scholarly journals Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents

2021 ◽  
pp. 1-7
Author(s):  
Yue Li ◽  
Xueya Cai ◽  
Yunjiao Mao ◽  
Zijing Cheng ◽  
Helena Temkin-Greener
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Minority ◽  
Negative Binomial ◽  
Nursing Home Residents ◽  
Ethnic Disparities ◽  
Relative Increase ◽  
Racial And Ethnic Disparities ◽  
Rate Ratios ◽  
Racial And Ethnic Minority

Abstract Objectives: To evaluate trends in racial and ethnic disparities in weekly cumulative rates of coronavirus disease 2019 (COVID-19) cases and deaths in Connecticut nursing homes. Design: Longitudinal analysis of nursing-home COVID-19 reports and other databases. Multivariable negative binomial models were used to estimate disparities in COVID-19 incidence and fatality rates across nursing-home groups with varying proportions of racial and ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. Trends in such disparities were estimated from week 1 (April 13) to week 10 (ending on June 19, 2020). Setting: The study was conducted across 211 nursing homes. Results: The average number of cases ranged from 6.1 cases per facility for the low-proportion group to 11.7 cases per facility for the high-proportion group in week 1, and from 26.7 to 58.5 cases per facility in week 10. Compared to the low-proportion group, the adjusted incidence rate ratios (IRRs) for the high-proportion group were 1.18 (95% confidence interval [CI], 0.77–1.80; P > .10) in week 1 and 1.54 (95% CI, 1.05–2.25; P < .05) in week 10, showing a 30% (95% CI, 5%–62%) relative increase (P < .05). The average weekly number of COVID-19–related deaths ranged from 0 to 0.3 deaths per facility for different groups in week 1, and from 7.6 to 13.3 deaths per facility in week 10. Adjusted disparities in fatalities similarly increased over time. Conclusions: Connecticut nursing homes caring for predominately racial and ethnic minority residents tended to have higher COVID-19 incidence and fatality rates. These across-facility disparities increased during the early periods of the pandemic.

scholarly journals Racial and Ethnic Disparities in Pain Management for Nursing Home Residents: A Scoping Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 885-885
Author(s):  
Cassandra Dictus ◽  
Youngmin Cho ◽  
Tamara Baker ◽  
Anna Beeber
Keyword(s):  
Nursing Home ◽  
Pain Management ◽  
Nursing Homes ◽  
Racial Disparities ◽  
Racial Differences ◽  
Racial Bias ◽  
Nursing Home Residents ◽  
Ethnic Disparities ◽  
Nursing Home Care

Abstract Within nursing homes, residents commonly experience pain that unfortunately goes underrecognized and undertreated, having a dramatic negative impact on residents' quality of life. Nursing homes are becoming more racially and ethnically diverse, and there is concerning evidence documenting disparities in the quality of nursing home care. In other healthcare settings, people of diverse race groups often receive less optimal pain management, but the evidence regarding racial disparities has not been synthesized for nursing homes. Thus, the purpose of this review was to investigate what is known about racial disparities related to pain management (e.g. assessment, treatment, preferences) in US nursing homes. We completed a scoping literature review using PRISMA-ScR guidelines and searching PubMed, CINHAL, and Scopus for peer-reviewed, empirical studies. Most studies were older large retrospective cohort studies of administrative data documenting that White residents were more likely than residents of diverse race groups to have pain documented and treated. Only a few studies looked at possible reasons to explain the disparities; differences were not found to be related to nursing staff racial bias nor differences in pain-related diagnoses. However, there was evidence of racial differences in resident behavior and attitudes related to pain management. None of the studies examined systemic factors related to differences among nursing homes, which has been implicated in studies looking at other outcomes including COVID-19. More research is needed which examines the causal mechanisms behind the documented racial disparities in pain management so that gaps in care can be reduced.

scholarly journals Analysis of Racial and Ethnic Disparities as Possible Risk Factors for Development of Incontinence by Nursing Home Residents

2015 ◽  
Vol 38 (6) ◽  
pp. 449-461 ◽  
Author(s):  
Donna Z. Bliss ◽  
Olga V. Gurvich ◽  
Kay Savik ◽  
Lynn E. Eberly ◽  
Susan Harms ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities

Variations in death notification of nursing home residents to Australian Coroners

2018 ◽  
Vol 25 (5) ◽  
pp. 357-363
Author(s):  
Joseph Elias Ibrahim ◽  
Chebiwot Kipsaina ◽  
Cathy Martin ◽  
David Leo Ranson ◽  
Lyndal Bugeja
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Negative Binomial ◽  
Nursing Home Residents ◽  
Comprehensive Model ◽  
Manner Of Death ◽  
Home Setting ◽  
The Impact ◽  
Age Of Death

ObjectivesTo examine the impact of changes to the reporting requirements in coronial legislation on the nature and frequency of nursing home resident deaths reported to Coroners.DesignNational retrospective study of a population cohort of nursing home resident deaths.SettingAccredited Australian nursing homes between July 2000 and June 2013.ParticipantsResidents who died in nursing homes accredited by the Aged Care Standards and Accreditation Agency reported to Coroners.Main outcome measuresWe explored three death-reporting models in the nursing home setting: comprehensive model, selective ‘mechanism of death’ model and selective ‘age of death’ model. These models were examined by manner of death subgroups: natural, falls-related and other external causes using the outcome measure of deaths notified to the Coroner per 1000 residents. We used an interrupted time series analysis using generalised linear regression with a negative binomial probability distribution and a log link function.ResultsThe comprehensive model showed the proportion of reportable deaths due to natural causes far exceeded those from falls and other external cause. In contrast, the selective notification models reduced the total number of reportable deaths. Similarly, the selective ‘age of death’ model showed a decline in the reportable external cause deaths.ConclusionsVariation in the causes, locations and ages of persons whose deaths are legally required to be notified to Coroners impacts the frequency and nature of deaths of nursing home residents investigated by Coroners. This demonstrates that legislation needs to be carefully framed and applied to ensure that the prevention mandate of Coroners in Australia is to be achieved.

scholarly journals A Profile of Black and Latinx Older Adults Receiving Care in Nursing Homes: 2011-2017

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 241-241
Author(s):  
Andrew Dick ◽  
Bei Wu ◽  
David Grabowski ◽  
Mansi Agarwal ◽  
Gayani Perera ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Current Trends ◽  
Services And Supports

Abstract Between the years 1999-2008, a substantial increase in nursing home use occurred among Black and Latinx older adults, while white older adults’ use of nursing homes decreased. These disparate trends suggested potential racial and ethnic disparities in options for preferred long-term services and supports (LTSS) settings. Over the last decade, several initiatives have been put in place to support LTSS needs in the community. However, it is unclear whether Black and Latinx older adults are continuing to use nursing home services at disproportionate rates. We used LTCfocus data for 2011-2017 to explore current trends in nursing home use and access among Black and Latinx older adults in light of these current initiatives. Our findings reveal a continued rise in Black and Latinx older adults’ use of nursing homes while white older adults’ use continues to decline. More notably, there has been a decline in nursing homes servicing these minority groups.

School Disorder and Dropping Out: The Intersection of Gender, Race, and Ethnicity

2016 ◽  
Vol 51 (2) ◽  
pp. 193-218 ◽  
Author(s):  
Anthony A. Peguero ◽  
Gabriel J. Merrin ◽  
Jun Sung Hong ◽  
Kecia R. Johnson
Keyword(s):  
Native American ◽  
Ethnic Minority ◽  
Asian American ◽  
Ethnic Disparities ◽  
School Level ◽  
Dropping Out ◽  
Racial And Ethnic Disparities ◽  
Minority Adolescents ◽  
School Disorder ◽  
Racial And Ethnic Minority

A growing body of research is exploring the affects school disorder has on educational progress. It is also known that educational success and failure are linked to gender, racial, and ethnic disparities. Other issues, however, remain less explored. For example, how do perceptions of individual adolescents about disorder affect behavior? Or whether or how school-level physical and social disorder are related to gender, racial, and ethnic disparities. Do any of these factors affect the likelihood of dropping out? This study draws from the Education Longitudinal Study of 2002, with a focus on a subsample consisting of Black/African American, Latina/o American, Asian American, Native American, multiracial American, and White American public school students in 580 public schools. We analyze the role school disorder has on dropping out, among racial and ethnic minority adolescents. The results suggest that, in general, school disorder has greater influence among racial and ethnic minority youth.

scholarly journals County-Level Social Determinants of Health and COVID-19 in Nursing Homes, United States, June 1, 2020–January 31, 2021

2021 ◽  
pp. 003335492110536
Author(s):  
Adam Hege ◽  
Sandi Lane ◽  
Trent Spaulding ◽  
Margaret Sugg ◽  
Lakshmi S. Iyer
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Ethnic Minority ◽  
Census Data ◽  
Determinants Of Health ◽  
Future Research ◽  
County Level ◽  
Infection Rates ◽  
Structural Determinants ◽  
Racial And Ethnic Minority

Objectives Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home–associated COVID-19 infection rates and county-level and nursing home attributes. Methods We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. Results Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (−0.007) or state-owned (−0.025) and nonprofit (–0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home–associated COVID-19 infection rates early in the study. High median annual personal income (−0.002) at the county level correlated with lower nursing home–associated COVID-19 infection rates. Conclusions Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.

scholarly journals Disparities in COVID-19 Mortality in High-Minority Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 523-524
Author(s):  
Robert Weech-Maldonado ◽  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Gregory Orewa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Resource Availability ◽  
Negative Binomial ◽  
Ethnic Disparities ◽  
Organizational Characteristics ◽  
Term Care ◽  
Facility Level ◽  
The Relationship ◽  
Racial Ethnic

Abstract Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Minorities continue to utilize nursing home services at a higher rate than White residents, contributing to existing health inequity concerns. This study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality using the CMS Nursing Home COVID-19 Public File. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. Four nested sequential negative binomial regressions were used to model the relationship between racial/ethnic disparities in COVID-19 deaths and the separate contributions of facility-level resident characteristics (percent of females, percent of residents 65 years and older, percent of residents with congestive heart failure, hypertension, and obesity, and the average level of residents’ acuity), resource availability (nursing homes’ payer-mix, occupancy rate, county-level Social Deprivation Index, and nursing home location), and other organizational characteristics (nursing home for-profit status, chain affiliation, and self-reported nursing, clinical, aides, and other staff shortages). After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p &lt; 0.001) as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the long-term care.

scholarly journals A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

2021 ◽  
pp. 1-13
Author(s):  
Julie L. O’Sullivan ◽  
Sonia Lech ◽  
Paul Gellert ◽  
Ulrike Grittner ◽  
Jan-Niklas Voigt-Antons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Psychotropic Medication ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. Design: Cluster-randomized controlled trial. Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI −3.54, 2.33 for TBI and .36 points, 95% CI −3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Sign in / Sign up

Export Citation Format

Share Document