Advocacy for the human rights of older people in the COVID pandemic and beyond: a call to mental health professionals

Peisah, Carmelle; Byrnes, Andrew; Doron, Israel; Dark, Michael; Quinn, Gérard

doi:10.1017/s1041610220001076

Cited by 39 publications

(43 citation statements)

References 18 publications

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“…This confluence of events in the context of the pandemic, and impacts for residents, their families and care home staff, has been framed as a human rights issue [ 12 ]. In the UK, it is argued that underinvestment in the care home sector and a poor interface with the health sector led to ill-informed policies, for example the rapid hospital discharge policies in the early period of the lockdown [ 9 , 13–15 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Hollinghurst¹,

Lyons²,

Fry³

et al. 2020

Age and Ageing

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Background Mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages, and insufficient or lack of timely COVID-19 testing. Aim To analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4-years. Study Design and Setting We used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods We calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted hazard ratios for age, gender, social economic status and prior health conditions. Results Survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1·72 (1·55, 1·90) compared to 2016. Compared to the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2·15 (2·11,2·20) in 2016–2019 to 2·94 (2·81,3·08) in 2020. Conclusions The survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

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Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Hollinghurst¹,

Lyons²,

Fry³

et al. 2020

Age and Ageing

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“…4 In addition, in difficult times like this, frail older people are at risk for social exclusion. 5 Geriatric psychiatrists should defend community living as a basic human-right for frail older people, as well as preventing social isolation.…”

Section: Dear Editormentioning

confidence: 99%

Defending community living for frail older people during the COVID‐19 pandemic

et al. 2020

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“…This confluence of events in the context of the pandemic, and impacts for residents, their families and care home staff, has been framed as a human rights issue (15). In the UK it is argued that underinvestment in the care home sector and a poor interface with the health sector led to ill-informed policies.…”

Section: Introductionmentioning

confidence: 99%

Intensity of COVID-19 in care homes following Hospital Discharge in the early stages of the UK epidemic

Hollinghurst

North

Emmerson

et al. 2021

Preprint

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BackgroundA defining feature of the COVID-19 pandemic in many countries was the tragic extent to which care home residents were affected, and the difficulty preventing introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the start of the pandemic, prior to widespread testing, was transfer of patients from hospitals, which were experiencing high levels of nosocomial events.MethodsWe tested the hypothesis that hospital discharge events increased the intensity of care home cases using a national individually linked health record cohort in Wales, UK. We monitored 186,772 hospital discharge events over the period March to July 2020, tracking individuals to 923 care homes and recording the daily case rate in the homes populated by 15,772 residents. We estimated the risk of an increase in cases rates following exposure to a hospital discharge using multi-level hierarchical logistic regression, and a novel stochastic Hawkes process outbreak model.FindingsIn regression analysis, after adjusting for care home size, we found no significant association between hospital discharge and subsequent increases in care home case numbers (odds ratio: 0.99, 95% CI 0.82, 1.90). Risk factors for increased cases included care home size, care home resident density, and provision of nursing care. Using our outbreak model, we found a significant effect of hospital discharge on the subsequent intensity of cases. However, the effect was small, and considerably less than the effect of care home size, suggesting the highest risk of introduction came from interaction with the community. We estimated approximately 1.8% of hospital discharged patients may have been infected.InterpretationThere is growing evidence in the UK that the risk of transfer of COVID-19 from the high-risk hospital setting to the high-risk care home setting during the early stages of the pandemic was relatively small. Although access to testing was limited to initial symptomatic cases in each care home at this time, our results suggest that reduced numbers of discharges, selection of patients, and action taken within care homes following transfer all may have contributed to mitigation. The precise key transmission routes from the community remain to be quantified.

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Advocacy for the human rights of older people in the COVID pandemic and beyond: a call to mental health professionals

Cited by 39 publications

References 18 publications

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Defending community living for frail older people during the COVID‐19 pandemic

Intensity of COVID-19 in care homes following Hospital Discharge in the early stages of the UK epidemic

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