Facility- and ward-level factors associated with SARS-CoV-2 outbreaks among residents in long-term care facilities: A retrospective cohort study.

OBJECTIVES: Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19. Yet, the reasons why certain LTCFs are affected more by outbreaks are poorly understood. This study aimed to identify the facility- and ward-level factors associated with SARS-CoV-2 outbreaks among LTCF residents. METHODS: We conducted a retrospective cohort study of multiple Dutch LTCFs (N = 60; with 298 wards providing care for ∼5600 residents) from September 2020 to June 2021. A dataset was constructed linking SARS-CoV-2 cases among LTCF residents to facility- and ward-level factors. Multilevel logistic regression analyses examined the associations between these factors and the likelihood of a SARS-CoV-2 outbreak among residents. RESULTS: During periods of the Classic variant, the mechanical recirculation of air was associated with significantly increased odds of a SARS-CoV-2 outbreak. During periods of the Alpha variant, the factors associated with significantly increased odds included large ward size (≥21 beds), wards providing psychogeriatric care, fewer restrictions on staff movement between wards and facilities, and a greater number of cases among staff (>10 cases). CONCLUSION: Policy and protocols on reducing resident density, staff movement, and mechanical recirculation of air in buildings are recommended to enhance outbreak preparedness in LTCFs. The implementation of low-threshold preventive measures among psychogeriatric residents is important because they appear as a particularly vulnerable group.

Opioid Prescribing Behavior in Long-Term Geriatric Care in the Netherlands.

OBJECTIVES: Pain is a highly prevalent problem in older adults and dying patients. Opioids are the main analgesic for moderate to severe pain in these patients. Different properties of various opioids can make them more or less suitable for this specific population. We therefore aim to explore opioid prescribing behavior in a group of physicians specialized in long-term geriatric care and to identify factors that are taken into account when selecting a specific opioid for treatment of pain in older patients and patients in the dying phase. DESIGN: A cross-sectional study using an online questionnaire. SETTING AND PARTICIPANTS: All members of the Dutch Association of Elderly Care Physicians and Social Geriatricians (Verenso) on the mailing list of the weekly digital newsletter were invited to participate between November and December 2017. MEASURES: Preferences in opioids for the treatment of pain in nondying and dying older patients were recorded, as were the factors that were considered for these preferences. RESULTS: 142 members completed the questionnaire (9%). Opioids of first choice were oxycodone (61%) for nondying and morphine (90%) for dying older patients. The second choice in both cases was fentanyl (56% for nondying and 31% in dying older patients). Personal experience was the main consideration in opioid prescribing (74%-98%). In daily practice, recommendations in guidelines are only considered by 8% to 9% and renal function by 0% to 1% of the respondents. CONCLUSIONS/IMPLICATIONS: Oxycodone is the opioid of first choice for physicians in long-term geriatric care in the Netherlands when prescribing for nondying older patients. In contrast, morphine is preferred for dying patients. Fentanyl as a second choice is mainly reserved for situations of stable pain. Prescribers base their choices almost exclusively on personal experience and are barely influenced by guidelines. Further research should therefore focus on clinical relevance for, and implementation in, daily practice.