scholarly journals A world apart: levels and factors of excess mortality due to COVID-19 in care homes. The case of Wallonia - Belgium.

2020 ◽  
Author(s):  
Olivier J. Hardy ◽  
Dominique Dubourg ◽  
Mélanie Bourguignon ◽  
Simon Dellicour ◽  
Thierry Eggerickx ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Elderly People ◽  
Death Rate ◽  
Care Home ◽  
Nursing Home Residents ◽  
Epidemiological Studies ◽  
Health Condition ◽  
Care Homes ◽  
Death Rates ◽  
The Impact

COVID-19 became pandemic in 2020 and causes higher mortality in males (M) than females (F) and among older people. In some countries, like Belgium, more than half of COVID-19 confirmed or suspected deaths occurring in spring 2020 concerned residents of care homes. The high incidence in this population is certainly linked to its peculiar age structure but could also result from its poorer general health condition and/or from a higher contamination through the staff of care homes, while protection equipment and testing capacity were initially limited. To address these issues, we used data from Wallonia (Belgium) to characterize the distribution of death rates among care home institutions, to compare the dynamics of deaths in and outside care homes, and to analyse how age and sex affected COVID-19 death rates inside and outside care homes. We also used annual death rates as a proxy for the health condition of each population. We found that: (1) COVID-19 death rate per institution varied widely from 0‰ to 340‰ (mean 43‰) and increased both with the size of the institution (number of beds) and with the importance of medical care provided. (2) 65% of COVID-19 deaths in Wallonia concerned residents of care homes where the outbreak started after but at a faster pace than the outbreak seen in the external population. (3) The impact of age on both annual and COVID-19 mortality closely follows exponential laws (i.e. Gompertz law) but mortality was much higher for the population living in care homes where the age effect was lower (mortality rate doubling every 20 years of age increment in care homes, 6 years outside them). (4) Both within and outside care homes, the ratio of M/F death rates was 1.6 for annual mortality but reached 2.0 for COVID-19 mortality, a ratio consistent among both confirmed and suspected COVID-19 deaths. (5) When reported to the annual death rate per sex and age, the COVID-19 relative mortality was little affected by age and reached 24% (M) and 18% (F) of their respective annual rate in nursing homes, while these percentages reduced to 10% (M) and 9% (F) in homes for elderly people (with less medical assistance), and to 5% (M) and 4% (F) outside of care homes. In conclusion, a c. 130x higher COVID-19 mortality rate found in care homes compared to the outside population can be attributed to the near multiplicative combination of: (1) a 11x higher mortality due to the old age of its residents, (2) a 3.8x higher mortality due to the low average health condition of its residents, and (3) probably a 3.5x higher infection rate (1.6x in homes for elderly people) due to the transmission by its staff, a problem more acute in large institutions. Our results highlight that nursing home residents should be treated as a very specific population, both for epidemiological studies and to take preventive measures, due to their extreme vulnerability to COVID-19.

The impact of climate temperature on counts, recovery, and death rates due to SARS-CoV-2 in South Africa. (Preprint)

2020 ◽  
Author(s):  
Neven Chetty ◽  
Bamise Adeleye ◽  
Abiola Olawale Ilori
Keyword(s):  
South Africa ◽  
South African ◽  
Death Rate ◽  
Western Cape ◽  
Warm Climate ◽  
The South ◽  
Recovery Rates ◽  
Death Rates ◽  
Online Resource ◽  
The Impact

BACKGROUND The impact of climate temperature on the counts (number of positive COVID-19 cases reported), recovery, and death rates of COVID-19 cases in South Africa's nine provinces was investigated. The data for confirmed cases of COVID-19 were collected for March 25 and June 30, 2020 (14 weeks) from South Africa's Government COVID-19 online resource, while the daily provincial climate temperatures were collected from the website of the South African Weather Service. Our result indicates that a higher or lower climate temperature does not prevent or delay the spread and death rates but shows significant positive impacts on the recovery rates of COVID-19 patients. Thus, it indicates that the climate temperature is unlikely to impose a strict limit on the spread of COVID-19. There is no correlation between the cases and death rates, an indicator that no particular temperature range is closely associated with a faster or slower death rate of COVID-19 patients. As evidence from our study, a warm climate temperature can only increase the recovery rate of COVID-19 patients, ultimately impacting the death and active case rates and freeing up resources quicker to enable health facilities to deal with those patients' climbing rates who need treatment. OBJECTIVE This study aims to investigate the impact of climate temperature variation on the counts, recovery, and death rates of COVID-19 cases in all South Africa's provinces. The findings were compared with those of countries with comparable climate temperature values. METHODS The data for confirmed cases of COVID-19 were collected for March 25 and June 30 (14 weeks) for South African provinces, including daily counts, death, and recovery rates. The dates were grouped into two, wherein weeks 1-5 represent the periods of total lockdown to contain the spread of COVID-19 in South Africa. Weeks 6-14 are periods where the lockdown was eased to various levels 4 and 3. The daily information of COVID-19 count, death, and recovery was obtained from South Africa's Government COVID-19 online resource (https://sacoronavirus.co.za). Daily provincial climate temperatures were collected from the website of the South African Weather Service (https://www.weathersa.co.za). The provinces of South Africa are Eastern Cape, Western Cape, Northern Cape, Limpopo, Northwest, Mpumalanga, Free State, KwaZulu-Natal, Western Cape, and Gauteng. Weekly consideration was given to the daily climate temperature (average minimum and maximum). The recorded values were considered, respectively, to be in the ratio of death-to-count (D/C) and recovery-to-count (R/C). Descriptive statistics were performed for all the data collected for this study. The analyses were performed using the Person’s bivariate correlation to analyze the association between climate temperature, death-to-count, and recovery-to-count ratios of COVID-19. RESULTS The results showed that higher climate temperatures aren't essential to avoid the COVID-19 from being spread. The present results conform to the reports that suggested that COVID-19 is unlike the seasonal flu, which does dissipate as the climate temperature rises [17]. Accordingly, the ratio of counts and death-to-count cannot be concluded to be influenced by variations in the climate temperatures within the study areas. CONCLUSIONS The study investigates the impact of climate temperature on the counts, recovery, and death rates of COVID-19 cases in all South Africa's provinces. The findings were compared with those of countries with comparable climate temperatures as South Africa. Our result indicates that a higher or lower climate temperature does not prevent or delay the spread and death rates but shows significant positive impacts on the recovery rates of COVID-19 patients. Warm climate temperatures seem not to restrict the spread of the COVID-19 as the count rate was substantial at every climate temperatures. Thus, it indicates that the climate temperature is unlikely to impose a strict limit on the spread of COVID-19. There is no correlation between the cases and death rates, an indicator that there is no particular temperature range of the climatic conditions closely associated with a faster or slower death rate of COVID-19 patients. However, other shortcomings in this study's process should not be ignored. Some other factors may have contributed to recovery rates, such as the South African government's timely intervention to announce a national lockout at the early stage of the outbreak, the availability of intensive medical care, and social distancing effects. Nevertheless, this study shows that a warm climate temperature can only help COVID-19 patients recover more quickly, thereby having huge impacts on the death and active case rates.

scholarly journals Living in a care home during COVID-19: a case study of one person living with dementia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ian Davies-Abbott ◽  
Catrin Hedd Jones ◽  
Gill Windle
Keyword(s):  
Study Design ◽  
Single Case ◽  
Care Home ◽  
Care Homes ◽  
Single Case Study ◽  
Content Type ◽  
Case Study Design ◽  
People With Dementia ◽  
The Impact

Purpose This paper aims to understand the lived experience of a person living with dementia in a care home during the COVID-19 pandemic. It responds to the absence in research of the voices of people with dementia living in care homes during the pandemic. Design/methodology/approach The paper adopts a single case study design applied thematic analysis to semi-structured interview data to discover the experiences of one person living with dementia in a care home during a period of lockdown. Findings Five themes reveal how the participant responded to the practical and emotional challenges of the pandemic: autonomy; fears; keeping connected; keeping safe and other people living with dementia. These themes highlight the participant’s ability to adapt, accept and dispute lockdown restrictions, revealing considerable insight into their situation. Research limitations/implications The pandemic has restricted access to care homes, which informed the single case study design. This approach to the research may restrict the generalisability of the findings. Other researchers are encouraged to include the voices of people with dementia living in care homes in further studies. Practical implications Implications for practice, presented in this paper, promote quality psychosocial approaches when health-care workers engage with people living with dementia during periods of restricted activity. Originality/value Unlike other studies about the impact of the pandemic on care homes, this paper explores the experience of the pandemic in care homes from the perspective of a person living with dementia.

scholarly journals Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050665
Author(s):  
Jason Scott ◽  
Katie Brittain ◽  
Kate Byrnes ◽  
Pam Dawson ◽  
Stephanie Mulrine ◽  
...  
Keyword(s):  
Data Extraction ◽  
Care Home ◽  
Incident Reporting ◽  
Care Homes ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Safety Issues ◽  
Care Home Staff ◽  
Service Specification ◽  
The Impact

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

scholarly journals Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19

2021 ◽  
Author(s):  
Clarissa Marie Giebel ◽  
Kerry Hanna ◽  
Jacqueline Cannon ◽  
Paul Marlow ◽  
Hilary Tetlow ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Care Home ◽  
Home Visitation ◽  
Control Measures ◽  
Care Homes ◽  
Family Carers ◽  
Care Home Staff ◽  
The Uk ◽  
The Impact

Background: Vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods: Family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results: Across 62 baseline and follow-up interviews with family carers (n=26; 11) and care home staff (n=16; 9), five core themes were developed: Delayed and inconsistent offers of face-to-face visits; Procedures and facilitation of visits; Frustration and anger among family carers; Variable uptake of the COVID-19 vaccine; Misinformation, education, and free choice. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions: We make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff.

scholarly journals What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016-2018

2019 ◽  
Author(s):  
Thomas Inns ◽  
Deb Wilson ◽  
Petra Manley ◽  
John P Harris ◽  
Sarah J O’Brien ◽  
...  
Keyword(s):  
Care Home ◽  
Implementation Strategies ◽  
The Elderly ◽  
Care Homes ◽  
Viral Pathogens ◽  
North East ◽  
Infectious Gastroenteritis ◽  
Homes For The Elderly ◽  
Stool Samples ◽  
The Impact

Abstract Background Outbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings. Methods We analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression. Results From the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01-1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60-0.91), compared to outbreaks caused by other viral pathogens. Conclusions These results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.

scholarly journals Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

2020 ◽  
Author(s):  
Chris Emmerson ◽  
James P Adamson ◽  
Drew Turner ◽  
Mike B Gravenor ◽  
Jane Salmon ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Cox Regression ◽  
Care Home ◽  
Cohort Analysis ◽  
Time Dependent ◽  
Care Homes ◽  
Health Board ◽  
High Morbidity ◽  
Discharge From Hospital ◽  
The Impact

Abstract Background Adult residential and nursing care homes are settings in which older and often vulnerable people live in close proximity. This population experiences a higher proportion of respiratory and gastrointestinal illnesses than the general population and has been shown to have a high morbidity and mortality in relation to COVID-19. Methods We examined the number of hospital discharges to all Welsh adult care homes and the subsequent outbreaks of COVID-19 occurring over an 18 week period 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on the incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics (including size, type of provision and health board). Results A total of 1068 care homes were monitored; 330 homes experienced an outbreak of COVID-19, and 511 homes received a discharge from hospital over the study period. The exposure to discharge from hospital was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.49, p = 0.28), after adjusting for care home size, which was by far the most significant predictor. Hazard ratios (95% CI) in comparison to homes of <10 residents were: 3.4 (2.0, 5.8) for 10-24 residents; 8.3 (5.0, 13.8) for 25-49 residents; and 17.3 (9.6, 31.1) for homes of 50+ residents. When stratified for care home size, the outbreak rates were very similar for periods when homes were exposed to a hospital discharge, in comparison to periods when homes were unexposed. Conclusion Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk. Keywords: COVID-19, care homes, hospital discharge, outbreak, time dependent Cox regression

scholarly journals The “Cameos of Care Homes” project – care home staff’s Vanguard involvement and reflections

2019 ◽  
Vol 23 (2) ◽  
pp. 107-115
Author(s):  
Jess Harris ◽  
Jill Manthorpe
Keyword(s):  
Design Methodology ◽  
Research Output ◽  
Care Home ◽  
Care Homes ◽  
Content Type ◽  
Care Home Staff ◽  
Learning Cultures ◽  
Care Workers ◽  
The Impact ◽  
Practical Implications

Purpose The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes’ learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure.

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.

The Impact of Variation in Trauma Care Times: Urban versus Rural

1995 ◽  
Vol 10 (3) ◽  
pp. 161-166 ◽  
Author(s):  
Thomas J. Esposito ◽  
Ronald V. Maier ◽  
Frederick P. Rivara ◽  
Susan Pilcher ◽  
Janet Griffith ◽  
...  
Keyword(s):  
Trauma Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Death Rate ◽  
Motor Vehicle ◽  
Preventable Death ◽  
Retrospective Case ◽  
Death Rates ◽  
Physician Contact ◽  
The Impact

AbstractStudy Objectives:To document the existence and nature of variation in times to trauma care between urban and rural locations; to assess the impact of identified variations on outcome.Design:Retrospective case reviewSetting:Washington state, 1986Participants:Motor-vehicle-collision fatalitiesMethods:Previously unreported definitions of urban and rural location and possibly preventable death were used to conduct a comparative analysis of urban and rural fatalities. Trauma care times in the prehospital and the emergency department (ED) phases of care were abstracted. Their relationships to corresponding crude death rates and possibly preventable death rates also were examined.Results:Prehospital times averaged two times longer in rural locations than in urban areas. First-physician contact in the ED averaged six times longer in rural locations than in urban settings. Concomitantly, the crude death rate in rural settings was three times that of the urban areas. The overall possibly preventable death rate was double the urban rates in rural incidents. When stratified by phase of care, rate of possibly preventable death showed no urban/rural variation for the prehospital phase, but was three times greater for the ED phase in rural areas than in urban ones.Conclusions:Trauma care times and adverse outcome appear to be associated. Allocation of resources to decrease length of and geographic variation in time to definitive care, particularly in the ED phase, seems appropriate.

scholarly journals Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Fiona Grimm ◽  
Karen Hodgson ◽  
Richard Brine ◽  
Sarah R Deeny
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Admissions ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Hospital Treatment ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Healthcare Needs

BackgroundCare home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. ObjectivesTo examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. MethodsRetrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May 2020 and primary admission reasons for this period were compared across years. ResultsHospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). ConclusionsThis is the first study showing that care home residents' hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

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