renal disease (aHR, 1.21; 95% CI, 1.18-1.24) and diabetes (aHR, 1.16; 95% CI, 1.13-1.18). Risk of mortality increased with age (eg, age >90 years vs 65-70 years: aHR, 2.55; 95% CI, 2.44-2.67), impaired cognition (eg, severely impaired vs not impaired: aHR, 1.79; 95% CI, 1.71-1.86), and functional impairment (eg, severely impaired vs not impaired: aHR, 1.94; 1.83-2.05). Conclusions and Relevance: These findings suggest that among long-stay nursing home residents, risk of SARS-CoV-2 infection was associated with county and facility of residence, while risk of hospitalization and death after SARS-CoV-2 infection was associated with facility and individual resident characteristics. For many resident characteristics, there were substantial differences in risk of hospitalization vs mortality. This may represent resident preferences, triaging decisions, or inadequate recognition of risk of death.


Subject(s)
COVID-19 , Homes for the Aged , Hospitalization , Nursing Homes , Pandemics , Severity of Illness Index , Aged , Aged, 80 and over , Body Mass Index , COVID-19/mortality , Comorbidity , Female , Humans , Longitudinal Studies , Male , Physical Functional Performance , Residence Characteristics , Retrospective Studies , Risk Factors , SARS-CoV-2 , Sex Factors , United States
19.
Ann Intern Med ; 174(7): 1014-1015, 2021 07.
Article in English | MEDLINE | ID: covidwho-1384006
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