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Martínez-Payá M, Carrillo I, Guilabert M. Lessons Learned from the COVID-19 Pandemic in Nursing Homes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16919. [PMID: 36554806 PMCID: PMC9779143 DOI: 10.3390/ijerph192416919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Nursing homes are one of the hardest-hit environments in terms of mortality from COVID-19. Given the reactive management of the pandemic, it is necessary to reflect on, and answer, the question as to which good practices (interventions) were implemented in care homes (population) to improve management and care quality (outcomes). This systematic review aimed to identify and describe good practices adopted in care homes during the COVID-19 pandemic or other recent epidemics. We conducted searches in Embase, PubMed, ScienceDirect, ProQuest Central, and Scopus over the period 1-30 November, 2021, using the descriptors "nursing homes", "long-term care", "long-term care facilities" and "COVID-19"; and the keywords "learnings", "lessons", "positive learnings", "positive lessons", "SARS", "MERS", "COVID-19" and "pandemic". We identified 15 papers describing 14 best practices and 26 specific actions taken for COVID-19 management in long-term care facilities. Following the IDEF methodology, the practices were classified into strategic processes (staff training, communication with the national health system, person-centered care, and protocols), operational processes (cohorts, diagnostic testing, case monitoring, personal protective equipment, staff reinforcement, restriction of visits, social distancing, and alternative means for communication with families) and support processes (provision of equipment and hygiene reinforcement). Fifty percent of practices were likely to be maintained beyond the outbreak to improve the operation and quality of the long-term care facilities. This review summarizes the most common measures adopted to manage the COVID-19 pandemic in the context of increased vulnerability and highlights the deficiencies that must be addressed.
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Affiliation(s)
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
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Arnedo-Pena A, Romeu-Garcia MA, Gascó-Laborda JC, Meseguer-Ferrer N, Safont-Adsuara L, Prades-Vila L, Flores-Medina M, Rusen V, Tirado-Balaguer MD, Sabater-Vidal S, Gil-Fortuño M, Pérez-Olaso O, Hernández-Pérez N, Moreno-Muñoz R, Bellido-Blasco J. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. EPIDEMIOLOGIA 2022; 3:179-190. [PMID: 36417250 PMCID: PMC9620907 DOI: 10.3390/epidemiologia3020014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/14/2022] Open
Abstract
During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents' CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents' severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.
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Affiliation(s)
- Alberto Arnedo-Pena
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Health Science, Public University of Navarra, 31006 Pamplona, Spain
| | - Maria Angeles Romeu-Garcia
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Juan Carlos Gascó-Laborda
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Noemi Meseguer-Ferrer
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Lourdes Safont-Adsuara
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Laura Prades-Vila
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Matilde Flores-Medina
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Viorica Rusen
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | | | - Susana Sabater-Vidal
- Microbiology Laboratory, Universitary General Hospital, 12004 Castelló de la Plana, Spain; (M.D.T.-B.); (S.S.-V.)
| | - Maria Gil-Fortuño
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Oscar Pérez-Olaso
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Noelia Hernández-Pérez
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Rosario Moreno-Muñoz
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
| | - Juan Bellido-Blasco
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
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Marin-Gomez FX, Mendioroz-Peña J, Mayer MA, Méndez-Boo L, Mora N, Hermosilla E, Coma E, Vilaseca JM, Leis A, Medina M, Catalina QM, Vidal-Alaball J. Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:483. [PMID: 35010742 PMCID: PMC8744689 DOI: 10.3390/ijerph19010483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Jacobo Mendioroz-Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, 08005 Barcelona, Spain
| | - Miguel-Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Núria Mora
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Josep-Maria Vilaseca
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Manolo Medina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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