1
|
Arsenault-Lapierre G, Lemay-Compagnat A, Guillette M, Couturier Y, Massamba V, Dufour I, Maubert E, Fournier C, Denis J, Morin C, Vedel I. Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations. JMIR Form Res 2024; 8:e55064. [PMID: 38717803 PMCID: PMC11112472 DOI: 10.2196/55064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. OBJECTIVE The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. METHODS An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization's jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled "university/peripheral"; organizations for which only part of the territory is in rural areas, labeled "mixed"; and organizations in remote or isolated areas, labeled "remote/isolated") and according to different types of participants (managers, leading clinicians, and other participants). RESULTS Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. CONCLUSIONS These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.
Collapse
Affiliation(s)
- Genevieve Arsenault-Lapierre
- Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Côte Saint-Luc, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Lemay-Compagnat
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| | - Maxime Guillette
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | - Yves Couturier
- Department of Social Work, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Isabelle Dufour
- School of Nursing, Sherbrooke University, Sherbrooke, QC, Canada
- Center on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Maubert
- Integrated University Health and Social Services Network of McGill University, Montreal, QC, Canada
| | - Christine Fournier
- Integrated University Health and Social Services Network of Université de Montréal, Montreal, QC, Canada
| | - Julie Denis
- Integrated University Health and Social Services Network of Université Laval, Quebec, QC, Canada
| | - Caroline Morin
- Integrated University Health and Social Services Network of Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, Montreal, QC, Canada
| |
Collapse
|
2
|
Couret A, Lapeyre-Mestre M, Renoux A, Gardette V. Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort. Front Public Health 2024; 12:1284542. [PMID: 38487186 PMCID: PMC10937384 DOI: 10.3389/fpubh.2024.1284542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pluriprofessional and coordinated healthcare use is recommended for Alzheimer's Disease and Related Diseases (ADRD). Despite a protective health system, France is characterized by persistent and significant social inequalities in health. Although social health inequalities are well documented, less is known about social disparities in healthcare use in ADRD, especially in France. Therefore, this study aimed to describe healthcare use according to socioeconomic deprivation among ADRD subjects and the possible potentiating role of deprivation by age. Methods We studied subjects identified with incident ADRD in 2017 in the French health insurance database (SNDS). We described a large extent of their healthcare use during the year following their ADRD identification. Deprivation was assessed through French deprivation index (Fdep), measured at the municipality level, and categorized into quintiles. We compared healthcare use according to the Fdep quintiles through chi-square tests. We stratified the description of certain healthcare uses by age groups (40-64 years, 65-74 years, 75-84 years, 85 years, and older), number of comorbidities (0, 1, 2-3, 4 comorbidities and more), or the presence of psychiatric comorbidity. Results In total, 124,441 subjects were included. The most deprived subjects had less use of physiotherapy (28.56% vs. 38.24%), ambulatory specialists (27.24% vs. 34.07%), ambulatory speech therapy (6.35% vs. 16.64%), preventive consultations (62.34% vs. 69.65%), and were less institutionalized (28.09% vs. 31.33%) than the less deprived ones. Conversely, they were more exposed to antipsychotics (11.16% vs. 8.43%), benzodiazepines (24.34% vs. 19.07%), hospital emergency care (63.84% vs. 57.57%), and potentially avoidable hospitalizations (12.04% vs. 10.95%) than the less deprived ones. Discussion and conclusion The healthcare use of subjects with ADRD in France differed according to the deprivation index, suggesting potential health renunciation as in other diseases. These social inequalities may be driven by financial barriers and lower education levels, which contribute to health literacy (especially for preventive care). Further studies may explore them.
Collapse
Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS “Pharmacologie En Population cohorteS et biobanqueS,” Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
| |
Collapse
|
3
|
Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
Collapse
Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| |
Collapse
|
4
|
Hoang MT, Kåreholt I, Schön P, von Koch L, Xu H, Tan EC, Johnell K, Eriksdotter M, Garcia-Ptacek S. The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias: A Swedish Nationwide Study. J Alzheimers Dis 2023; 96:789-800. [PMID: 37840486 PMCID: PMC10657673 DOI: 10.3233/jad-230388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied. OBJECTIVE To explore the socioeconomic disparity in long-term care for PWD. METHODS This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression. RESULTS PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care. CONCLUSIONS Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.
Collapse
Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Pär Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C.K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Theme, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
Higgs G, Langford M, Llewellyn M. Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2218-2229. [PMID: 35212427 PMCID: PMC10078699 DOI: 10.1111/hsc.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/17/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.
Collapse
Affiliation(s)
- Gary Higgs
- Faculty of Computing, Engineering and ScienceWales Institute of Social and Economic Research and Data (WISERD) and GIS Research CentreUniversity of South WalesPontypriddUK
| | - Mitchel Langford
- Faculty of Computing, Engineering and ScienceWales Institute of Social and Economic Research and Data (WISERD) and GIS Research CentreUniversity of South WalesPontypriddUK
| | - Mark Llewellyn
- Welsh Institute for Health and Social CareUniversity of South WalesPontypriddUK
| |
Collapse
|
6
|
Harrison SL, Lip GYH, Akbari A, Torabi F, Ritchie LA, Akpan A, Halcox J, Rodgers S, Hollinghurst J, Harris D, Lane DA. Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales. J Am Med Dir Assoc 2022; 23:1548-1554.e11. [PMID: 35667411 DOI: 10.1016/j.jamda.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents. DESIGN Retrospective cohort study using population-scale individual-level linked data sources between 2003 and 2018 in the Secure Anonymized Information Linkage (SAIL) Databank. SETTING AND PARTICIPANTS People age ≥65 years residing in long-term care homes in Wales. METHODS Competing risk models and logistic regression models were used to examine the association between prior stroke, incident stroke, and mortality following stroke. RESULTS Of 86,602 individuals, 7.0% (n = 6055) experienced a stroke in the 12 months prior to care home entry. The incidence of stroke within 12 months after entry to a care home was 26.2 per 1000 person-years [95% confidence interval (CI) 25.0, 27.5]. Previous stroke was associated with higher risk of incident stroke after moving to a care home (subdistribution hazard ratio 1.83, 95% CI 1.57, 2.13) and 30-day mortality following stroke (odds ratio 2.18, 95% CI 1.59, 2.98). Severe frailty was not significantly associated with risk of stroke or 30-day mortality following stroke. Secondary stroke prevention included statins (50.5%), antiplatelets (61.2%), anticoagulants (52.4% of those with atrial fibrillation), and antihypertensives (92.1% of those with hypertension). CONCLUSIONS AND IMPLICATIONS At the time of care home entry, individuals with history of stroke in the previous 12 months are at a higher risk of incident stroke and mortality following an incident stroke. These individuals are frequently not prescribed medications for secondary stroke prevention. Further evidence is needed to determine the optimal care pathways for older people living in long-term care homes with history of stroke.
Collapse
Affiliation(s)
- Stephanie L Harrison
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Gregory Y H Lip
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales; Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Fatemeh Torabi
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Leona A Ritchie
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Asangaedem Akpan
- Musculoskeletal and Aging Science, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
| | - Julian Halcox
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Sarah Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Joe Hollinghurst
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Daniel Harris
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales; Swansea Bay University Health Board, Swansea, Wales
| | - Deirdre A Lane
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
7
|
Parlapani E, Holeva V, Nikopoulou VA, Kaprinis S, Nouskas I, Diakogiannis I. A review on the COVID-19-related psychological impact on older adults: vulnerable or not? Aging Clin Exp Res 2021; 33:1729-1743. [PMID: 33999378 PMCID: PMC8127443 DOI: 10.1007/s40520-021-01873-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020. AIM To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools. METHOD A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise. RESULTS Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic. CONCLUSIONS Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.
Collapse
Affiliation(s)
- Eleni Parlapani
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece.
| | - Vasiliki Holeva
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece
| | - Vasiliki Aliki Nikopoulou
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece
| | - Stergios Kaprinis
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Diakogiannis
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece
| |
Collapse
|
8
|
Morciano M, Stokes J, Kontopantelis E, Hall I, Turner AJ. Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study. BMC Med 2021; 19:71. [PMID: 33663498 PMCID: PMC7932761 DOI: 10.1186/s12916-021-01945-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.
Collapse
Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK.
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Ian Hall
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Alex J Turner
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|