scholarly journals The Impact of COVID-19 on Adjusted Mortality Risk in Care Homes for Older Adults in Wales, United Kingdom: A retrospective population-based cohort study for mortality in 2016-2020

2020 ◽  
Author(s):  
Joe Hollinghurst ◽  
Jane Lyons ◽  
Richard Fry ◽  
Ashley Akbari ◽  
Mike Gravenor ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Care Home ◽  
Care Homes ◽  
Mortality Data ◽  
Survival Curves ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Impact

ABSTRACTBackgroundMortality in care homes has had a prominent focus during the COVID-19 outbreak. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages, and insufficient or lack of timely COVID-19 testing. Care homes are particularly vulnerable to infectious diseases.AimTo analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4-years.Study Design and SettingWe used anonymised Electronic Health Records (EHRs) and administrative data from the Secure Anonymised Information Linkage (SAIL) Databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.MethodsWe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted hazard ratios for age, gender, social economic status and prior health conditions.ResultsSurvival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1·72 (1·55, 1·90) compared to 2016. Compared to the general population in 2016-2019, adjusted care home mortality HRs for older adults rose from 2·15 (2·11,2·20) in 2016-2019 to 2·94 (2·81,3·08) in 2020.ConclusionsThe survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

scholarly journals The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

2020 ◽  
Author(s):  
Joe Hollinghurst ◽  
Jane Lyons ◽  
Richard Fry ◽  
Ashley Akbari ◽  
Mike Gravenor ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Mortality Risk ◽  
Care Home ◽  
Care Homes ◽  
Mortality Data ◽  
Survival Curves ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Anxiety, isolation and diminishing resources: the impact of COVID-19 pandemic on residential care home facilities for older people in south-east Nigeria

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prince Chiagozie Ekoh
Keyword(s):  
Older Adults ◽  
Care Home ◽  
Health Impact ◽  
Sub Saharan Africa ◽  
Care Homes ◽  
Family Structures ◽  
Content Type ◽  
Sub Saharan ◽  
Fear And Anxiety ◽  
The Impact

Purpose Institutionalized older adults in care homes and long-care facilities have been identified as being at greater risk of COVID-19 related morbidity and mortality. Thus, this paper aims to explore the impact of COVID-19 on care homes in south-east Nigeria given the recent increasing popularity of care homes in Nigeria. Design/methodology/approach The study adopted qualitative research method, and data was collected from 10 older residents and 5 caregivers using interviews from two care homes, while ensuring the safety of the researcher and participants. The collected data was analyzed using thematic analysis. Findings Findings revealed that the physical health impact of the COVID-19 pandemic is not a major problem in the homes. However, fear and anxiety, social disconnection and economic hardship were the major problems identified by the older residents and caregivers in the homes. Originality/value The popularity of care homes in Nigeria is growing as family structures continue to change. However, previous studies which have revealed devastating effect of COVID-19 on institutionalized older adults have been from the global north. This is the first study designed to bridge the gap in literature and contribute to knowledge on this topic from Nigeria and Sub-Saharan Africa.

P2746Survival of people with valvular heart disease in the community (OxValve-Survive)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Taylor ◽  
J M Ordonez-Mena ◽  
A K Roalfe ◽  
J Wilson ◽  
S Myerson ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cause Of Death ◽  
Valvular Heart Disease ◽  
Cox Regression ◽  
Severe Disease ◽  
Research Centre ◽  
Mortality Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background Valvular heart disease (VHD) occurs commonly in older patients (>65 years) but the majority is mild disease, which is of uncertain importance. Understanding the impact of VHD on mortality in this older group of patients would help determine its relevance and aid the appropriate use of healthcare resources. OxValve is a cohort study in Oxfordshire screening people aged 65 and over for VHD. Over 4,009 participants were recruited between August 2009 and May 2016 and screened using echocardiography to establish the presence and severity of VHD. AIMS To report survival in the OxValve cohort, and to investigate whether people with VHD are at increased risk of death. Methods The OxValve cohort was linked to Office for National Statistics mortality data to obtain date and cause of death. Cox regression was used to investigate the association of any VHD, VHD of significant severity, and VHD subtypes with all-cause and cause-specific mortality, adjusting for potential confounders including age, sex, socioeconomic status, smoking, and comorbidities. Results Linked mortality data was available for 3,511 OxValve participants up to September 2018 (median 5.85 years follow-up). VHD was present in 2,645 (75.3%) participants and of these 288 (8.2%) had significant VHD. In total, 311 (8.9%) participants had died. Cancer was the commonest cause of death (n=135), followed by cardiovascular disease (n=75) and respiratory disease (n=35). After adjustment for age and other covariates, mild to moderate VHD was not associated with increased all-cause mortality (HR 1.16, 95% CI: 0.89 to 1.50). However, VHD of significant severity (moderate or severe disease) was associated with a nearly two-fold higher risk of death overall (HR 1.92, 95% CI: 1:38 to 2.67) including increased CVD mortality (HR 2.25, 95% CI: 1.21 to 4.18). DISCUSSION Mild to moderate VHD was very common, but was not associated with increased mortality. Significant VHD was however associated with a two-fold reduction in survival. Further research is required to understand the natural history of VHD, how to identify those with progressive disease and when to intervene. Acknowledgement/Funding NIHR Biomedical Research Centre, Oxford

The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study

2019 ◽  
Vol 33 (6) ◽  
Author(s):  
Alfred Adiamah ◽  
Lu Ban ◽  
Joe West ◽  
David J Humes
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Cumulative Incidence ◽  
Population Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Esophagogastric Cancer ◽  
The Impact

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

scholarly journals Survival of people with valvular heart disease in a large, English community-based cohort study

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318823
Author(s):  
Clare J Taylor ◽  
José M Ordóñez-Mena ◽  
Nicholas R Jones ◽  
Andrea K Roalfe ◽  
Saul G Myerson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Outcome Analysis ◽  
Mortality Data ◽  
Risk Of Death ◽  
National Mortality ◽  
Increased Risk ◽  
Aortic Sclerosis ◽  
Clinically Significant

ObjectiveValvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality.MethodsThe OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis.ResultsMortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67).ConclusionsAdvanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.

scholarly journals 201 - Care Home Residents as Artists: Digital Connections in the age of Disconnect.

2021 ◽  
Vol 33 (S1) ◽  
pp. 6-7
Author(s):  
Nicola Abraham ◽  
Rachel Hudspith
Keyword(s):  
Older Adults ◽  
New Technologies ◽  
Housing Association ◽  
Care Home ◽  
Care Homes ◽  
News Reports ◽  
Global Pandemic ◽  
Failure To Protect ◽  
The Uk ◽  
The Impact

AbstractThroughout the current global pandemic, many people have had to adapt to new ways of interacting through virtual platforms. For those with access to new technologies this transition has been straightforward, but not easy and for those without it, life has become socially isolating, frightening, and lonely. The impact of COVID-19 on the mental health of older adults is a serious concern, particularly for those living in care homes who have been forgotten or neglected by exclusionary government policy. Amnesty International’s 2020 report As if Expendable: The UK Government’s Failure to Protect Older People in Care Homes During the COVID-19 Pandemic provides analysis of the neglect to care and sufficiently support older adults living with dementia in supported living. The results of this inaction to provide care has led to many avoidable deaths, and caused fear and heartache for those who have lost family, friends and colleagues. It is at this moment, during the third UK lockdown that we would like to share a narrative of hope about the actions that we have taken within care home contexts to provide relief, reconnect residents safely with their neighbours, and found creative ways to inclusively provide care, support and celebrations of the identities of people in these contexts who have become statistics in news reports.Between January and March 2021, undergraduate and postgraduate Applied Theatre students from The Royal Central School of Speech and Drama in partnership with Imperial College Healthcare NHS Trust collaborated with residents from One Housing Association to create and develop bespoke films, poems, songs and virtual reality 360 videos from the safety of their homes to bring to life their stories, hopes and inner artists. In this presentation, we will explore the impact of these projects on the participants’ wellbeing and examine the importance of providing older adults opportunities to be creative. We will additionally offer insights into the relationships that were made and developed during the projects, including family connections, intergenerational connections and playful relationships that emerged between the residents themselves and their Carers.

scholarly journals Effect of comorbidity on the risk of death associated with antipsychotic use among community-dwelling older adults

2012 ◽  
Vol 24 (7) ◽  
pp. 1058-1064 ◽  
Author(s):  
Natasa Gisev ◽  
Sirpa Hartikainen ◽  
Timothy F. Chen ◽  
Mikko Korhonen ◽  
J. Simon Bell
Keyword(s):  
Older Adults ◽  
Respiratory Disease ◽  
Population Based ◽  
Community Dwelling ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Antidepressant Use ◽  
Community Dwelling Older Adults

ABSTRACTBackground: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities.Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use.Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76).Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall sample size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.

scholarly journals Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England

BMJ ◽  
2021 ◽  
pp. n628 ◽  
Author(s):  
Harriet Forbes ◽  
Caroline E Morton ◽  
Seb Bacon ◽  
Helen I McDonald ◽  
Caroline Minassian ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Admissions ◽  
Absolute Risk ◽  
Population Based ◽  
Intensive Care Admission ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Uk

Abstract Objective To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic. Design Population based cohort study, on behalf of NHS England. Setting Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). Participants Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020. Main outcome measures Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household. Results Among 9 334 392 adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions. Conclusions In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.

scholarly journals The impact of dementia and other comorbidities on increased risk of subsequent hip fracture following hip fracture in Australia: a competing risk approach

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lara Harvey ◽  
Rebecca Mitchell ◽  
Henry Brodaty ◽  
Brian Draper ◽  
Jacqueline Close
Keyword(s):  
Hip Fracture ◽  
Metastatic Cancer ◽  
Competing Risk ◽  
Mortality Data ◽  
Risk Of Death ◽  
Second Hip Fracture ◽  
People With Dementia ◽  
Increased Risk ◽  
Risk Approach ◽  
The Impact

ABSTRACT ObjectivesOlder people with hip fracture are at increased risk of subsequent hip fracture. This study evaluates the relative impact of dementia, osteoporosis and other comorbidities on the increased risk of sustaining a subsequent fall-related hip fracture within ten years of a fall-related hip fracture, accounting for the competing risk of death. ApproachLinked hospital and mortality data for all individuals aged 65 years and older admitted to a hospital in New South Wales, Australia, with a fall-related hip fracture over a ten year period between 1 January 2003 and 31 December 2013 were analysed. Dementia, osteoporosis and comorbidities contributing to the Charlson Comorbidity Index (CCI) were identified using up to 40 additional diagnosis codes recorded in the hospitalisation data and a 1 year lookback period. A competing risk approach was used to account for the high mortality inherent in this older population. Cause-specific hazard ratios (CSHRs) were calculated with age, sex and comorbidities included as covariates in the models. To account for the relatively long time frame of the study, dementia, osteoporosis and other CCI comorbidities were treated as time-dependent covariates. Results Of the 50,290 individuals who sustained a fall-related hip fracture during the study period, 7.6% (4,102) had a subsequent fall-related hip fracture. Compared to people without dementia, people with dementia were more likely to die within 30 days of initial fracture (12.6% vs 6.4%, p<0.0001) and to sustain a subsequent hip fracture (9.8% compared to 6.6%, p<0.0001). In the multivariate hazards regressions, people with dementia had a 2.5 fold (CSHR 2.48, 99.9%CI 2.38-2.58, p<0.0001) increased risk of death and two fold (CSHR 2.02, 99.9%CI 1.81-2.26, p<0.0001) increased risk of second hip fracture. Of the comorbidities, metastatic cancer (CSHR 3.48, 99.9%CI 3.12-3.88, p<0.0001) and severe liver disease (CSHR 3.24, 99.9%CI 2.62-4.01, p<0.0001) were most strongly associated with death. Renal disease (CSHR 1.53, 99.9%CI 1.24-1.88, p<0.0001), osteoporosis (CSHR 1.44, 99.9%CI 1.28-1.62, p<0.0001), congestive heart failure (CSHR 1.42, 99.9%CI 1.24-1.64, p<0.0001), and acute myocardial infarction (CSHR 1.22, 99.9%CI 1.03-1.44, p<0.0001) were associated with increased risk of subsequent hip fracture. Conclusions Hip fractures are costly injuries in terms of health care resources and the impact on the individual and their families. People with dementia are at twice the risk of sustaining a second hip fracture and death compared to people without dementia. Interventions including known effective treatments for osteoporosis as well as falls prevention should be targeted to this vulnerable population.

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