Health conditions of potential risk for severe Covid-19 in institutionalized elderly people

Araújo, Mayara Priscilla Dantas; Nunes, Vilani Medeiros de Araújo; Costa, Larissa de Albuquerque; Souza, Talita Araújo de; Torres, Gilson de Vasconcelos; Nobre, Thaíza Teixeira Xavier

doi:10.1371/journal.pone.0245432

Cited by 25 publications

(23 citation statements)

References 21 publications

(29 reference statements)

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“…Strict lockdowns in our cohort were associated with higher FTTS incidence, triggered by individuals' difficult living conditions over multiple months (the long duration of the crisis, an anxiety-provoking atmosphere, social isolation, other residents' deaths, etc.). We found a strong statistical association between COVID-19 case fatality and FTTS diagnoses, a result that was triangulated by qualitative interview data and is consistent with other research from France [41], the United Kingdom [42], Finland [46], Spain [48,50], Italy [49], and the United States [47].…”

Section: Discussionsupporting

confidence: 90%

COVID-19 in French Nursing Homes during the Second Pandemic Wave: A Mixed-Methods Cross-Sectional Study

Dujmovic¹,

Roederer²,

Frison³

et al. 2021

Preprint

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Introduction French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment. Methods A cross-sectional, mixed-methods study using retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021. Results The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure-to-Thrive-Syndrome (FTTS) was diagnosed in 23% of COVID-positive residents. Those at highest risk of death were men (HR=1.78; IC95: 1.18 - 2.70; p=0.006) with FTTS (HR=4.04; IC95: 1.93 - 8.48; p<0.001) in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; IC95: 1.02 - 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; IC95: 0.18 - 0.51; p<0.001) or full-time physician on staff (HR=0.20; IC95: 0.08 - 0.53; p=0.001). Significant themes emerging from qualitative analysis centered on (i) the structural, chronic neglect of nursing homes, (ii) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (iii) the counterproductive effects of lockdowns on both residents and staff. Conclusion Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.

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Section: Discussionsupporting

confidence: 90%

COVID-19 in French Nursing Homes during the Second Pandemic Wave: A Mixed-Methods Cross-Sectional Study

Dujmovic¹,

Roederer²,

Frison³

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Caregivers were unable to support people who are not self-sufficient. Furthermore, individuals with unique needs (e.g., women in childbirth, the institutionalized elderly, or psychiatric patients) need support [31][32][33][34][35][36][37]. Interestingly, one patient with depression committed suicide [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Fear of the COVID-19 and medical liability. Insights from a series of 130 consecutives medico-legal claims evaluated in a single institution during SARS-CoV-2-related pandemic

2021

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Objectives: The aim of the current work was to evaluate the frequency and the type of cases of medical liability from a single center in the first ten months of the pandemic as well as to identify critical issues associated with the organization of public health during the coronavirus disease 2019 pandemic. Methods: We compared 130 cases evaluated for medical liability from March 2020 to January 2021 and compared with 159 cases from March 2019 to January 2020. The cases were divided in four pre-established groups: surgical error, diagnostic/therapeutic errors and nosocomial diseases, delays, and problems related to assistance. Results: Analysis showed a significant increase in cases due to delay in treat-ment/hospitalization and shortages in health care of non-autonomous patients [χ2 (1, N = 289) = 5.6746, p = 0.02]. Conclusions: The work showed an increase in medical/legal cases regarding non-COVID-19 emergencies in which the outcome is related to the time of treatment and/or arrival at the hospital. There was also a rise in complaints of deficits in supervision and care for non-autonomous patients. Despite the persistence of preventive measures for the current pandemic, measures should be taken to improve health care in these categories of patients.

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“…Pre-existing chronic respiratory conditions may increase the risk of a COVID-19 pneumonia becoming severe and life-threatening [13]. In addition, malnutrition is more prevalent in adults with comorbidities, being present in 24.6%, 23.3% and 12.9% of cognitively impaired, hypertensive, and diabetic older adults, respectively [14].…”

Section: Residents' Characteristicsmentioning

confidence: 99%

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

2021

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Introduction COVID-19 has caused unprecedented challenges in nursing homes. In this scoping review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges. Methods The MeSH terms “Nursing homes” and “COVID-19” were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes. Results The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations. Conclusion COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.

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Health conditions of potential risk for severe Covid-19 in institutionalized elderly people

Cited by 25 publications

References 21 publications

COVID-19 in French Nursing Homes during the Second Pandemic Wave: A Mixed-Methods Cross-Sectional Study

COVID-19 in French Nursing Homes during the Second Pandemic Wave: A Mixed-Methods Cross-Sectional Study

Fear of the COVID-19 and medical liability. Insights from a series of 130 consecutives medico-legal claims evaluated in a single institution during SARS-CoV-2-related pandemic

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

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