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Cohen C, Abt M, Bélanger L, Ortoleva Bucher C. COVID-19's Impact in Long-Term Care Facilities: The Health and Coping Strategies of Older Adults and Their Families. J Adv Nurs 2025; 81:3226-3239. [PMID: 39382352 PMCID: PMC12080103 DOI: 10.1111/jan.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 09/04/2024] [Accepted: 09/29/2024] [Indexed: 10/10/2024]
Abstract
AIM Describe the stressors that long-term care facility (LTCF) residents and their family members were exposed to during the COVID-19 pandemic, the resources they mobilised to cope with them, and the strategies used by professionals to support them. DESIGN A descriptive qualitative design study. METHOD Between March 2021 and February 2022, we carried out semi-structured interviews with 8 LTCF residents, 11 family members, and 6 focus groups made up of healthcare and support staff from 8 LTCFs. RESULTS Three themes emerged: (1) residents and family members: separated and suffering, (2) residents and family members: reinventing themselves, and (3) staff: attempts to maintain residents' well-being. CONCLUSION LTCF Residents' and their family members' exposure to the various stressors linked to the COVID-19 pandemic generated suffering. Healthcare and support staff implemented strategies to support them, notably to maintain links between them. Some deep reflection must occur on the concepts of LTCF residents' autonomy and self-determination when implementing protective measures in future pandemic situations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This study has provided new insights into the nature of the stressors faced by LTCF residents and their families, and the measures implemented by professionals to support them. The role of the families of LTCF residents needs to be better recognised. Our results indicate the importance of involving nurses in discussions on patient autonomy and self-determination when implementing protective measures (in a pandemic situation). IMPACT Exploring the nature of the stressors experienced by LTCF residents and their families enables professionals to tailor strategies to support them. Maintaining residents' self-determination is essential when implementing protective measures. Families involved with residents must be recognised and included in the assessment of stressors and the personalisation and implementation of strategies to support LTCF residents. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Christine Cohen
- La Source School of Nursing, HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Maryline Abt
- La Source School of Nursing, HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Louise Bélanger
- Département Sciences infirmièresUniversité du Québec en OutaouaisGatineauQCCanada
| | - Claudia Ortoleva Bucher
- La Source School of Nursing, HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
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Zachreson C, Tobin R, Walker C, Conway E, Shearer FM, McVernon J, Geard N. A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities. BMC Infect Dis 2024; 24:880. [PMID: 39210276 PMCID: PMC11360480 DOI: 10.1186/s12879-024-09788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Residential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness. METHODS In consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government's recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration. RESULTS In the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations. CONCLUSIONS Under realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.
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Affiliation(s)
- Cameron Zachreson
- School of Computing and Information Systems, The University of Melbourne, Parkville, Victoria, Australia.
| | - Ruarai Tobin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Camelia Walker
- School of Mathematics and Statistics, The University of Melbourne, Parkville, Victoria, Australia
| | - Eamon Conway
- The Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Freya M Shearer
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jodie McVernon
- Victorian Infectious Disease Reference Laboratory Epidemiology Unit, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nicholas Geard
- School of Computing and Information Systems, The University of Melbourne, Parkville, Victoria, Australia
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Clark SE, Bautista L, Neeb K, Montoya A, Gibson KE, Mantey J, Kabeto M, Min L, Mody L. Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A retrospective cohort study. J Am Geriatr Soc 2024; 72:551-558. [PMID: 37950496 PMCID: PMC10922032 DOI: 10.1111/jgs.18678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Post-acute sequelae of SARS-CoV-2 (PASC) describes a syndrome of physical and cognitive decline that persists after acute symptoms of infection resolve. Few studies have explored PASC among nursing home (NH) residents. METHODS A retrospective cohort study was conducted at two NHs in Michigan. COVID-positive patients were identified from March 21, 2020 to October 26, 2021. The comparison group were patients who lived at the same NH but who were never infected during the study period. Minimum Data Set was used to examine trajectories of functional dependence (Activity of Daily Living [ADL] composite score) and cognitive function (Brief Interview for Mental Status [BIMS]). Linear mixed-effects models were constructed to estimate short-term change in function and cognition immediately following diagnosis and over time for an additional 12 months, compared to pre-COVID and non-COVID trajectories and adjusting for sex, age, and dementia status. RESULTS We identified 171 residents (90 COVID-19 positive, 81 non-COVID) with 719 observations for our analyses. Cohort characteristics included: 108 (63%) ≥ 80 yrs.; 121 (71%) female; 160 (94%) non-Hispanic white; median of 3 comorbidities (IQR 2-4), with no significant differences in characteristics between groups. COVID-19 infection affected the trajectory of ADL recovery for the first 9 months following infection, characterized by an immediate post-infection decrease in functional status post-infection (-0.60 points, p = 0.002) followed by improvement toward the expected functional trajectory sans infection (0.04 points per month following infection, p = 0.271). CONCLUSIONS NH residents experienced a significant functional decline that persisted for 9 months following acute infection. Further research is needed to determine whether increased rehabilitation services after COVID-19 may help mitigate this decline.
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Affiliation(s)
- Sophie E Clark
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liza Bautista
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan, USA
| | - Karen Neeb
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan, USA
| | - Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Post-Acute Care Services, University of Michigan Medical Group, Ann Arbor, Michigan, USA
| | - Kristen E Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mohammed Kabeto
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lillian Min
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Benzinger P, Wahl HW, Bauer JM, Keilhauer A, Dutzi I, Maier S, Hölzer N, Achterberg WP, Denninger NE. Consequences of contact restrictions for long-term care residents during the first months of COVID-19 pandemic: a scoping review. Eur J Ageing 2023; 20:39. [PMID: 37847318 PMCID: PMC10581973 DOI: 10.1007/s10433-023-00787-6] [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] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
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.
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Affiliation(s)
- Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany.
- Institute of Health and Generations, University of Applied Sciences Kempten, Bahnhofstrasse 61, 87435, Kempten, Germany.
| | - Hans-Werner Wahl
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Anne Keilhauer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Ilona Dutzi
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Simone Maier
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Natalie Hölzer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Natascha-Elisabeth Denninger
- Centre for Research, Development and Technology Transfer, Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, 83024, Rosenheim, Germany
- Medical Faculty, Institute for Health and Nursing Science, International Graduate Academy, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
- Medical Faculty Heidelberg, Department of General Practice and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Schneider P, Abt M, Cohen C, Marmier N, Ortoleva Bucher C. The impact of protective measures against COVID-19 on the wellbeing of residents in nursing homes and their relatives: a rapid review. BMC Geriatr 2023; 23:649. [PMID: 37821833 PMCID: PMC10568910 DOI: 10.1186/s12877-023-04300-7] [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: 11/07/2022] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
During the COVID-19 pandemic and compared to other population groups, older people were at a heightened risk of developing lethal disease symptoms. Thus, many countries put in place protective measures to protect this "at-risk" population, especially in nursing homes, to limit the number of infections. These measures consisted mostly in the absence of social gatherings, the impossibility for relatives to enter the nursing homes, limitations in group activities, and the ban of group-eating. Although these measures were helpful to mitigate the spread of the disease, they also induced long periods of social isolation for the residents of nursing homes. This could have impacted the wellbeing and quality of life of residents and their relatives, with a possible impact on the overall health of residents. We designed this rapid review to investigate the literature on the impact of COVID-19 protective measures in nursing homes on the quality of life, wellbeing and physical health of residents and their relatives. Our results showed that most of the articles included in the review, either using qualitative or quantitative methods, evidenced a detrimental impact of protective measures on resident's and their relatives' wellbeing. We argue that, in the event of a new pandemic similar to the COVID-19, protective measures should also take into account their psychological impact, and not only their physical impact.
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Affiliation(s)
- P Schneider
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
| | - M Abt
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - C Cohen
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - N Marmier
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Health Care (IUFRS), Lausanne, Switzerland
| | - C Ortoleva Bucher
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Beck MS, Bi S, Atai FD, Rianon NJ. Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:29-34. [PMID: 37650851 DOI: 10.3928/00989134-20230816-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and ALF residents. The objective of the current study was to determine the degree and significance of weight loss during quarantine through retrospective chart review and use these findings to guide a quality improvement project. Pre-and post-COVID-19 weights were compared for 53 house call program residents. Descriptive statistics and logistic regression were used. This small convenience sample demonstrated significant weight loss for 40% of ALF residents quarantined during the COVID-19 pandemic. Males showed a greater risk of significant weight loss. Weight loss of 5% in 1 month is considered problematic in older adults. As quarantine measures continue to be used for COVID-19 outbreaks, weight changes, particularly among males, need to be monitored and reported for intervention. [Journal of Gerontological Nursing, 49(9), 29-34.].
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Long-Term Care and the COVID-19 Pandemic: Lessons Learned. Nurs Clin North Am 2023; 58:35-48. [PMID: 36731958 PMCID: PMC9606037 DOI: 10.1016/j.cnur.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
US nursing homes and other long-term care (LTC) communities such as assisted living and adult day care services have been disproportionally affected by COVID-19. Nurses and health care workers provided care and services despite health concerns for themselves and family members. Nurses on the frontline were called to act with extraordinary tenacity, skill, flexibility, and creativity to prevent infection; prevent complications; and optimize function, health, and well-being. The purpose of this article is to provide an overview of the challenges posed by the COVID-19 pandemic and the strategies prioritized and implemented by nurse and interdisciplinary colleagues in LTC settings.
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Courtois-Amiot P, Allart H, de Cathelineau C, Legué C, Eischen P, Chetaille F, Lepineux D, Raynaud-Simon A, Sanchez M. COVID-19 as an Independent Risk Factor for Weight Loss in Older Adults Living in Nursing Homes. Gerontology 2023; 69:818-825. [PMID: 36807249 DOI: 10.1159/000529357] [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: 07/04/2022] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION In nursing homes, where residents are at elevated risk for malnutrition, the specific additive effect of the coronavirus disease 2019 (COVID-19) on weight loss has not yet been adequately evaluated. This study aimed to determine the factors independently associated with weight loss in nursing home residents who survived the first wave of the COVID-19 pandemic, whether they have contracted COVID-19 or not. METHODS This research was a retrospective study conducted in three nursing homes. Residents who survived the first French COVID-19 lockdown (March to May 2020) were included, provided their weight records were available. Baseline data included the body mass index (BMI), capacity to self-feed, need for texture-modified food, disability, and legal guardianship status. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. Univariate and multivariate logistic regression analyses were used to investigate associations between resident characteristics, COVID-19 status, and at least 5% weight loss. RESULTS Of the 316 included residents (72% female, mean age of 88 years, 48% severely disabled, and 38% under legal guardianship), 111 (35%) contracted COVID-19 and 102 (32%) lost at least 5% of their body weight. No difference was observed between the baseline characteristics of residents subsequently affected or unaffected by COVID-19. In the univariate analysis, old age, severe disability, texture-modified food, the need for close mealtime supervision, and COVID-19 were significantly associated with at least 5% weight loss. In the multivariate logistic regression analysis, COVID-19 (p = 0.02) and the need for close mealtime supervision (p = 0.02) were associated with weight loss in a model that also included age, BMI, texture-modified food, disability, and nursing home. CONCLUSION For nursing home residents, COVID-19 was an independent risk factor for weight loss. Weight loss was most common in residents needing close mealtime supervision, suggesting that organizational issues may have affected the quality of the nutritional care provided during the lockdown.
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Affiliation(s)
| | - Hélène Allart
- AP-HP, Geriatric Department, Bichat University Hospital, Paris, France
| | | | - Catherine Legué
- AP-HP, Geriatric Department, Bichat University Hospital, Paris, France
| | | | | | | | - Agathe Raynaud-Simon
- AP-HP, Geriatric Department, Bichat University Hospital, Paris, France
- University Paris Cité, Paris, France
- Gérond'if, Paris, France
| | - Manuel Sanchez
- AP-HP, Geriatric Department, Bichat University Hospital, Paris, France
- University Paris Cité, Paris, France
- Gérond'if, Paris, France
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Rodriguez-Rodriguez V, Rojo-Perez F, Perez de Arenaza Escribano C, Molina-Martínez MÁ, Fernandez-Mayoralas G, Sánchez-González D, Rojo-Abuin JM, Rodríguez-Blázquez C, Forjaz MJ, Martín García S. The Impact of COVID-19 on Nursing Homes: Study Design and Population Description. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16629. [PMID: 36554508 PMCID: PMC9779101 DOI: 10.3390/ijerph192416629] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 05/15/2023]
Abstract
Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.
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Affiliation(s)
| | - Fermina Rojo-Perez
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | | | - María-Ángeles Molina-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | | | - Diego Sánchez-González
- Departamento de Geografía, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
| | | | - Carmen Rodríguez-Blázquez
- National Epidemiology Centre, Carlos III Institute of Health, Network Centre for Biomedical Research in Neurodegenerative Diseases (CIBERNED), 28029 Madrid, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Institute of Health, Health Service Research Network on Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), 28029 Madrid, Spain
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Boltz M, Murphy T. The Massachusetts COVID-19 initiative provides evidence for a practical, multi-faceted, participatory implementation process. J Am Geriatr Soc 2022; 70:3067-3069. [PMID: 36075085 PMCID: PMC9537989 DOI: 10.1111/jgs.18027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
This editorial comments on the article by Lipsitz et al.
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Affiliation(s)
- Marie Boltz
- Ross and Carol Nese College of NursingPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Terrence Murphy
- Department of Public Health SciencesPennsylvania State UniversityState CollegePennsylvaniaUSA
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Impact of Cafeteria Service Discontinuation at a Dialysis Facility on Medium-Term Nutritional Status of Elderly Patients Undergoing Hemodialysis. Nutrients 2022; 14:nu14081628. [PMID: 35458190 PMCID: PMC9031672 DOI: 10.3390/nu14081628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Despite evident lifestyle changes due to measures against the coronavirus disease 2019 (COVID-19) outbreak, few reports focus on the effects of eating-behavior changes on the nutritional status of elderly patients undergoing hemodialysis (HD). Thus, we examined dry-weight reduction, the simplest indicator of malnutrition among patients undergoing dialysis, and its association with the discontinuation of cafeteria services at a dialysis facility as per COVID-19 measures. This retrospective study included elderly patients (aged ≥ 65 years) undergoing HD at the Nagasaki Renal Center between December 2020 and October 2021. We collected nutrition-related data and patient characteristics and evaluated the association between the service discontinuation and dry-weight reduction 10 months after the discontinuation using multivariable logistic regression. This study included 204 patients, 79 of which were cafeteria users. During the observation period, cafeteria users showed significant dry-weight reduction; however, this was not observed among non-users. Multivariable logistic regression analysis indicated a close association between dry-weight reduction and the service discontinuation. That is, the dietary services cancelation caused dry-weight reduction in patients who relied on the cafeteria. As elderly patients undergoing HD are vulnerable to changes in their eating environment, alternative nutritional management methods need to be considered.
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Camilleri C, Fogle CS, O'Brien KG, Sammut S. The Impact of COVID-19 and Associated Interventions on Mental Health: A Cross-Sectional Study in a Sample of University Students. Front Psychiatry 2022; 12:801859. [PMID: 35153865 PMCID: PMC8825780 DOI: 10.3389/fpsyt.2021.801859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health issues have continued to rise globally, including among university students. The COVID-19 pandemic has exacerbated the previously existing and concerning problem. Given that coping mechanisms have been proposed to mediate the relationship between stressors and mental health, the aim of our cross-sectional study was to investigate the mediation of coping mechanisms on the relationship between the impact of the COVID-19 pandemic and mental health. METHODS University students (≥18 years old; N = 676; 31% male, 69% female) were administered an anonymous survey addressing current demographics, COVID-19 pandemic-related demographics, personal experiences, sources of stress and perceived effect on mental health, politics, sources of news/information, and various pre-validated scales addressing mental health (DASS-21), the impact of the COVID-19 pandemic (IES-R) and coping strategies utilized (Brief COPE). RESULTS Our results indicate a substantial proportion of our sample reporting scores in the severe and extremely severe DASS-21 categories, in addition to ~50% reporting a perceived deterioration in mental health relative to pre-COVID-19 pandemic. Moreover, a substantial proportion of students reported IES-R scores at levels where PTSD is of clinical concern. Alarmingly, a significant proportion of females (~15%) reported scores reflecting potential long-term PTSD-related implications. Females tended to be more severely impacted in all mental health measures. Mediation analysis indicated that while dysfunctional coping mediated the relationship between the impact of the event (COVID-19 pandemic) and all three mental health outcomes, overall, this was not the case with the positive coping strategies. CONCLUSION Our study appears to indicate a reduced buffering influence on negative mental health outcomes by the positive coping mechanisms investigated in relation to the COVID-19 pandemic and secondary interventions implemented. While the findings of this study pertain specifically to university students, they corroborate the existing extensive body of research (from physiological to behavioral, preclinical to clinical) pertaining to the response associated with major stressful events at every level of society. In this regard, the findings imply the necessity for health and other authorities, tasked with safeguarding public well-being, to avoid reactive interventions that do not appropriately balance the risks and benefits, potentially exacerbating pre-existing psychopathologies and compromising social order.
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Affiliation(s)
| | | | | | - Stephen Sammut
- Department of Psychology, Franciscan University of Steubenville, Steubenville, OH, United States
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Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med 2021; 12:1127-1136. [PMID: 34136990 PMCID: PMC8208072 DOI: 10.1007/s41999-021-00531-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION COVID-19 has caused unprecedented challenges in nursing homes. In this scoping review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges. METHODS The MeSH terms "Nursing homes" and "COVID-19" were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes. RESULTS The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents' well-being, and technological innovations. CONCLUSION COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.
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Affiliation(s)
- Shamik Giri
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lee Minn Chenn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing (MISA), St James's Hospital, 6th Floor, Dublin, 8, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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Power GA, Carson J. The promise of transformed long-term care homes: Evidence from the pandemic. Healthc Manage Forum 2021; 35:25-28. [PMID: 34555963 DOI: 10.1177/08404704211037794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A combination of factors during the SARS-CoV-2 pandemic led to a disproportionately high mortality rate among residents of long-term care homes in Canada and around the globe. Retrospectively, some of these factors could have been avoided or minimized. Many infection control approaches recommended by public health experts and regulators, while well intended to keep people safe from disease exposure, threatened other vital aspects of health and well-being. Furthermore, focusing narrowly on infection control practices does not address longstanding operational and infrastructural factors that contributed significantly to the pandemic toll. In this article, we review traditional (ie institutional) long-term care practices that were associated with increased risk during the pandemic and highlight one transformational model (the Green House Project) that worked well to protect the lives and livelihood of people within congregate care settings. Drawing on this evidence, we identify specific strategies for necessary and overdue improvements in long-term care homes.
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Affiliation(s)
- G Allen Power
- 6927Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Jennifer Carson
- Dementia Engagement, Education, and Research Program, School of Public Health, 222641University of Nevada, Reno, Nevada, USA
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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: 3.0] [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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17
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Stratil JM, Biallas RL, Burns J, Arnold L, Geffert K, Kunzler AM, Monsef I, Stadelmaier J, Wabnitz K, 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. Hippokratia 2021. [DOI: 10.1002/14651858.cd015085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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 Lars 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
| | - 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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Martinchek M, Beiting KJ, Walker J, Graupner J, Huisingh-Scheetz M, Thompson K, Gleason LJ, Levine S. Weight Loss in COVID-19-Positive Nursing Home Residents. J Am Med Dir Assoc 2020; 22:257-258. [PMID: 33352194 PMCID: PMC7699303 DOI: 10.1016/j.jamda.2020.11.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Michelle Martinchek
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA; Department of Physician Assistant Studies, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Kimberly J Beiting
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA.
| | - Jacob Walker
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Jeffrey Graupner
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Katherine Thompson
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Stacie Levine
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
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