Family Communication in Long-Term Care During a Pandemic: Lessons for Enhancing Emotional Experiences

Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review

PURPOSE

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic.

METHODS

A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof).

RESULTS

After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes.

CONCLUSION

Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

U.S. nursing home leadership experiences with COVID-19 and its impact on residents and staff: A qualitative analysis

OBJECTIVES

To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff.

DESIGN

Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach.

SETTING AND PARTICIPANTS

A stratified sample frame defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022.

RESULTS

Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions.

CONCLUSIONS AND IMPLICATIONS

New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.

Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review

BACKGROUND

In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions.

OBJECTIVE

The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages.

METHODS

A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine.

RESULTS

Overall, patients' families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations.

CONCLUSIONS

Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice.

The impact of protective measures against COVID-19 on the wellbeing of residents in nursing homes and their relatives: a rapid review

During the COVID-19 pandemic and compared to other population groups, older people were at a heightened risk of developing lethal disease symptoms. Thus, many countries put in place protective measures to protect this "at-risk" population, especially in nursing homes, to limit the number of infections. These measures consisted mostly in the absence of social gatherings, the impossibility for relatives to enter the nursing homes, limitations in group activities, and the ban of group-eating. Although these measures were helpful to mitigate the spread of the disease, they also induced long periods of social isolation for the residents of nursing homes. This could have impacted the wellbeing and quality of life of residents and their relatives, with a possible impact on the overall health of residents. We designed this rapid review to investigate the literature on the impact of COVID-19 protective measures in nursing homes on the quality of life, wellbeing and physical health of residents and their relatives. Our results showed that most of the articles included in the review, either using qualitative or quantitative methods, evidenced a detrimental impact of protective measures on resident's and their relatives' wellbeing. We argue that, in the event of a new pandemic similar to the COVID-19, protective measures should also take into account their psychological impact, and not only their physical impact.

Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies

BACKGROUND

The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy.

OBJECTIVE

This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic.

METHODS

In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication & Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised.

RESULTS

In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable).

CONCLUSIONS

Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study's findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/36269.

Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic

OBJECTIVES

COVID-19-related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents' loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness.

DESIGN

National survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5).

SETTINGS AND PARTICIPANTS

US Nursing Home Directors of Nursing/Administrators (n = 1676).

METHODS

The survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results.

RESULTS

One-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues.

CONCLUSIONS AND IMPLICATIONS

Despite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents' social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.

Intergenerational solidarity with digital communication and psychological well-being among older parents during the COVID-19 pandemic

We aimed to identify intergenerational solidarity (emotional closeness, in-person contact, phone contact, geographic proximity, consensus, and conflict) with digital communication (texting, video call, and social media interaction) with adult children among older parents during the COVID-19 pandemic. In addition, we aimed to investigate whether intergenerational solidarity with digital communication latent classes were associated with older parents' psychological well-being. We used the 2022 survey of the Longitudinal Study of Generations (LSOG). The sample consisted of 519 older parents who reported about 1245 adult children. Two-level latent class analysis identified six classes at the child level (Level 1: distant but digitally connected, tight-knit and digitally connected, tight-knit traditional, detached, intimate but distant, and sociable). In addition, the analysis identified three classes at the parent level (Level 2: digitally connected, mixed, and intimate but distant). Results of multivariate regression showed that older parents in the digitally connected latent class had better psychological well-being than those in the mixed latent class. Consequently, our finding indicates that digital solidarity with adult children can be beneficial for older parents' psychological well-being during the COVID-19 pandemic.

Design, synthesis, and evaluation of hydrazones as dual inhibitors of ryanodine receptors and acetylcholinesterases for Alzheimer's disease

Alzheimer's disease (AD) implicates neuronal loss, plaque and neurofibrillary tangle formation, and disturbed neuronal Ca²⁺ homeostasis, which leads to severe dementia, memory loss, as well as thinking and behavioral perturbations that could ultimately lead to death. Calcium dysregulation and low acetylcholine levels are two main mechanisms implicated in Alzheimer's disease progression. Simultaneous inhibition of calcium oscillations (store overload-induced Ca²⁺ release [SOICR]) and acetylcholinesterase (AChE) by a single molecule may bring a new breath of hope for AD treatment. Here, we described some dantrolene derivatives as dual inhibitors of the ryanodine receptor and AChE. Two series of acylhydrazone/sulfonylhydrazone derivatives with aromaticgroup were designed and synthesized. In this study, the target compounds were evaluated for their ability to inhibit SOICR and AChE in vitro, using dantrolene and donepezil as positive controls. Compound 22a exhibited excellent and balanced inhibitory potency against SOICR (inhibition (%) = 90.1, IC₅₀ = 0.162 μM) and AChE (inhibition (%) = 93.5, IC₅₀ = 0.372 μM). Docking simulations showed that several preferred compounds could bind to the active sites of both the proteins, further validating the rationality of the design strategy. Potential therapeutic effects in AD were evaluated using the Barnes maze and Morris water maze tests, which demonstrated that compound 22a significantly improved memory and cognitive behavior in AD model mice. Moreover, it was also found that compound 22a could enhance synaptic strength by measuring hippocampal long-term potentiation (LTP) in brain slices. These results suggested that the introduction of a sulfonyl-hydrazone scaffold and aromatic substitution to dantrolene derivatives provided a useful template for the development of potential chemical entities against AD.

2023 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.

Navigating the COVID-19 pandemic together: Discussions between persons with early-stage dementia and their adult children

OBJECTIVES

Studies have separately examined the health impacts of the COVID-19 pandemic on persons with dementia and their caregivers. Less attention has been paid to the social and emotional impacts of the pandemic in this population or how these individuals are mutually coping with the pandemic. Guided by the social citizenship theory, this qualitative study sought to characterize how persons with dementia and their adult children are coping during this time with a focus on the strengths demonstrated by persons with dementia.

METHODS

Participants were 43 dyads of individuals aged 55 and older with early-stage dementia and their adult children. Discussions between parent-child dyads were recorded. Using reflexive thematic analysis, themes related to social and emotional impacts of the pandemic and coping strategies were identified.

RESULTS

Adult children shared with their parents how the pandemic resulted in reduced social engagement and challenging work arrangements. Dyads described how the pandemic positively impacted their relationship, allowing some of them to spend more time together. In coping with the pandemic, adult children provided instrumental support to their parents and parents reciprocated with emotional support. Participants also coped by making meaning of their situation during discussions.

CONCLUSIONS

Findings characterize the resilience of persons with dementia and the mutuality of the relationship between both members of the care partner dyad, as both parents and adult children offered support to one another. Facilitating dyadic discussions may be a cost-effective way to sustain social connections and offer ongoing coping support through the pandemic or other challenging circumstances.

Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study

BACKGROUND

The COVID-19 pandemic has significant impact on long-term care (LTC) residents' health and well-being.

OBJECTIVES

This study investigated resident experiences of loneliness during the COVID-19 pandemic in Canadian LTC homes to offer lessons learned and implications.

METHODS

15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one-on-one semi-structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes.

RESULTS

Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity.

CONCLUSIONS

Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences.

IMPLICATIONS FOR PRACTICE

Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents' experiences of loneliness due to social isolation and/or grief and enhance their quality of life.

COVID-19 Experiences of Relatives of Nursing Home Residents

Nursing home residents comprise a disproportionate share of coronavirus-related deaths in the United States. Additionally, lockdown restrictions disrupted residents' relationships with their family members to an unknown extent. This study explored family members' perceived family role and interactions with nursing home residents and staff during the COVID-19 pandemic. Using a qualitative descriptive approach, 10 family members were interviewed using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, and data were analyzed using Braun and Clarke's Reflexive Thematic analysis. Themes and subthemes indicated that family members accounted for residents' care in new ways, found existing relationships becoming amplified under stress, maintained connections through creative alternatives, and also felt powerless to provide care, despite their knowledge and experience. Family members increasingly relied on staff to meet residents' care needs and provide updates, and often desired to provide assistance and companionship beyond what policy permitted, representing a major opportunity for improving experiences.

Digital and Non-Digital Solidarity between Older Parents and Their Middle-Aged Children: Associations with Mental Health during the COVID-19 Pandemic

We incorporated intergenerational digital communication (frequency of texting, video call, and social media interaction) into the intergenerational solidarity paradigm and identified new types of intergenerational and digital solidarity with adult children among older parents during the COVID-19 pandemic. In addition, we examined whether those types are associated with older parents' mental health (depressive symptoms, psychological well-being, and self-esteem). We used the 2021/2022 wave of the Longitudinal Study of Generations (LSOG), and a sample of 519 older parents (mean age = 69 years). Latent class analysis identified four classes describing intergenerational and digital solidarity with adult children (distant-but-digitally connected, tight-knit-traditional, detached, and ambivalent). We found that older parents who had distant-but-digitally connected and tight-knit-traditional relationships with their adult children reported better mental health, compared to those who had detached and ambivalent relationships with their adult children during the COVID-19 pandemic. Our findings suggest that intergenerational digital communication should be considered as a digital solidarity in intergenerational solidarity paradigm, which is useful for measuring multidimension of intergenerational relationships within family members during and after the pandemic.

Long-term impact of the COVID-19 pandemic on facility- and home-dwelling people with dementia: Perspectives from professionals involved in dementia care

Aim

The present study aimed to investigate the impact of the coronavirus disease 2019 (COVID‐19) pandemic on facility‐ and home‐dwelling people with dementia (PWD).

Methods

This observational study included two anonymous online survey questionnaires to explore the impact of the first wave of the COVID‐19 pandemic in Japan and the long‐term impact during the 2 years from the onset of the pandemic. The participants were medical and long‐term care facilities representatives for older people (945 facilities in the first survey, 686 in the second), and care managers (751 in the first survey, 241 in the second). A χ²‐test was carried out between the two surveys.

Results

For facility‐dwelling PWD, activities that stimulate cognitive and physical functioning increased significantly compared with the first wave of the pandemic (P < 0.05). Also, a decline in cognitive and walking functions and falls increased in the second survey compared with the first (P < 0.01). For home‐dwelling PWD, the broader impact of the pandemic on support for activities of daily living, social interaction and provision of medical care did not mitigate. The high prevalence of cognitive and physical functional decline in the first survey was similar in the second.

Conclusions

The prolonged COVID‐19 pandemic produced changes in the lives of home‐ and facility‐dwelling PWD, with widespread negative consequences for them. Our findings are useful to consider preventive supports to mitigate or avoid functional decline and symptom exacerbation in PWD due to changes in their living environment and the care they receive in the COVID‐19 era. Geriatr Gerontol Int 2022; 22: 832–838.

Family member roles in long term care: Lessons for the future from COVID-19

This study investigates nursing home residents' and care partners' experiences during COVID-19 visitation restrictions. A nonprobability purposive sample of care partners was recruited via social media and email listservs. Care partners completed surveys (N = 30) and follow-up interviews (n = 17). Before COVID-19, care partners visited residents 3+ times per week for socialization and care. After restrictions, communication between care partners and nursing homes deteriorated. Families experienced reduced communication about residents' health statuses and little COVID-19 case information. Care partners expanded their advocacy roles, proposing policies to protect residents' rights. Care partners reported losing irreplaceable time with residents during restrictions. In future emergencies, we must balance the value of family visits with public health protection such as personal protective equipment (PPE).

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.

Relatives' perspectives on encounters and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

Background

Relatives of nursing home (NH) residents have experienced national or local restrictions on visiting their elderly family member during the Covid-19 pandemic. Today, many NHs have a multicultural environment, as staff, residents and their relatives speak different languages. Thus far, studies of remote communication with staff with limited language skills during the Covid-19 pandemic are lacking.

Aim

The aim of the present study was to explore relatives’ experiences of encounters and communication with staff and residents in NHs during the Covid-19 pandemic.

Method

An explorative qualitative study using semi-structured telephone interviews with 17 relatives of NH residents (12 women and 5 men). Data were analyzed using qualitative content analysis to identify four main categories and nine sub-categories.

Results

Communicating during visiting restrictions was challenging, and relatives experienced ups and downs when trying to stay in contact with NH residents and staff. Relatives received general information, but desired information about residents’ everyday life without having to ask for it. Moreover, remote communication was difficult for residents with hearing impairment or dementia. Even relatives who understood different languages had to develop strategies to communicate with staff with limited language skills in Swedish and English. Relatives did not mention using translating applications to facilitate communication.

Conclusion

During visiting restrictions, relatives lacked information about residents’ everyday life and found communication with staff with limited language skills challenging. For this reason, and to enable communication with staff with limited language skills, there is a need to find practical and technical solutions for facilitating remote communication between relatives, residents and staff at NHs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03364-1.

The influence of the down- and upscaling of activities in long-term care facilities during the COVID-19 visitor ban on caregivers' exhaustion and ability to provide care and support: A questionnaire study

In the Netherlands, a national visitor-ban was in place in LTCFs during the first outbreak of COVID-19 in 2020. Meaningful activities were cancelled or downscaled, while others were performed more often. It is known that a lack of activities has several negative effects on residents, while the impact on caregivers remains largely unexplored. Here we investigate the influence of the down- and upscaling of activities on caregivers' physical and emotional exhaustion and their perceived ability to provide care and support. Downscaling of activities for residents, in particular watching television and musical activities, had a negative impact on caregivers' emotional exhaustion. The downscaling of watching television increased caregivers 'physical exhaustion. Furthermore, the downscaling of both activities had a negative impact on caregivers' perceived ability to provide ADL care and emotional support. This study triggers the need for more knowledge about the function of meaningful activities for residents, from a LTCF caregivers' perspective.

Loneliness during COVID-19: Development and influencing factors

In early pandemic waves, when vaccination against COVID-19 was not yet an option, distancing and reduced social contact were the most effective measures to slow down the pandemic. Changes in frequency and forms of social contact have reduced the spread of the COVID-19 virus and thus saved lives, yet there is increasing evidence for negative side effects such as mental health issues. In the present study, we investigate the development of loneliness and its predictors to examine the role of changes in social networks due to social distancing and other COVID-19-related life changes. A total of 737 participants (age range = 18-81 years) completed an online survey in three waves during the last quarter of 2020 at one-month intervals. Latent growth and multilevel modeling revealed that emotional loneliness increased over time, while social loneliness remained stable. Moreover, socially lonely individuals were likely to also develop emotional loneliness over time. Increased social distancing and sanitary measures were accompanied by decreased social interactions and loss of individuals considered SOS contacts and confidants. Changes in specific social network indicators were differentially associated with changes in emotional vs social loneliness: Loss of friends considered confidants was associated with increasing emotional loneliness, whereas loss of friends considered SOS contacts and reduced overall social interactions were related to increasing social loneliness. Lastly, individuals with more family-and-friend SOS contacts, more friends as confidants and an overall higher number of social interactions were more protected from feeling socially or emotionally lonely. Study findings enhance the understanding of underlying mechanisms differentially contributing to social and emotional loneliness and offer practical suggestions to reduce mental-health side effects of social distancing.

2022 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.

"Precious Time Together Was Taken Away": Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers

During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being.

Perceived changes in social contact during COVID-19 pandemic in the United States

The COVID-19 pandemic and its restrictions have led to a shift in how people connect with others. This study investigated (a) profiles of social contact change across social ties and modes of contact, (b) predictors of these profiles, and (c) the association between these profiles and mental health during the pandemic. Participants (N = 2,098; Age mean = 50.94, range = 18-98; 48.3% female) were surveyed online twice, once prior to the pandemic (January 31-February 10, 2020) and again early in the outbreak (March 18-29, 2020). A latent profile analysis identified profiles of social contact change across social ties and communication methods. Additional analyses identified predictors of group membership and their association with mental health. Three latent groups were identified: (1) the "majority group" (77%) slightly restricted in-person contact and had a small increase in phone and text use, (2) the "high technology use group" (13%) restricted in-person contact and increased the use of all technology-based methods, and (3) the "isolated group" (10%) decreased in both in-person and technology-based contact. Compared to the majority group, the high technology use group reported higher depression and anxiety, whereas the isolated group reported higher loneliness. There were three distinct profiles of how adults in the United States changed their communication patterns with others early in the pandemic that were linked to distinct patterns of mental health. The results have implications for the development and the delivery of mental health treatment in times of social (physical) distancing.

How Did the Pandemic Affect Communication in Clinical Settings? A Qualitative Study with Critical and Emergency Care Nurses

The objective of the present study was to determine the subjective impact of the pandemic due to COVID-19 on communication, as perceived by nurses working at emergency services and Intensive Care Units at various hospitals in the Region of Murcia (Spain). A qualitative study was conducted based on the content analysis of 12 semi-structured individual interviews. The participant recruitment process was performed through a snowball sampling technique. Four main dimensions, eleven categories, and two sub-categories were obtained: (1) communication (communicative expressions, both verbal and non-verbal-, and limitations); (2) emotional aspects (positive, negative); (3) overload (first wave, second wave, and third wave); and (4) relationships (health professionals-patients, healthcare professionals, patients-family, and family-health professionals). The main findings of the study show that communication was slightly affected during the pandemic, especially the non-verbal kind, with verbal communication maintained and, in some occasions, strengthened. The lack of training in communication skills and its influence on the management of difficult periods was another important finding. Communication in general deteriorated during the pandemic, especially during the initial waves. Non-verbal communication was more affected due to the use of Personal Protective Equipment and the initial fear of infection, with this finding strongly observed in departments such as emergencies or critical care. The nurses who were interviewed underlined negative emotional aspects associated with a deficit in communication. The positive aspects described were associated with the creation of mutual support spaces and the group cohesion of the work teams during the pandemic. As an implication for current and future clinical practice, we recommend a coordinated institutional response to mitigate the potential emotional effects on workers by designing appropriate communication and emotional expression protocols.

Care for dementia patients and caregivers amid COVID-19 pandemic

BACKGROUND

Multiple efforts have been taken across the world to bridge gaps in evidence and provide recommendations for dementia care and caregiver support during the COVID-19 pandemic. We aimed to review the available literature on measures used to alleviate the negative impacts of the pandemic on dementia care.

METHODS

We searched three databases: PubMed, CINAHL and PsycINFO to identify studies that described strategies that were recommended or taken to provide care and support to persons with dementia and their caregivers during the COVID-19 pandemic.

RESULTS

We included a total of 37 papers, originating from high, middle and low-income countries. We also included 6 papers exploring safety of COVID-19 vaccinations. Infection prevention recommendations predominantly involved providing consistent reminders to persons with dementia to engage in infection prevention measures and included measures to restrict wandering in long-term care settings to reduce spread of infection. Medical care included tele and video consultations to maintain and monitor clinical stability. Guidance for continuing rehabilitation activities for persons with dementia through remotely conducted cognitive stimulating activities, physical exercises and environmental modifications were further highlighted by multiple studies/articles. In addition, strategies to support caregivers were also advised and included teleconsultations and psycho-educational programs.

CONCLUSION

The COVID-19 pandemic has exposed gaps in health and social care systems across the world, but has also revealed the enduring dedication of clinicians, expert groups and dementia support organizations to modify and adapt existing dementia care services to meet the needs of persons with dementia and their caregivers during periods of emergency.

COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From an Online Survey with Long-Term Care Administrators

Background

The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them.

Objective

This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic.

Methods

LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic.

Results

LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology.

Conclusions

Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic.

Facility and Family Communication during the COVID-19 Visit Restriction: Early Perspectives of Family Members

During the COVID-19 pandemic, family concerns regarding residents in long-term care facilities (LTCFs) increased due to a high proportion of COVID cases and deaths among residents and restrictions that made it impossible to visit. These changes created numerous challenges for facilities communicating with families, and between families and residents. However, little is known about how these facilities addressed these communication challenges and how those communication strategies were related to family perceptions about the facility. We implemented an online survey of family members or friends of residents in LTCFs from April 28 to June 19, 2020, using convenience sampling. A total of 174 responses nationwide reported the types of communications used, frequency of communication and alternative visits, and whether respondents had peace of mind, would recommend the facility, or were considering removing the resident from the facility. The results of our hierarchical logistic regression showed that respondents felt greater peace of mind when there were multiple communication channels to contact the resident. Also, respondents had more negative perceptions of a facility when they were not informed about confirmed COVID cases. Our findings suggest multiple communication channels and transparency about COVID status were effective in keeping positive family perceptions about the facility.

Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey

BACKGROUND

The geriatric population is supposed to be at high risk for psychological distress as well as adverse outcomes and mortality during the COVID-19 pandemic. This study aimed to investigate the levels of depression, anxiety, death anxiety and life satisfaction levels and factors related to life satisfaction in individuals aged 65 years and older during the pandemic and to compare these variables between nursing home (NH) and community-dwelling older adults.

METHOD

This study has a cross-sectional and descriptive design, and a total of 133 nursing NH and community-dwelling older adults were enrolled in the study. Turkish death anxiety scale (TDAS), life satisfaction scale (SLS) and depression anxiety stress scale-21 (DASS-21) were used for the assessment.

RESULTS

The majority of the older adults had no or mild depression, anxiety and stress symptoms in spite of the prolonged confinements, and were slightly satisfied with their lives. However, depression, anxiety, stress and TDAS levels were higher in participants aged 80 years and older. Residents of NHs had higher TDAS, depression and anxiety levels and lower SLS levels than community-dwelling older adults. Participants who were meeting their children and/or grandchildren less than 2 h a week, were found to have significantly lower SLS and higher depression scores. The increase in depression and TDAS scores predicted a decrease in SLS scores in older adults.

CONCLUSIONS

As NH resident older adults have higher psychological distress and decreased life satisfaction due to the social isolation caused by the prolonged confinements, NH staff should be regularly informed on both preventive measures and mental health consequences of the pandemic, and should be trained for basic therapeutic interventions. Older adults should be supported to use telecommunication technologies to contact their families and friends, and participate in safe and accessible person-centred activity programs.

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

OBJECTIVES

In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research.

METHODS

We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature.

RESULTS

Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies.

CONCLUSIONS

The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.

Changes in older adults' social contact during the COVID-19 pandemic

Objectives

To understand changes during the coronavirus disease 2019 (COVID-19) pandemic in weekly contact with nonresident family and friends for U.S. adults aged 70 and older in residential care and community settings.

Methods

Participants in the National Health and Aging Trends Study COVID-19 mail supplement (N = 3,098) reported frequency of phone, electronic, video, and in-person contact with nonresident family and friends in a typical week before and during the pandemic. We examined less than weekly contact by mode for those in residential care settings and community residents with and without limitations. We estimated multinomial logit models to examine predictors of change to less than weekly contact (vs. maintaining weekly or more contact) by mode, overall, and stratified by setting.

Results

Weekly in-person contact fell substantially (from 61% to 39%) and more so in residential care (from 56% to 22%), where nearly 4 in 10 transitioned to less than weekly in-person contact (doubling to 8 out of 10). Weekly or more contact was largely stable for electronic and telephone modes across settings. Weekly or more video contact increased mainly for community residents without limitations. Compared to community residents without limitations, those in assisted living or nursing homes had more than 5 times the odds (adjusted odds ratio [AOR] = 5.3; p = .01) of changing to less than weekly in-person contact; those in independent living also had higher odds of changing to less than weekly in-person (AOR = 2.6; p = .01) and video (AOR = 3.4; p = .01) contact.

Discussion

The pandemic revealed the importance of ensuring that communication technologies to maintain social ties are available to and usable by older adults, particularly for those living in residential care settings.

Change in mental health, physical health, and social relationships during highly restrictive lockdown in the COVID-19 pandemic: evidence from Australia

BACKGROUND

A novel coronavirus first reported in Wuhan City in China in 2019 (COVID-19) developed into a global pandemic throughout 2020. Many countries around the world implemented strict social distancing policies to curb the spread of the virus. In this study we aimed to examine potential change in mental/physical health and social relationships during a highly restrictive COVID-19 lockdown period in Australia during April 2020.

METHODS

Our survey (n = 1, 599) included questions about concerns, social behaviour, perceived change in relationship quality, social media use, frequency of exercise, physical health, and mental health during COVID-19 lockdown (April, 2020).

RESULTS

When estimating their mental health for the previous year 13% of participants reported more negative than positive emotion, whereas this increased to 41% when participants reflected on their time during COVID-19 lockdown. A substantial proportion (39-54%) of participants reported deterioration in mental health, physical health, financial situation, and work productivity. However, most of these participants reported 'somewhat' rather than 'a lot' of deterioration, and many others reported 'no change' (40-50%) or even 'improvement' (6-17%). Even less impact was apparent for social relationships (68% reported 'no change') as participants compensated for decreased face-to-face interaction via increased technology-mediated interaction.

CONCLUSIONS

The psychological toll of COVID-19 on Australians may not have been as large as other parts of the world with greater infection rates. Our findings highlight how technology-mediated communication can allow people to adequately maintain social relationships during an extreme lockdown event.

2021 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety

The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.

[Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review]

Hintergrund

Die COVID-19-Pandemie stellt Bewohner von Altenpflegeeinrichtungen, deren Angehörige bzw. Besucher ebenso wie Mitarbeitende vor große Herausforderungen. Viruseindämmende Maßnahmen wirken sich stark auf das Wohlbefinden der betroffenen Personengruppen aus.

Material und Methode

Systematische Literatursuche nach Studien zu psychosozialen Folgen der Pandemie für Bewohner, deren Angehörige bzw. Besucher sowie Mitarbeitende und Zusammenführung der Ergebnisse mittels narrativer Synthese.

Ergebnisse

Es wurden 756 Studien gesichtet, davon 15 Arbeiten eingeschlossen. Die Daten wurden zwischen Februar und Juni 2020 mit Teilnehmenden aus 14 Ländern erhoben. Es wurden v. a. Einsamkeit, Trauer und Depressivität, aber auch Angst, als häufige Reaktionen der Bewohner auf die Kontakt- und Besuchsrestriktionen berichtet. Bewohner mit kognitiven Einschränkungen litten stärker unter den Auswirkungen, auch wenn es gegenteilige Hinweise gibt. Angehörige bzw. Besucher berichteten ebenfalls von einer Zunahme ihrer Einsamkeit und einer reduzierten Lebensqualität. In den Befragungen der Mitarbeitenden schildern diese Angst vor einer Infektion sowohl bei sich als auch bei den Bewohnern. Infizierte Mitarbeitende in den USA äußerten Wut darüber, nicht ausreichend geschützt worden zu sein. Darüber hinaus berichteten Mitarbeitende von einer erheblichen Mehrbelastung.

Schlussfolgerung

Infolge der Pandemie und der ergriffenen Maßnahmen wurden negative psychosozialen Folgen bei Bewohnern, deren Angehörigen bzw. Besuchern und den Mitarbeitenden berichtet. Die abzuleitenden Unterstützungsbedarfe der 3 Personengruppen sind unterschiedlich und sollten bei zukünftigen Maßnahmen hinsichtlich der Pandemie stärker mitevaluiert werden.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00391-021-01859-x) enthält eine Übersicht über die Suchstrategie und eine Übersicht über die Auswahlkriterien und eine Auflistung der eingeschlossenen Studien. Beitrag und Zusatzmaterial stehen Ihnen im elektronischen Volltextarchiv auf https://www.springermedizin.de/zeitschrift-fuer-gerontologie-und-geriatrie/7952776 zur Verfügung. Sie finden das Zusatzmaterial am Beitragsende unter „Supplementary Material“.