scholarly journals Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications

2020 ◽  
Author(s):  
Anna E Bone ◽  
Anne M Finucane ◽  
Javiera Leniz ◽  
Irene J Higginson ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
High Mortality ◽  
Care Home ◽  
Healthcare Systems ◽  
Population Based ◽  
Care Homes ◽  
List Type ◽  
Integrated Models ◽  
Care Needs ◽  
England And Wales

AbstractBackgroundCOVID-19 has directly and indirectly caused high mortality worldwide.AimTo explore patterns of mortality during the COVID-19 pandemic and implications for palliative care provision, planning, and research.DesignDescriptive analysis and population-based modelling of routine data.Participants and settingAll deaths registered in England and Wales between 7th March and 15th May 2020. We described the following mortality categories by age, gender and place of death: 1) baseline deaths (deaths that would typically occur in a given period) 2) COVID-19 deaths 3) additional deaths not directly attributed to COVID-19. We estimated the proportion of COVID-19 deaths among people who would be in their last year of life in the absence of the pandemic, using simple modelling with explicit assumptions.ResultsDuring the first 10 weeks of the pandemic there were 101,615 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220% compared to home and hospital deaths which increased by 77% and 90%. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ≥75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 44% (38% to 50%) of COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic.ConclusionsHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings. Integrated models of palliative care in care homes are urgently needed.Key statementsWhat is already known about the topic?The COVID-19 pandemic has directly and indirectly resulted in high mortality in many affected nations.Internationally the response has been focused on prevention and curative treatments, with little emphasis on palliative care needs of people dying during the COVID-19 pandemic.We do not know how many of those dying with COVID-19 would have been in their last year of life in the absence of the pandemic, and this group may have distinct care needs.What this paper addsThe number of people dying in care homes trebled during the first 10 weeks of the COVID-19 pandemic in England and Wales; many of these deaths were ‘additional deaths’, that is associated with the COVID-19 pandemic but not directly as a result of COVID-19.We estimate almost half of all COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic.Implications for practice, theory or policyHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings.The need for integrated models of palliative care in care home settings is imperative and research to underpin these models is warranted.

scholarly journals Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

2020 ◽  
Vol 34 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Liz Forbat ◽  
Wai-Man Liu ◽  
Jane Koerner ◽  
Lawrence Lam ◽  
Juliane Samara ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Care Home ◽  
Care Homes ◽  
Randomised Control Trial ◽  
Specialist Palliative Care ◽  
Stepped Wedge ◽  
Model Of Care ◽  
Care Needs ◽  
Palliative Care Needs

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. Design: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. Setting/participants: 1700 residents in 12 Australian care homes for older people. Results: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: −0.44, −0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). Conclusion: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

OP9  Perch – preliminary exploration of the role of paramedics in care homes

2020 ◽  
Vol 37 (10) ◽  
pp. e5.2-e6
Author(s):  
Mark Kingston ◽  
Leigh Keen ◽  
Stephanie Green ◽  
Lesley Griffiths
Keyword(s):  
Primary Care ◽  
Care Home ◽  
Care Homes ◽  
Health Board ◽  
List Type ◽  
Role Clarity ◽  
England And Wales ◽  
Fact Finding ◽  
The Impact

BackgroundHalf a million people live in UK care homes. General practices struggle to deliver primary care for residents due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In response, some areas are involving paramedics in proactive support to care homes, part of a shift towards paramedics undertaking non-emergency community care. Yet such workforce changes require urgent evaluation to understand implications for residents, staff and health services. We aimed to explore the role of non-emergency paramedics in care homes to support the design of portfolio research.MethodsWe convened a Research Development Group of care home, ambulance service, health board, primary care, public and academic representatives. We:Conducted fact-finding visits to sitesAnalysed 999 call data from care homesSurveyed ENRICH (Enabling Research in Care Homes) care home managers in England and WalesHeld a stakeholder workshop to explore the issuesResultsWe identified sites in England and Wales where paramedics provide non-emergency care in care homes. Operating models varied with paramedics employed by ambulance services, health boards and practices. Monthly 999 data from 300 homes confirmed high call and hospital conveyance rates. Survey respondents thought paramedics were well suited to assessing residents, identifying issues, improving care and avoiding admissions. They foresaw benefits to inter-professional working, clinical support and person-centred care, but raised concerns over professional boundaries and role clarity. These messages were reinforced in our workshop, where the value of timely assessment was highlighted, alongside challenges of funding and governance.ConclusionsThe role of paramedics is shifting into dedicated primary and community work, including care homes. It is imperative that research is aligned and informs evidence based practice. We are developing PERCH2, a feasibility study evaluating the impact of paramedics working in this way.

34 Specialist palliative care providers’ perspectives on how to meet the service delivery challenges in adult care homes in england: a national survey

2018 ◽  
Vol 8 (3) ◽  
pp. 372.2-373
Author(s):  
Alisha Newman ◽  
Gemma Allnatt ◽  
Nicola Bowtell ◽  
Kerry Archer-Dutton ◽  
Anita Hayes ◽  
...  
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
Health Research ◽  
Core Competencies ◽  
Care Home ◽  
Care Homes ◽  
List Type ◽  
Specialist Palliative Care ◽  
Provider Perspective

IntroductionCare homes (CHs) play a vital role in the delivery of care towards the end of life (National Institute for Health Research 2017; Public Health England 2017) yet little is known about specialist palliative care (SPC) support in this setting.AimTo increase understanding of how SPC services support adult CHs in England and identify from a SPC provider perspective the challenges and enablers to good quality SPC.MethodSPC services working directly with CHs in the community in England were invited to complete an online survey. Content analysis enabled qualitative data to be described.Results108 services participated. A range of challenges were identified including CH staff turnover lack of funding and retention of CH staff knowledge skills and competency.Proposed ways to reduce/resolve challenges included:Increased commissioning of SPC staff to work directly with CHs particularly to provide education/trainingStrategic centralised and longer–term approaches to funding to facilitate continuity of support to CHsMandatory SPC core competencies and accessible training for CH staff to facilitate the prioritisation and uptake of trainingIncreased collaboration within and across organisations including regulators commissioners and providers of SPC CH and GP services to increase consistency and quality of SPC education and resident careConclusionsThe data are of national relevance and enhances our understanding of the challenges and potential enablers to CH support from a SPC provider perspective. Increased funding and cross-organisational collaboration are thought to be important instruments for change. The views of others including CH staff should be sought.References. National Institute for Health Research. Advancing care – Research with care homes 2017. Available at: https://www.dc.nihr.ac.uk/themed-reviews/care-home-research.htm [Accessed: 29th May 2018]. Public Health England. Briefing 1 – Care home bed provision and potential end of life care need in people aged 75 or older in England2017. Available at: http://www.endoflifecareintelligence.org.uk/resources/publications/carehomes [Accessed: 29th May 2018]

scholarly journals Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

2020 ◽  
Vol 34 (9) ◽  
pp. 1193-1201 ◽  
Author(s):  
Anna E Bone ◽  
Anne M Finucane ◽  
Javiera Leniz ◽  
Irene J Higginson ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Descriptive Analysis ◽  
Palliative Care Service ◽  
Routine Data ◽  
Population Based ◽  
Service Planning ◽  
Care Homes ◽  
Care Needs ◽  
Health And Social Care

Background: COVID-19 has directly and indirectly caused high mortality worldwide. Aim: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. Design: Descriptive analysis and population-based modelling of routine data. Participants and setting: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. Results: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. Conclusion: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

Young Adults With Traumatic Brain Injury in Long-Term Care Homes: A Population-Based Study

2010 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Angela Colantonio ◽  
Dana Howse ◽  
Jigisha Patel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Long Term Care ◽  
Secondary Data ◽  
Population Based ◽  
Care Homes ◽  
Care Needs ◽  
Cross Sectional ◽  
Term Care

AbstractThe aim of this research was to identify the number and characteristics of adults under the age of 65 with a diagnosis of traumatic brain injury (TBI) living in long-term care homes (nursing homes, homes for the aged and charitable homes) in Ontario, Canada. Methods: The study used a cross-sectional design. Secondary data analysis of a comprehensive provincial database of long-term care homes was conducted. Results: Of the 399 residents coded as having a TBI, 154 were < 65 years of age. Virtually all residents were limited in personal care and required assistance for eating (94.2%), toileting (92.2%) and dressing (99.4%). A large percentage also required care for challenging behaviours, while care needs due to substance abuse was common among 12.3% of TBI residents. Conclusion: As similar research in Australia has found, young persons in long-term care homes in Ontario, Canada, have high level personal health needs, however the appropriateness of this environment is questionable.

scholarly journals Disease trajectories, place and mode of death in people with head and neck cancer: Findings from the ‘Head and Neck 5000’ population-based prospective clinical cohort study

2020 ◽  
Vol 34 (5) ◽  
pp. 639-650 ◽  
Author(s):  
Catriona R Mayland ◽  
Kate Ingarfield ◽  
Simon N Rogers ◽  
Paola Dey ◽  
Steven Thomas ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Population Based ◽  
Hospital Death ◽  
Care Needs ◽  
Curative Intent ◽  
Mode Of Death

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with ‘non-curative’ and ‘curative’ intent, respectively. Within 12 months, 109/161 (68%) in the ‘non-curative’ group died compared with 482/5241 (9%) in the ‘curative’ group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in ‘non-curative’ and ‘curative’ groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% ‘non-curative’; 23.5% ‘curative’) and 45.7% of the ‘curative’ group died in hospital. Conclusion: In addition to those with incurable head and neck cancer, there is a small but significant ‘curative’ subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.

scholarly journals Interrogating structural inequalities in COVID-19 Mortality in England and Wales

2021 ◽  
Author(s):  
Gareth J Griffith ◽  
George Davey Smith ◽  
David Manley ◽  
Laura D Howe ◽  
Gwilym Owen
Keyword(s):  
Age Structure ◽  
Regional Inequality ◽  
Care Homes ◽  
List Type ◽  
England And Wales ◽  
Spatial Inequalities ◽  
Regional Trends ◽  
June July ◽  
Second Wave ◽  
Structural Inequalities

AbstractBackgroundNumerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the complex spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention.MethodsWe use publicly available population data on COVID-19 related- and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider four spatial scales at which processes driving inequality may act and apportion inequality between these.ResultsAdjusting for population age structure, number of care homes and residing in the North we find highest regional inequality in March and June/July. We find finer-grained within-region increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities.ConclusionsResults support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the “second-wave”. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally-targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.Key MessagesRegional inequality in COVID-19 mortality declined from an initial peak in April, before increasing again in June/July.Within-region inequality increased steadily from March until July.Strong regional trends are evident in COVID-19 mortality in June/July, prior to wider reporting of regional differences in “second wave”.Analogous spatial inequalities are not present in non-COVID related mortality over the study period.These inequalities are not explained by age structure, care homes, or deprivation.

scholarly journals Changes in health and functioning of care home residents over two decades: what can we learn from population based studies?

2020 ◽  
Author(s):  
Robert O Barker ◽  
Barbara Hanratty ◽  
Andrew Kingston ◽  
Sheena Ramsay ◽  
Fiona E Matthews
Keyword(s):  
Care Home ◽  
Population Based ◽  
Severe Disability ◽  
Support Needs ◽  
Cross Sectional ◽  
England And Wales ◽  
Care Home Staff ◽  
Using Data ◽  
The Impact ◽  
Over Time

Background Care home residents have complex care and support needs, as demonstrated by their vulnerability during the COVID-19 pandemic. There is a perception that the needs of residents have increased, but evidence is limited. We investigated changes in health and functioning of care home residents over two decades in England and Wales. Methods We conducted a repeated cross-sectional analysis over a 24-year period (1992-2016), using data from three longitudinal studies, the Cognitive Function and Ageing Studies (CFAS) I and II and English Longitudinal Study of Ageing (ELSA). To adjust for ageing of respondents over time results are presented for the 75-84 age group. Results Analysis of 2,280 observations from 1,745 care home residents demonstrated increases in severe disability (difficulty in at least two from washing, dressing and toileting). The prevalence of severe disability increased from 63% in 1992 to 87% in 2014 (subsequent fall in 2016 although wide confidence intervals). The prevalence of complex multimorbidity (problems in at least three out of six body systems) increased within studies over time, from 33% to 54% in CFAS I/II between 1992 and 2012, and 26% to 54% in ELSA between 2006 and 2016. Conclusion Over two decades, there has been an increase in disability and the complexity of health problems amongst care home residents in England and Wales. A rise in support needs for residents places increasing demands on care home staff and health professionals. This is an important concern for policymakers when considering the impact of COVID-19 infection in care homes.

scholarly journals Understanding COVID-19 testing pathways in English care homes to identify the role of point-of-care testing: an interview-based process mapping study

2020 ◽  
Author(s):  
Massimo Micocci ◽  
Adam L Gordon ◽  
A. Joy Allen ◽  
Timothy Hicks ◽  
Patrick Kierkegaard ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Point Of Care ◽  
Care Home ◽  
Care Homes ◽  
List Type ◽  
Process Mapping ◽  
Point Of Care Testing ◽  
Testing Procedures ◽  
People With Dementia

AbstractIntroductionCare home residents are at high risk of dying from COVID-19. Regular testing producing rapid and reliable results is important in this population because infections spread quickly and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs).MethodsTen staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways.ResultsFour main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust.ConclusionSwab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.Key-pointsTesting for COVID-19 in care homes is complex and requires reconfiguration of staffing and environment.Isolation and testing procedures are challenged when providing person-centred care to people with dementia.Point-of-care testing results could give care homes greater flexibility to test in person-centred ways.There was evidence that care home staff interpret testing guidance, rather than follow it verbatim.Each POCT must be evaluated in the context of care homes to understand its effect on care home processes.

scholarly journals Is Point-of-Care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of Point-of-Care Polymerase Chain Reaction test for SARS-COV-2

2020 ◽  
Author(s):  
Massimo Micocci ◽  
Adam L Gordon ◽  
Mikyung Kelly Seo ◽  
A. Joy Allen ◽  
Kerrie Davies ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Point Of Care ◽  
Care Home ◽  
Care Homes ◽  
Polymerase Chain Reaction Test ◽  
List Type ◽  
Point Of Care Testing ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Positive Agreement

AbstractIntroductionReliable rapid testing on COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. Point-of-care testing (POCT) in care homes could provide rapid actionable results. This study aimed to examine the usability and test performance of point of care polymerase chain reaction (PCR) for COVID-19 in care homes.MethodsPoint-of-care PCR for detection of SARS-COV2 was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and use errors were assessed.ResultsPoint of care and laboratory polymerase chain reaction (PCR) tests were performed on 278 participants. The point of care and laboratory tests returned uncertain results or errors for 17 and 5 specimens respectively. Agreement analysis was conducted on 256 specimens. 175 were from staff: 162 asymptomatic; 13 symptomatic. 69 were from residents: 59 asymptomatic; 10 symptomatic. Asymptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2%-99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932 – 0.999). Symptomatic specimens showed 100% (95% CI: 2.5%-100%) positive agreement and 100% negative agreement (95% CI: 85.8%-100%), with overall PABAK of 1. No usability-related hazards emerged from this exploratory study.ConclusionApplications of point-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Agreement between POCT and laboratory PCR was good. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.Key pointsPoint of care tests (POCT) in care homes are feasible and could increase testing capacity for the control of COVID-19 infection.The test of agreement between POCT and laboratory PCR for care home residents and the staff was good.Adoption of POCT in care homes can be considered with appropriate preparatory steps and safeguards in place.Repetitive errors and test malfunctioning can be mitigated with bespoke training for care home staff.Integrated care pathways should be investigated to test the high variability of the context of use.

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