Consequences of contact restrictions for long-term care residents during the first months of COVID-19 pandemic: a scoping review

During the early stages of the COVID-19 pandemic, stringent measures were implemented in most countries to limit social contact between residents of long-term care facilities (LTCF) and visitors. The objective of this scoping review was to identify and map evidence of direct and indirect consequences of contact restrictions, guided by three conceptual perspectives: (1) stress and learned helplessness (i.e., failure to use coping behaviors even when they are available and actionalble); (2) social contact loss; and (3) 'total institution' (i.e., a facility operates following a fixed plan due to spelled-out rules and norms, controlled by institutional representatives). We used the framework for conducting a scoping review by Arksey and O'Malley; included were peer-reviewed manuscripts reporting on the outcomes of contact restrictions from the beginning of the pandemic until the end of 2020. After removing duplicates, 6,656 records were screened and 62 manuscripts included. Results pertaining to the stress and learned helplessness perspective primarily focused on depressive symptoms, showing substantial increases compared to the pre-pandemic period. Studies examining cognitive and functional decline, as well as non-COVID-19 related mortality, were limited in number and presented mixed findings. The majority of study outcomes related to the social contact loss perspective focused on loneliness, but the study designs did not adequately allow for comparisons with the pre-pandemic status. The evidence concerning outcomes related to the 'total Institution' perspective was inconclusive. Although detrimental effects of social isolation in the long-term care context found support particularly in the negative affect domain, other outcome areas did not allow for definitive conclusions due to considerable variations in findings and, in some cases, insufficient statistical power.

Changes in risk factors for severe low-back pain among caregivers in care facilities in Japan from 2014 to 2018

In Japan, the practice of the no-lift policy, which states that care recipients should be lifted with care equipment rather than by human power, has been increasing since around 2014. The purpose of this study was to examine whether severe low back pain (LBP) risk factors in caregivers changed between 2014 and 2018. A questionnaire survey targeting administrators and caregivers working in care facilities for the elderly was conducted in 2014 and 2018. A total of 612 facilities and 2,712 caregivers responded to the questionnaires in 2014, and 504 facilities and 3,478 caregivers completed the questionnaires in 2018. The percentage of caregivers who experienced severe LBP did not differ significantly between 2014 (37.3%) and 2018 (38.3%). However, the number of facilities that introduced care equipment for transfer increased in 2018. Moreover, the number of participants who received training on care methods and using care equipment increased. Lifting a facility resident using human power and taking an unsuitable posture were associated with severe LBP in 2014, but only taking an unsuitable posture was associated with severe LBP in 2018. As taking an unsuitable posture remains to be a primary risk factor for severe LBP, it needs to be addressed in care facilities.

How can you prevent falls and subsequent fractures?

Over the years, a number of strategies have been investigated to prevent falls in older people in a number of settings. Over 200 randomised controlled trials now exist, and the challenge for the discerning clinician is to read and interpret the existing literature so as to be able to implement effective strategies, targeting the right individual with the right intervention. This chapter reviews the current literature and attempts to simplify what has become an enormously complex area. Interventions are reviewed in three main settings - community, hospital and care facilities and based on the type of approach - single, multiple or multifactorial interventions. It also considers the reality in which we practise and provides some 'best bets' to consider at this point in time.