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San Martín-Erice I, Escalada-Hernández P, García-Vivar C, Furtado-Eraso S, San Martín-Rodríguez L, Soto-Ruiz N. How did COVID-19 lockdown impact the health of older adults in nursing homes? A scoping review. BMC Geriatr 2024; 24:760. [PMID: 39277726 PMCID: PMC11401423 DOI: 10.1186/s12877-024-05356-9] [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] [Received: 04/12/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on older adults in nursing homes is significant, with high death rates, disrupted care, isolation measures, and inadequate treatment. Social isolation has increased risks of cognitive disorders, anxiety, and depression. While many studies have examined the pandemic's effects on nursing home staff and residents' families, less is known about the health consequences for the residents themselves. This review aims to synthesize literature on the COVID-19 lockdown's impact on the functional, cognitive, and psycho-emotional states of older adults in nursing homes. METHODS A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA extension for Scoping Reviews (PRISMA-ScR). Four databases were searched: CINAHL, PubMed, Web of Science, and PsycINFO. The eligibility criteria included studies on older adults in nursing homes during the COVID-19 pandemic, with data that could be disaggregated for this population and results on the lockdown's impact on physical, cognitive, and psycho-emotional levels. RESULTS Seventeen articles met the criteria for data extraction The synthesis was categorized into four main areas: functional, cognitive and psycho-emotional status, and isolation measures. Key findings included decreased functional abilities, lower cognitive test scores during the pandemic's first waves, development of psychological symptoms, and increased negative feelings among residents. CONCLUSIONS Highlighting the consequences of confinement for nursing home residents is essential for updating evidence, developing effective strategies, and establishing protocols to mitigate the impact and prevent health issues in future pandemics.
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Affiliation(s)
- Isabel San Martín-Erice
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain.
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Sara Furtado-Eraso
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. de Barañain S/N, Pamplona, Navarra, 31008, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Ariander A, Olaison A, Andersson C, Sjödahl R, Nilsson L, Kastbom L. Ethical challenges causing moral distress: nursing home staff's experiences of working during the COVID-19 pandemic. Scand J Prim Health Care 2024; 42:266-275. [PMID: 38334427 PMCID: PMC11003312 DOI: 10.1080/02813432.2024.2308573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic. DESIGN Individual interviews. Latent qualitative content analysis. SETTING Ten nursing homes in Sweden. SUBJECTS Physicians, nurses and nurse assistants working in Swedish nursing homes. MAIN OUTCOME MEASURES Participants' experiences of working in nursing homes during the COVID-19 pandemic. RESULTS Four manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories. CONCLUSION During the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce.
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Affiliation(s)
- Annaclara Ariander
- Primary Health Care Centre in Johannelund and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | | | - Rune Sjödahl
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Sennfält S, Hedman C, Fürst CJ. Associations between the spread of COVID-19 and end-of-life circumstances in the non-infected population of Sweden. Scand J Public Health 2024; 52:290-298. [PMID: 38153142 PMCID: PMC11067408 DOI: 10.1177/14034948231216197] [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] [Received: 02/26/2023] [Revised: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
AIMS Since its outbreak in 2020, the COVID-19 pandemic has directly caused the premature death of millions. However, indirect consequences, such as social restrictions, have affected a far greater number. We explored the association between the spread of COVID-19 and end-of-life circumstances in the infected and non-infected population in Sweden. METHODS In this descriptive, population-based, observational study, we primarily used data from the Swedish National Registry of Palliative Care, which covers about 60% of all deaths in Sweden. We explored the association between the spread of COVID-19 and place of death, people present at death and end-of-life symptoms using regression analyses. RESULTS The study included 190,291 individuals who died in any region of Sweden from 1 January 2019 to 30 June 2022, of which 10,646 were COVID-19 cases. Correlated to the temporal and geographical spread of COVID-19, there was a greater proportion of individuals dying without the presence of their next-of-kin, and consequently more people dying alone, both in those with and without COVID-19. There was a similar pattern of a greater proportion of deaths taking place in nursing homes and in the individual's own home. However, we did not find substantial associations to reported symptoms, such as anxiety or confusion. CONCLUSIONS This study shows the profound effects of the COVID-19 pandemic on end-of-life circumstances in both the infected and non-infected population in Sweden. As we prepare for future pandemics, there is a need to develop strategies to minimise the impact on non-infected individuals.
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Affiliation(s)
- Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Christel Hedman
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Sweden
| | - Carl Johan Fürst
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
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Blotière PO, Maura G, Raitanen J, Pulkki J, Forma L, Johnell K, Aaltonen M, Wastesson JW. Long-term care use, hospitalizations and mortality during COVID-19 in Finland and Sweden: A nationwide register-based study in 2020. Scand J Public Health 2024; 52:345-353. [PMID: 38481014 PMCID: PMC11067386 DOI: 10.1177/14034948241235730] [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: 07/31/2023] [Revised: 02/02/2024] [Accepted: 02/10/2024] [Indexed: 05/04/2024]
Abstract
AIM To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018-2019 period and community-living individuals. METHODS From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Swedish study populations in January 2018 as the standard population, we reported changes in sex- and age-standardized monthly rates of entry into and exit from LTC facilities, mortality and hospital admission among LTC residents and community-living individuals in 2020. RESULTS Around 850,000 Finns and 1.4 million Swedes 70+ were included. LTC use decreased in both countries from 2018 to 2020. In the first wave (March/April 2020), Finland experienced a decrease in LTC entry rates and an increase in LTC exit rates, both more marked than Sweden. This was largely due to short-term movements. Mortality rates peaked in April and December 2020 for LTC residents in Finland, while mortality peaked for both community-living individuals and LTC residents in Sweden. A decrease in hospital admissions from LTC facilities occurred in April 2020 and was less marked in Finland versus Sweden. CONCLUSIONS During the first wave of the pandemic mortality was consistently higher in Sweden. We also found a larger decrease in LTC use and, among LTC residents, a smaller decrease in hospital admissions in Finland than in Sweden. This study calls for assessing the health consequences of the differences observed between these two Scandinavian countries as part of the lessons from the COVID-19 pandemic.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Géric Maura
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jonas W. Wastesson
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Sweden
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Sanftenberg L, Hoerger A, Mayr K, Nassehi A, Wildgruber D, Hausen A, Janke C, Hoelscher M, Hindenburg D, Eidenschink C, Rink L, Sebastião M, Teupser D, Kosub H, Zoellinger I, Dreischulte T, Gensichen J. ["…Not Even in The Corridor!" - Subjective Perception Of Institutional Measures During The Covid-19 Pandemic Of Nursing Home Residents: A Qualitative Study]. DAS GESUNDHEITSWESEN 2024; 86:247-253. [PMID: 38335992 DOI: 10.1055/a-2189-2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND In the context of the Covid-19 pandemic, institutional measures were decreed to protect nursing home residents from infection. Their appropriateness has been a subject of controversy. The aim of this work was to better understand the subjective perception of the protective measures during the Covid-19 pandemic by the nursing home residents in Bavaria and to shed light on the role of nursing staff and general practitioners in coping with the crisis. METHODS Semi-structured interviews were conducted with residents of inpatient long-term care facilities. Data analysis was carried out by means of structured content analysis according to Kuckartz. RESULTS A total of ten nursing home residents with various degrees of care were interviewed, five of whom had already been infected with Covid-19 at the time of the survey. The respondents reported, on the one hand, their need for protection and, on the other hand, the isolation they experienced during the pandemic. Trust in the care provided by the nursing staff was emphasized. A reliable personal contact to already known general practitioners was missing. CONCLUSION The role of nurses and general practitioners deserves more attention and may be a key to better acceptance and management of such crisis situations.
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Affiliation(s)
- Linda Sanftenberg
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Anja Hoerger
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Katharina Mayr
- Institut für Soziologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Armin Nassehi
- Institut für Soziologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Domenika Wildgruber
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Germany
| | - Anita Hausen
- Katholische Stiftungshochschule München, University of Applied Sciences, München, Germany
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Christian Janke
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Michael Hoelscher
- Abteilung für Infektions- und Tropenmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Dagmar Hindenburg
- Institut für Allgemeinmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Laura Rink
- Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen, Erlangen, Germany
| | - Maria Sebastião
- Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen, Erlangen, Germany
| | - Daniel Teupser
- Institut für Laboratoriumsmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Helena Kosub
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Isabel Zoellinger
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Tobias Dreischulte
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Germany
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Coffey KC, Lydecker AD, Roghmann MC. What did nursing home residents think about COVID-19 prevention practices in the era of vaccination and treatment? Am J Infect Control 2023; 51:1452-1454. [PMID: 37295672 PMCID: PMC10247293 DOI: 10.1016/j.ajic.2023.06.006] [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] [Received: 04/14/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
We surveyed 57 nursing home residents to assess the subjective impact of COVID-19 prevention practices. Residents were mostly accepting of testing and symptom screening; however, many would like more choices. Sixty-nine percent want to have some say in when or where to mask. Most (87%) residents want to return to group activities. Residents on long-stay units (58%) are more likely than residents on short-stay units (27%) to accept additional risk of COVID-19 transmission to increase their quality of life.
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Affiliation(s)
- K C Coffey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore, MD
| | - Alison D Lydecker
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore, MD
| | - Mary-Claire Roghmann
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore, MD.
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Urlings JHJ, Backhaus R, Verbeek H, de Boer B, Koopmans RTCM, Gerritsen DL, Hamers JPH. After COVID-19 vaccinations: what does living and working in nursing homes look like? BMC Geriatr 2023; 23:298. [PMID: 37193994 PMCID: PMC10186323 DOI: 10.1186/s12877-023-03987-y] [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: 06/11/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.
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Affiliation(s)
- Judith H J Urlings
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- De Waalboog "Joachim en Anna", Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Joseph CA, Kobayashi LC, Frain LN, Finlay JM. "I Can't Take Any Chances": A Mixed Methods Study of Frailty, Isolation, Worry, and Loneliness Among Aging Adults During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:789-799. [PMID: 36621930 PMCID: PMC9850116 DOI: 10.1177/07334648221147918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Little is known about how frailty has shaped experiences of living through the COVID-19 pandemic. In this cross-sectional mixed methods study, we analyzed data from the nationwide COVID-19 Coping Study from December 2020 through January 2021 (N = 2094 US adults aged ≥55) to investigate quantitative associations between frailty and the prevalence of physical isolation, worry about COVID-19, and loneliness. Reflexive thematic analysis explored aging adults' lived experiences of frailty during the pandemic. In multivariable-adjusted population-weighted modified Poisson regression models, we found that frailty was associated with increased prevalence of physical isolation, worry about COVID-19, and loneliness. Qualitative experiences of aging with frailty during the pandemic were diverse, and encompassed isolation, worry, and loneliness, as well as coping strategies and resilience. The findings may inform individualized multi-factorial strategies (e.g., physical activity, nutrition, and social interaction) to support well-being among adults aging with frailty during the pandemic.
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Affiliation(s)
- Carly A. Joseph
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA,College of Medicine, Central Michigan University, Mount Pleasant, MI, USA,Carly A. Joseph, MPH, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Laura N. Frain
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jessica M. Finlay
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Tingvold L, Moholt JM, Førland O, Jacobsen FF, Tranvåg O. Intended, Unintended, Unanticipated? Consequences of Social Distancing Measures for Nursing Home Residents During the Covid-19 Pandemic. Glob Qual Nurs Res 2023; 10:23333936231176204. [PMID: 37261277 PMCID: PMC10227487 DOI: 10.1177/23333936231176204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.
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Affiliation(s)
- Laila Tingvold
- Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Oddvar Førland
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Oscar Tranvåg
- Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian Research Centre for Women’s Health, University Hospital, Oslo, Norway
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Rojo-Perez F, Rodriguez-Rodriguez V, Fernandez-Mayoralas G, Sánchez-González D, Perez de Arenaza Escribano C, Rojo-Abuin JM, Forjaz MJ, Molina-Martínez MÁ, Rodriguez-Blazquez C. Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16354. [PMID: 36498426 PMCID: PMC9739633 DOI: 10.3390/ijerph192316354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.
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Affiliation(s)
- Fermina Rojo-Perez
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | | | | | - Diego Sánchez-González
- Department of Geography, National Distance Education University (UNED), 28040 Madrid, Spain
| | | | | | - Maria João Forjaz
- National Centre of Epidemiology and Health Service Research Network on Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Institute of Health, 28029 Madrid, Spain
| | - María-Ángeles Molina-Martínez
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, National Distance Education University (UNED), 28040 Madrid, Spain
| | - Carmen Rodriguez-Blazquez
- National Centre of Epidemiology and Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, 28029 Madrid, Spain
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Gustafsson PE, Fonseca-Rodríguez O, Nilsson I, San Sebastián M. Intersectional inequalities in loneliness among older adults before and during the early phase of the COVID-19 pandemic: A total population survey in the Swedish eldercare setting. Soc Sci Med 2022; 314:115447. [PMID: 36288648 PMCID: PMC9556960 DOI: 10.1016/j.socscimed.2022.115447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 01/26/2023]
Abstract
Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.
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Affiliation(s)
- Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Sweden,Corresponding author
| | | | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Unit of Occupational Therapy, Umeå University, 901 87, Sweden
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12
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Johansson-Pajala RM, Alam M, Gusdal A, Heideken Wågert PV, Löwenmark A, Boström AM, Hammar LM. Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study. BMC Geriatr 2022; 22:927. [PMID: 36456904 PMCID: PMC9714409 DOI: 10.1186/s12877-022-03544-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people's experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences. METHODS A retrospective cross-sectional design using data from the national user satisfaction survey (March - May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables. RESULTS Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS. CONCLUSION Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people' mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.
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Affiliation(s)
- Rose-Marie Johansson-Pajala
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Moudud Alam
- grid.411953.b0000 0001 0304 6002School of Information and Engineering/Statistics, Dalarna University, Falun, Sweden
| | - Annelie Gusdal
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Petra von Heideken Wågert
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Annica Löwenmark
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden
| | - Anne-Marie Boström
- grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden ,grid.4714.60000 0004 1937 0626R&D unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lena Marmstål Hammar
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, P.O 325, SE-63105 Eskilstuna/Västerås, Sweden ,grid.4714.60000 0004 1937 0626Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
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Crespo-Martín A, Palacios-Ceña D, Huertas-Hoyas E, Güeita-Rodríguez J, Fernández-Gómez G, Pérez-Corrales J. Emotional Impact and Perception of Support in Nursing Home Residents during the COVID-19 Lockdown: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15712. [PMID: 36497786 PMCID: PMC9735792 DOI: 10.3390/ijerph192315712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED Social isolation measures implemented in nursing homes during the COVID-19 pandemic generated occupational imbalance, discomfort, and mental health impairment in residents. We aimed to analyze the lived experience of elderly nursing home residents during the lockdown and social contact restrictions resulting from the COVID-19 pandemic. METHODS Exploratory qualitative study. Information was collected through in-depth interviews and field notes. An inductive thematic analysis was performed and international recommendations for the development of qualitative studies were followed. RESULTS Twenty-four participants residing in nursing homes were included. Two main themes were identified: (1) emotional impact of the experience of COVID-19 lockdown (subthemes: experience of contradictory feelings; illness and death; importance of routine; feeling busy; and role of religious beliefs); and (2) support as a therapeutic tool (subthemes: family support; peer support; and professional support). CONCLUSION Social restrictions by COVID-19 caused significant changes in residents' occupations and routines, producing fear, loneliness, and abandonment of desired occupations; however, very important supports were also identified that helped to overcome the lockdown, such as social support, spirituality, and gratitude.
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Affiliation(s)
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
| | - Elisabet Huertas-Hoyas
- Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
| | - Javier Güeita-Rodríguez
- Research Group of Humanities and Qualitative Research in Health Science, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
| | - Gemma Fernández-Gómez
- Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
| | - Jorge Pérez-Corrales
- Research Group of Humanities and Qualitative Research in Health Science, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
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Lai VSK, Yau SY, Lee LYK, Li BSY, Law SSP, Huang S. Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15287. [PMID: 36430006 PMCID: PMC9692584 DOI: 10.3390/ijerph192215287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Older people and health care workers in residential care homes are particularly vulnerable to the adverse impacts of the COVID-19 pandemic. As COVID-19 has been spreading around the world for more than two years, the nature of care delivery has been substantially transformed. This study aims at understanding the long-term and ongoing impacts of COVID-19 on the delivery of care in residential care homes. It investigates how the delivery of care has been transformed by the COVID-19 pandemic and how health care workers adapted to these changes from the perspectives of frontline health care workers. Semi-structured interviews were conducted from February to December 2021 with a purposive sample of 30 health care workers from six residential care homes in Hong Kong. Thematic analysis identified three themes, including (1) enhancing infection prevention and control measures; (2) maintaining the psychosocial wellbeing of residents; and (3) developing resilience. Discussions and implications were drawn from these findings.
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Affiliation(s)
- Veronica Sze-Ki Lai
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Sui-Yu Yau
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Becky Siu-Yin Li
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Susan Sin-Ping Law
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Shixin Huang
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, China
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15
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Akbaba A, Erünal M, Ozdamar H, Mert H, Dursun H, Kaya D. Determination of the Fear of COVID-19 and the Quality of Life of Patients With Transcatheter Aortic Valve Implants During the Pandemic. Clin Nurs Res 2022; 31:1422-1430. [PMID: 35676892 DOI: 10.1177/10547738221102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to determine the fear of COVID-19 and the quality of life of patients with transcatheter aortic valve implantation (TAVI) during the pandemic. This descriptive cross-sectional study included 132 TAVI patients. Data were collected using a patient information form, the Fear of COVID-19 Scale (FCV-19S), and the EuroQol-5 Dimension (EQ-5D). The mean FCV-19S score of the patients was 17.37 ± 6.12. The mean EQ-5D index score was 0.56 ± 0.37 and the mean VAS score was 65.5 ± 11.5. As per the dimensions of the EQ-5D index, 75% of the patients had mobility problems. According to the logistic regression analysis results, mobility was the most affected parameter, as demonstrated by the worsening in symptoms during the pandemic (odds ratio: 7.370, 95% CI [2.183, 24.881]). The patients with TAVI had a moderate level of fear associated with COVID-19, and the pandemic negatively affected their quality of life.
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Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, Grellety E. COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study. BMJ Open 2022; 12:e060276. [PMID: 36127110 PMCID: PMC9490301 DOI: 10.1136/bmjopen-2021-060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/01/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment. METHODS A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021. RESULTS The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff. CONCLUSION Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.
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Affiliation(s)
- Morgane Dujmovic
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Thomas Roederer
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Severine Frison
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Carla Melki
- Emergency Cell, Médecins Sans Frontières, Paris, France
| | - Thomas Lauvin
- Emergency Cell, Médecins Sans Frontières, Paris, France
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17
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Kylén M, von Koch L, Wottrich AW, Elf M. Living with the aftermaths of a stroke in the era of the COVID-19 pandemic; the significance of home and close surroundings. Health Place 2022; 76:102852. [PMID: 35803042 PMCID: PMC9222220 DOI: 10.1016/j.healthplace.2022.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/22/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61–91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities–strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.
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Affiliation(s)
- Maya Kylén
- Dalarna University, School of Health and Welfare, Falun, Sweden; Lund University, Department of Health Sciences, Lund, Sweden.
| | - Lena von Koch
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Annica Wohlin Wottrich
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Marie Elf
- Dalarna University, School of Health and Welfare, Falun, Sweden
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COVID-19-Related Lifestyle Changes among Community-Dwelling Older Adult Day-Care Users: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010256. [PMID: 35010515 PMCID: PMC8750638 DOI: 10.3390/ijerph19010256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022]
Abstract
In Japan, the community-based comprehensive care system is an important initiative. The purpose of this study was to understand COVID-19-related lifestyle changes experienced by older adults who lived in communities and used day-care services. Using a qualitative inductive research method, semi-structured interviews were conducted with 13 older adults who used day-care services in Kyoto City, which assessed lifestyle changes before and after the spread of COVID-19 during March-April 2021. The extracted lifestyle change codes were classified into six categories and 16 subcategories. The data revealed that older adults felt socially isolated and experienced multiple changes in their lives, including limited leisure activities, changes in roles, decreased interpersonal interaction with family and acquaintances, poor diet and sleep quality, and reduced attention to personal appearance and grooming. The findings suggest that during COVID-19, older adults had difficulty adapting to the various changes in their lives and showed a decline in physical and mental functioning. Thus, it is important for day-care facilities to create sustainable spaces in response to the various care needs of community-dwelling older adults whose lifestyles have changed as a result of the COVID-19 situation.
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, Litwin T, Kreutz C, Boger AH, Lindner S, Verboom B, Voss S, Movsisyan A. Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev 2021; 9:CD015085. [PMID: 34523727 PMCID: PMC8442144 DOI: 10.1002/14651858.cd015085.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Starting in late 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2, spread around the world. Long-term care facilities are at particularly high risk of outbreaks, and the burden of morbidity and mortality is very high among residents living in these facilities. OBJECTIVES To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors. SEARCH METHODS On 22 January 2021, we searched the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL. We also conducted backward citation searches of existing reviews. SELECTION CRITERIA We considered experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long-term care facilities to protect residents and staff against SARS-CoV-2 infection. Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted-time-series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings. MAIN RESULTS We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries. Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing. There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty. Overall, we identified five intervention domains, each including a number of specific measures. Entry regulation measures (4 observational studies; 4 modelling studies) Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents. Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies) Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain. Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact -regulating and transmission -reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain. Surveillance measures (2 observational studies; 6 modelling studies) Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear. Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Outbreak control measures (4 observational studies; 3 modelling studies) Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent measures (2 observational studies; 1 modelling study) A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain. AUTHORS' CONCLUSIONS This review provides a comprehensive framework and synthesis of a range of non-pharmacological measures implemented in long-term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here. Overall, more studies producing stronger evidence on the effects of non-pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke L Biallas
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura Arnold
- Academy of Public Health Services, Duesseldorf, Germany
| | - Karin Geffert
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Litwin
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Anna Helen Boger
- Institute of Medical Biometry and Statistics (IMBI), Freiburg Center for Data Analysis and Modeling (FDM), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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