Commentary: COVID in care homes—challenges and dilemmas in healthcare delivery

Gordon, Adam L; Goodman, Claire; Achterberg, Wilco P.; Barker, Robert; Burns, Eileen; Hanratty, Barbara; Martin, Finbarr C.; Meyer, Julienne; O’Neill, Desmond; Schols, Jos M. G. A.; Spilsbury, Karen

doi:10.1093/ageing/afaa113

Cited by 178 publications

(194 citation statements)

References 8 publications

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“…The pandemic on i.e mortality of institutionalized elderly has been reported to be severe; the outbreak was associated with a very high mortality rate and high rates of positively tested residents of nursing homes [49]. Isolating nursing home residents in their rooms is associated with morbidity and raises patient safety and sta ng issues [50]. The SARS-CoV-2 pandemic could also have lasting psychological impacts on care home staff [50].…”

Section: Limitationsmentioning

confidence: 99%

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The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

Thyrian

Kracht

Nikelski

et al. 2020

Preprint

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Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. Elderly people with comorbidities are at a higher risk and the different levels of government in Germany reacted jointly to the challenge with social distancing and a lockdown. Little empirical evidence exists about the psychosocial situation of elderly people during this time. Thus, the aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety, and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and daily living at home in Germany. Methods: This analysis is based on data from standardized telephone interviews in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Participants were recruited from currently running interventional trials. Therefore, data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, frequency of social activities due to the pandemic and perceived impact of the pandemic on health care services were assessed during the time of lockdown. Results: The vast majority of participants consider themselves sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low levels of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or birthday visits have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies are reported to have worsened due to the pandemic. Also visits to general practitioners decreased. Discussion: The study shows a limited impact of the pandemic on psychological variables including depression, anxiety and loneliness in the short-term. People are well informed but not especially concerned about themselves or others. There is a decrease in social activities as expected, in line with the restrictions imposed. The impact on health care provision is prominent. There is a need for longitudinal studies to assess longer-term effects of the pandemic and social distancing on elderly people with cognitive impairment living at home and their caregivers. There is also a need for qualitative, in-depth studies to further interpret the results. In general, elderly people in the setting under examination and with the limitations of this specific study seem to compensate restrictions during the time of lockdown in Germany rather well.

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Section: Limitationsmentioning

confidence: 99%

“…Isolating nursing home residents in their rooms is associated with morbidity and raises patient safety and sta ng issues [50]. The SARS-CoV-2 pandemic could also have lasting psychological impacts on care home staff [50]. It is important that the necessary and appropriate support is provided.…”

Section: Limitationsmentioning

confidence: 99%

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

Thyrian

Kracht

Nikelski

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The impact of the pandemic on i.e mortality of institutionalized elderly has been reported to be severe; the outbreak was associated with a very high mortality rate and high rates of positively tested residents of nursing homes [49]. Isolating care home residents in their rooms is associated with morbidity and raises patient safety and sta ng issues [50]. The SARS-CoV-2 pandemic could also have lasting psychological impacts on care home staff [50].…”

Section: Limitationsmentioning

confidence: 99%

“…Isolating care home residents in their rooms is associated with morbidity and raises patient safety and sta ng issues [50]. The SARS-CoV-2 pandemic could also have lasting psychological impacts on care home staff [50]. It is important that support is provided.…”

Section: Limitationsmentioning

confidence: 99%

The Situation of Elderly With Cognitive Impairment Living at Home During Lockdown in the Corona-pandemic in Germany

Thyrian

Kracht

Nikelski

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods: This analysis is based on data of a telephone-based assessment in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results: The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions: The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

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“…The impact of COVID-19 in nursing homes is aggravated by delayed recognition due to atypical clinical presentation in elderly persons, and di culties of implementing stringent control measures 5 . In addition, it was augmented by shortages of personal protection equipment (PPE) 6 . In view of the severe consequences, understanding how SARS-CoV-2 transmits in this population is crucial.…”

Section: Introductionmentioning

confidence: 99%

Unravelling the modes of transmission of SARS-CoV-2 during a nursing home outbreak: looking beyond the church super-spread event

Voeten

Sikkema

Damen

et al. 2020

Preprint

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BackgroundAn outbreak of COVID-19 in a nursing home in the Netherlands, following an on-site church service held on March 8, 2020, triggered an investigation to unravel sources and chain(s) of transmission.MethodsEpidemiological data were collected from registries and through a questionnaire among church visitors. Symptomatic residents and healthcare workers (HCWs) were tested for SARS-CoV-2 by RT-PCR and subjected to whole genome sequencing (WGS). Sequences from a selection of people from the same area were included as community reference.ResultsAfter the church service, 30 of 39 visitors (77%) developed symptoms; 14 were tested and were positive for COVID-19 (11 residents and 3 non-residents). In the following five weeks, 62 of 300 residents (21%) and 30 of 640 HCWs (5%) tested positive for COVID-19; 21 of 62 residents (34%) died. The outbreak was controlled through a cascade of measures. WGS of samples from residents and HCWs identified a diversity of sequence types, grouped into eight clusters. Seven resident church visitors all were infected with distinct viruses, four of which belonged to two larger clusters in the nursing home.ConclusionsAlthough initial investigation suggested the church service as source of the outbreak, detailed analysis showed a more complex picture, most consistent with widespread regional circulation of the virus in the weeks before the outbreak, and multiple introductions into the nursing home before the visitor ban. The findings underscore the importance of careful outbreak investigations to understand SARS-CoV-2 transmission to develop evidence-based mitigation measures.

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Commentary: COVID in care homes—challenges and dilemmas in healthcare delivery

Cited by 178 publications

References 8 publications

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

The Situation of Elderly With Cognitive Impairment Living at Home During Lockdown in the Corona-pandemic in Germany

Unravelling the modes of transmission of SARS-CoV-2 during a nursing home outbreak: looking beyond the church super-spread event

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