A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

Abstract

The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

Dementia wellbeing and COVID‐19: Review and expert consensus on current research and knowledge gaps

“…Another theme, related to the prevention of COVID‐19 in dementia, was the reduced ability of many people living with dementia to understand and comply with pandemic restrictions, social distancing and the use of face masks, 50–53 potentially increasing vulnerability to COVID‐19 infection. Long‐term care facility characteristics, such as size, degree of crowding, low levels of testing and personal protective equipment (PPE) were related to more COVID‐19 outbreaks 58–60 . Available published COVID‐19 vaccine trial data indicate that all participants provided written consent (implying preserved mental capacity) and none had dementia 130 .…”

A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

“…The protocol is registered on PROSPERO 13 and reporting follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 14 Ethical approval was not required for this systematic review.…”

Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study

“…Despite a wealth of individual reports of outbreaks and fatalities in aged care facilities related to COVID-19 [7][8][9][10][11][12], as well as review articles quantifying the outsized impact of this pandemic in the frail populations [3], structural, organizational and practice-related protective factors in these setting have been analyzed to a lesser degree. Several studies, mainly conducted in North America, have investigated the relationship between COVID-19 outbreaks and certain features of long-term care facilities (including nursing homes), such as their geography, size, design, staffing levels, compliance with infection prevention and control (IPC) regulations, health inspections and quality ratings [13][14][15]. However, there is considerable heterogeneity among these studies, in terms of study design (mainly cross-sectional cohort studies), settings, participants, time frame, considered variables, and outcome measures.…”