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Leung CLK, Wei WI, Li KK, McNeil EB, Tang A, Wong SYS, Kwok KO. Revisiting Vaccine Hesitancy in Residential Care Homes for the Elderly for Pandemic Preparedness: A Lesson from COVID-19. Vaccines (Basel) 2023; 11:1700. [PMID: 38006032 PMCID: PMC10675220 DOI: 10.3390/vaccines11111700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Residents in residential care homes for the elderly (RCHEs) are at high risk of severe illnesses and mortality, while staff have high exposure to intimate care activities. Addressing vaccine hesitancy is crucial to safeguard vaccine uptake in this vulnerable setting, especially amid a pandemic. In response to this, we conducted a cross-sectional survey to measure the level of vaccine hesitancy and to examine its associated factors among residents and staff in RCHEs in Hong Kong. We recruited residents and staff from 31 RCHEs in July-November 2022. Of 204 residents, 9.8% had a higher level of vaccine hesitancy (scored ≥ 4 out of 7, mean = 2.44). Around 7% of the staff (n = 168) showed higher vaccine hesitancy (mean = 2.45). From multi-level regression analyses, higher social loneliness, higher anxiety, poorer cognitive ability, being vaccinated with fewer doses, and lower institutional vaccination rates predicted residents' vaccine hesitancy. Similarly, higher emotional loneliness, higher anxiety, being vaccinated with fewer doses, and working in larger RCHEs predicted staff's vaccine hesitancy. Although the reliance on self-report data and convenience sampling may hamper the generalizability of the results, this study highlighted the importance of addressing the loneliness of residents and staff in RCHEs to combat vaccine hesitancy. Innovative and technology-aided interventions are needed to build social support and ensure social interactions among the residents and staff, especially amid outbreaks.
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Affiliation(s)
- Cyrus Lap Kwan Leung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (C.L.K.L.); (W.I.W.); (E.B.M.); (S.Y.S.W.)
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (C.L.K.L.); (W.I.W.); (E.B.M.); (S.Y.S.W.)
| | - Kin-Kit Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China;
| | - Edward B. McNeil
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (C.L.K.L.); (W.I.W.); (E.B.M.); (S.Y.S.W.)
| | - Arthur Tang
- School of Science, Engineering and Technology, RMIT University, Ho Chi Minh City 700000, Vietnam;
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (C.L.K.L.); (W.I.W.); (E.B.M.); (S.Y.S.W.)
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (C.L.K.L.); (W.I.W.); (E.B.M.); (S.Y.S.W.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, China
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Yu J, Yun H, Unruh MA, O'Donnell EM, Katz PR, Ancker JS, Jung HY. Perspectives of Physicians with Experience in Nursing Home Care on Telehealth Use During the COVID-19 Public Health Emergency. J Gen Intern Med 2023; 38:1722-1728. [PMID: 36913142 PMCID: PMC10010241 DOI: 10.1007/s11606-023-08087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking. OBJECTIVE To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs. PARTICIPANTS Medical directors or attending physicians in NHs. APPROACH We conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use. MAIN MEASURES The extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision. KEY RESULTS Participants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment. CONCLUSIONS Participants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
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Affiliation(s)
- Jiani Yu
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA.
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Eloise M O'Donnell
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
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Washington KT, Piontek A, Jabbari J, Benson JJ, Demiris G, Tatum PE, Oliver DP. The Lived Experience of Physical Separation for Hospice Patients and Families amid COVID-19. J Pain Symptom Manage 2022; 63:971-979. [PMID: 35192877 PMCID: PMC8856963 DOI: 10.1016/j.jpainsymman.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
CONTEXT Many hospice patients were physically separated from family members and healthcare professionals during the early COVID-19 pandemic. OBJECTIVES Researchers sought to describe the lived experience of physical separation for hospice patients and family caregivers who adhered to public health guidelines intended to limit the transmission of COVID-19 in the spring of 2020. METHODS Researchers performed a secondary analysis of qualitative data collected during a multi-site clinical trial of an intervention that incorporated family caregivers into care plan reviews during biweekly hospice interdisciplinary team meetings. Twenty-eight adult family caregivers of hospice patients with cancer participated in at least one care plan review between March 7, 2020 and June 10, 2020. The final analytic dataset included the transcribed content of 60 care plan reviews, which were analyzed via reflexive thematic analysis. RESULTS Hospice patients and their family caregivers experienced physical separation as interrupted care that resulted in the potential for unmet informational, functional, and social and emotional needs. Connection strategies employed to adapt to care interruptions and address patient and caregiver needs were not consistently effective. CONCLUSION Inclusive, innovative connection strategies are needed to ensure that high-quality end-of-life care is provided to hospice patients and their family caregivers when physical presence must be limited.
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Affiliation(s)
- Karla T Washington
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA.
| | - Amy Piontek
- Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA; The Graduate School at Washington University in St. Louis (J.J.), St. Louis, Missouri, USA
| | - Jacquelyn J Benson
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing (G.D.), Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine (G.D.), Philadelphia, Pennsylvania, USA
| | - Paul E Tatum
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Washington University in St. Louis, Department of Medicine, Division of Palliative Medicine (K.T.W., J.J.B., P.E.T., D.P.O.), St. Louis, Missouri, USA; Goldfarb School of Nursing at Barnes-Jewish College (A.P., J.J., D.P.O.), St. Louis, Missouri, USA
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Chu CH, Ronquillo C, Khan S, Hung L, Boscart V. Technology Recommendations to Support Person-Centered Care in Long-Term Care Homes during the COVID-19 Pandemic and Beyond. J Aging Soc Policy 2021; 33:539-554. [PMID: 34278980 DOI: 10.1080/08959420.2021.1927620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.
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Affiliation(s)
- Charlene H Chu
- Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Assistant Professor (cross-appointed), Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada.,Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada
| | - Charlene Ronquillo
- Scientist, School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Shehroz Khan
- Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada
| | - Lillian Hung
- Assistant Professor, School of Nursing, University of British of Columbia, Vancouver, British Columbia, Canada
| | - Veronique Boscart
- Affiliate Scientist, KITE, Toronto Rehabilitation Institution, Toronto, Ontario, Canada.,Executive Dean, School of Health & Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
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Gallistl V, Seifert A, Kolland F. COVID-19 as a "Digital Push?" Research Experiences From Long-Term Care and Recommendations for the Post-pandemic Era. Front Public Health 2021; 9:660064. [PMID: 34041216 PMCID: PMC8141793 DOI: 10.3389/fpubh.2021.660064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Vera Gallistl
- Institute of Sociology, University of Vienna, Vienna, Austria.,Centre for Gerontology, Karl-Landsteiner-Privatuniversität, Krems, Austria
| | - Alexander Seifert
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Franz Kolland
- Institute of Sociology, University of Vienna, Vienna, Austria.,Centre for Gerontology, Karl-Landsteiner-Privatuniversität, Krems, Austria
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Kistler CE, Zimmerman S, Khairat S. Health Information Technology Challenges and Innovations in Long-Term Care. J Am Med Dir Assoc 2021; 22:981-983. [PMID: 33896713 DOI: 10.1016/j.jamda.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Christine E Kistler
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Saif Khairat
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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7
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Health Technology to Support the Care of Older Adults. Comput Inform Nurs 2020; 38:605-606. [DOI: 10.1097/cin.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seifert A, Batsis JA, Smith AC. Telemedicine in Long-Term Care Facilities During and Beyond COVID-19: Challenges Caused by the Digital Divide. Front Public Health 2020; 8:601595. [PMID: 33194999 PMCID: PMC7649197 DOI: 10.3389/fpubh.2020.601595] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Seifert
- Center for Gerontology, University of Zurich, Zurich, Switzerland.,School of Social Work, Institute for Integration and Participation, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, Department of Nutrition, Center for Aging & Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
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Siette J, Wuthrich V, Low LF. Social Preparedness in Response to Spatial Distancing Measures for Aged Care During COVID-19. J Am Med Dir Assoc 2020; 21:985-986. [PMID: 32674832 PMCID: PMC7167563 DOI: 10.1016/j.jamda.2020.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Viviana Wuthrich
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia; Department of Psychology, Macquarie University, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Powell KR, Deroche CB, Alexander GL. Health Data Sharing in US Nursing Homes: A Mixed Methods Study. J Am Med Dir Assoc 2020; 22:1052-1059. [PMID: 32224261 DOI: 10.1016/j.jamda.2020.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES (1) To understand the extent to which nursing homes have the capability for data sharing and (2) to explore nursing home leaders' perceptions of data sharing with other health care facilities and with residents and family members. DESIGN Exploratory, mixed-methods. SETTING AND PARTICIPANTS We conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 815) representing every state in the United States. Next, semistructured interviews were used to elicit rich contextual information from (n = 12) administrators from nursing homes with varying data-sharing capabilities. METHODS We used descriptive statistics along with Rao-Scott chi-square and logistic regression models to examine the relationship between health data-sharing capabilities and nursing home characteristics such as location, bed size, and type of ownership. Qualitative data were analyzed using content analysis. RESULTS Of the 815 nursing homes completing the survey, 95% had computerized (electronic) medical records, and 46% had some capability for health information exchange. Nursing homes located in metropolitan areas had 2.53 (95% confidence interval = 1.53, 4.18) times greater odds for having health information exchange capability compared with nursing homes in small towns. Perceived challenges to health data sharing with residents and family members and external clinical partners include variance in systems and software, privacy and security concerns, and organizational factors slowing uptake of technology. Perceived benefits of health data sharing included improved communication, improved care planning, and anticipating future demand. CONCLUSIONS AND IMPLICATIONS As health data sharing becomes more ubiquitous in acute care settings, policy makers, nursing home leaders, and other stakeholders should prepare by working to mitigate barriers and capitalize on potential benefits of implementing this technology in nursing homes.
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