COVID-19 resources

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Dementia and the risk of death in elderly patients with COVID‐19 infection: systematic review and meta‐analysis

International Journal of Geriatric Psychiatry

Objectives: The COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. This study aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection. Methods: Literature search was based on Cochrane Library, Embase, PubMed and Google Scholar to locate articles published between December 2019 to July 2020, presenting the number of survived vs deceased patients with dementia and COVID‐19 infection. Results: A total of 233 articles were retrieved; 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, 8 met the inclusion criteria and were thus included into the final analysis (6493 patients ‐ mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non survivors compared with survivors (17.5% vs 5.4%, p<0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (Odds Ratio3.75; 95% Confidence Interval: 2.54 ‐ 5.54, p<0.0001, I2=49.5%) The Egger's regression test confirmed that there were not statistically evidences of publication bias (t=0.059; p=0.954). Conclusions: The preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.

Last updated on hub: 07 December 2020

Social policy responses to COVID‐19 in Canada and the United States: explaining policy variations between two liberal welfare state regimes

Social Policy and Administration

Canada and the United States are often grouped together as liberal welfare‐state regimes, with broadly similar levels of social spending. Yet, as the COVID‐19 pandemic reveals, the two countries engage in highly divergent approaches to social policymaking during a massive public health emergency. Drawing on evidence from the first 5 months of the pandemic, this article compares social policy measures taken by the United States and Canadian governments in response to COVID‐19. In general, this paper shows that Canadian responses were both more rapid and comprehensive than those of the United States. This variation, the authors argue, can be explained by analysing the divergent political institutions, pre‐existing policy legacies, and variations in cross‐partisan consensus, which have all shaped national decision‐making in the middle of the crisis.

Last updated on hub: 07 December 2020

Restructuring paradigm in the wake of COVID-19: a study of Kerala model

Journal of Human Behavior in the Social Environment

The novel coronavirus that shook the world population has restructured the world order. While the scientists are grappling hard to find a solution to the imminent problem at hand, the pandemic has thrown the human race into a perplexed stage questioning and mostly changing everything they believed in. The pandemic has replaced human beings as social animal to virtual being. The social distancing mandate required for the survival as propounded by WHO has forced individuals to keep the other humans at bay. The present paper is an attempt to look at the changes the world is facing with respect to the social, cultural, economic, and psychological aspects with a special focus on the internationally acclaimed Kerala model of survival. Kerala, a small state located within the southern peninsula of the country has played an important role in containing the spread of the virus despite its larger population density. The paper focuses on the innovative mechanics followed by the state to curtail the spreading. It also attempts to look at the changes that have been brought in the general human behavior.

Last updated on hub: 07 December 2020

Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

Systematic reviews

Background: The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods: EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning(CAL). All search results were processed using CAL to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results: Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions: Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors.

Last updated on hub: 07 December 2020

Building long-term care staff capacity during COVID-19 through just-in-time learning: evaluation of a modified ECHO model

Journal of the American Medical Directors Association

Objectives: The onset of the COVID-19 pandemic significantly challenged the capacity of long-term care (LTC) homes in Canada resulting in new, pressing priorities for leaders and healthcare providers (HCPs) in the care and safety of LTC residents. This study aimed to determine whether Project ECHO® (Extension for Community Healthcare Outcomes) Care of the Elderly Long-Term Care (COE-LTC): COVID-19, a virtual education program, was effective at delivering just-in-time learning and best practices to support LTC teams and residents during the pandemic. Design: Mixed methods evaluation. Setting and Participants: Interprofessional HCPs working in LTC homes or deployed to work in LTC homes primarily in Ontario, Canada, who participated in 12 weekly, 60-minute sessions. Methods: Quantitative and qualitative surveys assessing reach, satisfaction, self-efficacy, practice change, impact on resident care and knowledge sharing. Results: Of the 252 registrants for ECHO COE-LTC: COVID-19, 160 (63.4%) attended at least one weekly session. Nurses and nurse practitioners represented the largest proportion of HCPs (43.8%). Overall, both confidence and comfort level working with residents who were at risk, confirmed or suspected of having COVID-19 increased after participating in the ECHO sessions (effect sizes≥0.7, Wilcoxon signed rank p<.001). Participants also reported impact on intent to change behavior, resident care and knowledge sharing. Conclusions and Implications: The results demonstrate that ECHO COE-LTC: COVID 19 effectively delivered time sensitive information and best practices to support LTC teams and residents. It may be a critical platform during this pandemic and in future crises to deliver just-in-time learning during periods of constantly changing information.

Last updated on hub: 07 December 2020

Implementation of an algorithm of cohort classification to prevent the spread of COVID-19 in nursing homes

Journal of the American Medical Directors Association

Older adults living in nursing homes are the most vulnerable group of the COVID-19 pandemic. There are many difficulties in isolating residents and limiting the spread in this setting. These researchers have developed a simple algorithm with a traffic light shape for resident classification and sectorization within nursing homes, based on basic diagnostic tests, surveillance of symptoms onset and close contact monitoring. The researchers have implemented the algorithm in several centers with good data on adherence. Suggestions for implementation and evaluation are discussed.

Last updated on hub: 07 December 2020

Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians

Journal of the American Medical Directors Association

Objectives: To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. The aim of this study was an exploration of dilemmas experienced by Elderly Care Physicians (ECPs) as a result of the COVID-19 driven restrictive visiting policy. Setting and Participants: ECPs working in Dutch NHs. Methods: A qualitative exploratory study was performed using an open-ended questionnaire. A thematic analysis was applied. Data was collected between April 17 and May 10, 2020. Results: Seventy-six ECPs answered the questionnaire describing a total of 114 cases in which they experienced a dilemma. Thematic analysis revealed four major themes: (1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones; (2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented; (3) The profound emotional impact on ECPs; (4) Many alternatives for visits highlight the wish to compensate for the absence of face to face contact opportunities. However, given the diversity of NH residents, alternatives were often only suitable for some of them. Conclusions and Implications: ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones and care professionals. The dilemmas encountered as a result of the policy highlight the wish by ECPs to offer solutions tailored to the individual residents. This study identified an overview of aspects to consider when drafting future visiting policies for NHs during the COVID-19 pandemic.

Last updated on hub: 07 December 2020

Evaluating perspectives of relatives of nursing home residents on the nursing home visiting restrictions during the COVID-19 Crisis: a Dutch cross-sectional survey study

Journal of the American Medical Directors Association

Objectives: Coronavirus disease 2019 (COVID-19) has caused many nursing homes to prohibit resident visits to prevent viral spread. Although visiting restrictions are instituted to prolong the life of nursing home residents, they may detrimentally affect their quality of life. The aim of this study was to capture perspectives from the relatives of nursing home residents on nursing home visiting restrictions. Design: A cross-sectional online survey was conducted. Setting and Participants: A convenience sample of Dutch relatives of nursing home residents (n = 1997) completed an online survey on their perspectives regarding nursing home visiting restrictions. Methods: The survey included Likert-item, multiselect, and open-answer questions targeting 4 key areas: (1) communication access to residents, (2) adverse effects of visiting restrictions on residents and relatives, (3) potential protective effect of visiting restrictions, (4) important aspects for relatives during and after visiting restrictions. Results: Satisfaction of communication access to nursing home residents was highest when respondents had the possibility to communicate with nursing home residents by nurses informing them via telephone, contact behind glass, and contact outside maintaining physical distance. Satisfaction rates increased when respondents had multiple opportunities to stay in contact with residents. Respondents were concerned that residents had increased loneliness (76%), sadness (66%), and decreased quality of life (62%), whereas study respondents reported personal sadness (73%) and fear (26%). There was no consensus among respondents if adverse effects of the visiting restrictions outweighed the protective effect for nursing home residents. Respondents expressed the need for increased information, communication options, and better safety protocols. Conclusion and Implications: Providing multiple opportunities to stay in touch with nursing home residents can increase satisfaction of communication between residents and relatives. Increased context-specific information, communication options, and safety protocols should be addressed in national health policy.

Last updated on hub: 07 December 2020

Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect

Age and Ageing

In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

Last updated on hub: 07 December 2020

Virtual home visits during the COVID-19 pandemic: social workers’ perspectives

Practice: Social Work in Action

The home visit is a key aspect of child and family social work. Following the announcement of lockdown in England, all but the most urgent of home visits ‘went virtual’ overnight. During lockdown, the researchers spoke to 31 child and family social workers across nine local authorities in England as they began to undertake virtual home visits. Here, this paper focuses on social workers’ reflections on virtual practice and consider the possibilities, limitations and future implications of virtual home visiting.

Last updated on hub: 07 December 2020

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