Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way

Factors influencing long-term care facility performance during the COVID-19 pandemic: a scoping review

BACKGROUND

The COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy.

OBJECTIVE

To build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance.

METHODS

We followed the Joanna Briggs Institute's methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented.

RESULTS

We retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were "efficacy" (75.7%) and "safety" (75.7%). The most common internal factors were "organizational context" (72.9%) and "human resources" (62.1%), and the most common external factors were "visitors" (27.1%) and "public health guidelines" (25.7%).

CONCLUSIONS

Our review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity.

TRIAL REGISTRATION

Research Registry ID: researchregistry7026.

Towards an integrative approach of healthcare: implementing positive health in three cases in the Netherlands

BACKGROUND

The healthcare system is under tremendous pressure. One possible solution towards relieving some of this pressure is to use Positive Health, which takes 'health' as a starting point, rather than 'illness'. Positive Health provides opportunities for stimulating integrated care.

METHODS

Three cases in the Netherlands are studied in this paper. Their way of working with Positive Health is investigated through semi-structured and narrative interviews, using realist-evaluation and thematic analyses.

RESULTS

Seven 'working elements' are identified that enhance the chances of successfully implementing Positive Health in practice (part 1). The interviews show that healthcare professionals have noticed that people adopt a healthier lifestyle and gain a greater degree of control over their own health. This boosts job satisfaction for healthcare professionals too. The organisations and professionals involved are enthusiastic about working with Positive Health, but still experience barriers (part 2).

CONCLUSIONS

The results of this study imply that implementing Positive Health in practice can facilitate collaboration between organisations and professionals from different disciplines, such as healthcare, welfare, and municipal health services. Operating from the perspective of a shared goal, professionals from different disciplines will find it easier to jointly organise activities to foster citizens' health. Additionally, more attention is paid to non-medical problems affecting people's well-being, such as loneliness or financial problems.

Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná

OBJECTIVE

To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná.

METHOD

Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model.

RESULTS

A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93).

CONCLUSION

The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.

Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks

BACKGROUND

Residential InReach presents an alternative to hospital admission for aged care residents swabbed for COVID-19, though relative outcomes remain unknown.

AIMS

To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' ('sCOVID'), including hospital vs InReach-based care.

METHODS

Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April-October 2020 (pre-vaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative.

RESULTS

There were no significant differences in age, gender, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. 28-day mortality was similar between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (p=0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (p<0.001), delirium (p<0.001), hospital transfer for acuity (p=0.02; but not public health/facility reasons), CFS (p=0.04), prior ischaemic heart disease (p=0.01) and dementia (p=0.02). For COVID-19 patients, 28-day mortality was associated with initial oxygen saturation (p=0.02), delirium (p<0.001), and hospital transfer for acuity (p=0.01), but not public health/facility reasons.

CONCLUSION

Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity. This article is protected by copyright. All rights reserved.