Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study

AbstractImportanceNursing home (NH) residents are particularly vulnerable to SARS-CoV-2 infections and coronavirus disease 2019 (COVID-19) lethality. However, excess deaths in this population have rarely been documented.ObjectivesThe primary objective was to assess the number of excess deaths among NH residents during the first wave of the COVID-19 pandemic in France. The secondary objectives were to determine the number of excess deaths as a proportion of the total excess deaths in the general population and determine whether a harvesting effect was present.DesignWe studied a cohort of 494,753 adults (as of March 1st, 2020) aged 60 and over in 6,515 NHs in mainland France. This cohort was exposed to the first wave of the COVID-19 pandemic (from March 1st to May 31st, 2020) and was compared with the corresponding, reference cohorts from 2014 to 2019 (using data from the French National Health Data System).Main outcome and measuresThe main outcome was all-cause death. Weekly excess deaths and standardized mortality ratios (SMRs) were estimated.ResultThere were 13,505 excess deaths among NH residents. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than among females (SMR: 1.51 and 1.38, respectively) and decreased with age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94, and 1.31 for 95 or over; Males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94, and 1.41 for 95 or over). We did not observe a harvesting effect (up until August 30th, 2020). By extrapolating to all NH residents nationally (N=570,003), the latter accounted for 51% of the total excess deaths in the general population (N=15,114 out of 29,563).ConclusionNH residents accounted for about half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger residents than among older residents. We did not observe a harvesting effect. A real-time mortality surveillance system and the identification of individual and environmental risk factors might help to design the future model of care for older dependent adults.Key pointsDuring the first wave of the COVID-19 pandemic in France, the mortality among nursing home residents increased by 43%.Nursing home residents accounted for 51% of the total excess deaths in France.The excess mortality was higher among younger residents than among older residents.The excess mortality was higher among males than among females.We did not observe a harvesting effect during the study period (ending on August 30th, 2020, i.e., three months after the end of the first wave).

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Death From Stroke in End-Stage Kidney Disease

Stroke ◽

10.1161/strokeaha.118.023644 ◽

2019 ◽

Vol 50 (2) ◽

pp. 487-490 ◽

Cited By ~ 1

Author(s):

Nicole L. De La Mata ◽

Philip Masson ◽

Rustam Al-Shahi Salman ◽

Patrick J. Kelly ◽

Angela C. Webster

Keyword(s):

Kidney Disease ◽

General Population ◽

Standardized Mortality Ratio ◽

Stroke Mortality ◽

End Stage Kidney Disease ◽

Mortality Ratio ◽

Standardized Mortality Ratios ◽

Using Data ◽

End Stage ◽

Over Time

Background and Purpose— People with end-stage kidney disease (ESKD) are at greater risk of stroke. We aimed to compare stroke mortality between the ESKD population and the general population. Methods— We included all patients with incident ESKD in Australia, 1980 to 2013, and New Zealand, 1988 to 2012. The primary cause of death was ascertained using data linkage with national death registers. We produced standardized mortality ratios for stroke deaths, by age, sex, and calendar year. Results— We included 60 823 patients with ESKD, where 941 stroke deaths occurred during 381 874 person-years. Patients with ESKD had >3× the stroke deaths compared with the general population (standardized mortality ratio, 3.4; 95% CI, 3.2–3.6), markedly higher in younger people and women. The greatest excess was in intracerebral hemorrhages (standardized mortality ratio, 5.2; 95% CI, 4.5–5.9). Excess stroke deaths in patients with ESKD decreased over time, although were still double in 2013 (2013 standardized mortality ratio, 2.1; 95% CI, 1.5–2.9). Conclusions— People with ESKD experience much greater stroke mortality with the greatest difference for women and younger people. However, mortality has improved over time.

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Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway

Journal of Clinical Nursing ◽

10.1111/j.1365-2702.2007.02132.x ◽

2008 ◽

Vol 17 (9) ◽

pp. 1227-1236 ◽

Cited By ~ 34

Author(s):

Jorunn Drageset ◽

Gerd Karin Natvig ◽

Geir Egil Eide ◽

Elizabeth C Clipp ◽

Margareth Bondevik ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Cognitive Impairment ◽

General Population ◽

Nursing Home Residents ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Applicability of Neighborhood and Building Scale Wastewater-Based Genomic Epidemiology to Track the SARS-CoV-2 Pandemic and other Pathogens

10.1101/2021.02.18.21251939 ◽

2021 ◽

Author(s):

Rachel R. Spurbeck ◽

Angela T. Minard-Smith ◽

Lindsay A. Catlin

Keyword(s):

Nursing Home ◽

Viral Load ◽

Quantitative Polymerase Chain Reaction ◽

Treatment Plant ◽

Nursing Home Residents ◽

Viral Population ◽

List Type ◽

Whole Genome ◽

Sequencing Data ◽

Wastewater Samples

AbstractThe benefits of wastewater-based epidemiology (WBE) for tracking the viral load of SARS-CoV-2, the causative agent of COVID-19, have become apparent since the start of the pandemic. However, most sampling occurs at the wastewater treatment plant influent and therefore can only monitor SARS-CoV-2 concentration and spread within the entire catchment, which can encompass multiple municipalities. Furthermore, most WBE only quantifies the virus, and therefore miss crucial information that can be gained by sequencing SARS-CoV-2. Here we demonstrate feasibility of sampling at the neighborhood or building complex level using a mix of quantitative polymerase chain reaction (qPCR) and targeted sequencing to provide a more refined understanding of the local dynamics of SARS-CoV-2 strains. When coupled with the higher-level treatment plant samples, this creates an opportunity for health officials to monitor the spread of the virus at different spatial and temporal scales to inform policy decisions.Here we demonstrate the feasibility of tracking SARS-CoV-2 at the neighborhood, hospital, and nursing home level with the ability to detect one COVID-19 positive out of 60 nursing home residents. The viral load obtained was correlative with the number of COVID-19 patients being treated in the hospital. Sequencing of the samples over time demonstrated that nonsynonymous mutations fluctuate in the viral population, and wastewater-based sequencing could be an efficient approach to monitor for vaccine or convalescent plasma escape mutants, as well as mutations that could reduce the efficacy of diagnostics. Furthermore, while SARS-CoV-2 was detected by untargeted RNA sequencing, qPCR and targeted whole genome amplicon sequencing were more reliable methods for tracking the pandemic. From our sequencing data, clades and shifts in mutation profiles within the community were traceable and could be used to determine if vaccine or diagnostics need to be adapted to ensure continued efficacy.Graphical AbstractHighlightsNeighborhood or building level wastewater analysis accurately detects SARS-CoV-2SARS-CoV-2 was detected in wastewater from one infected person out of 60 residentsTotal RNAseq did not accurately detect SARS-CoV-2 in wastewater samples.Targeted whole genome sequencing of wastewater samples identified Spike mutations.

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The Newly Disabled: Blind Nursing Home Residents

Journal of Applied Gerontology ◽

10.1177/073346488800700307 ◽

1988 ◽

Vol 7 (3) ◽

pp. 367-388 ◽

Cited By ~ 3

Author(s):

Joan Retsinas ◽

Patricia Garrity

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Functional Status ◽

Nursing Home Residents ◽

Hearing Impairments ◽

Nursing Home Staff ◽

Using Data

The sarse literature on blind nursing home residents describes them as isolated, withdrawn, and dependent. We introduce a model that links blindness to immobility, isolation, dependence, loss of affect, and disinterest in the outside world. Using data from one nursing home, we compared the functional status and mobility of residents who were blind before admission with that of residents who became blind after admission. The results suggest that preadmission blind residents' dependence, isolation, and immobility were attributed not solely to their blindness, but to their severe nonvisual disabilities, including hearing impairments. Postadmission blind residents, however, did suffer because of their blindness. To improve blind residents' quality of life, we offer practical suggestions for training nursing home staff.

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Comparison of Dried Blood Spots and Venous Blood for the Detection of SARS-CoV-2 Antibodies in a Population of Nursing Home Residents

Microbiology Spectrum ◽

10.1128/spectrum.00178-21 ◽

2021 ◽

Author(s):

Eline Meyers ◽

Stefan Heytens ◽

Asangwing Formukong ◽

Hanne Vercruysse ◽

An De Sutter ◽

...

Keyword(s):

Nursing Home ◽

General Population ◽

Large Scale ◽

Room Temperature ◽

Venous Blood ◽

Nursing Home Residents ◽

Dried Blood Spots ◽

Serological Tests ◽

Finger Prick ◽

Study Population

Since the implementation of newly developed SARS-CoV-2 vaccines in the general population, serological tests are of increasing importance. Because DBS samples can be obtained with a finger prick and can be shipped and stored at room temperature, they are optimal for use in large-scale SARS-CoV-2 serosurveillance or postauthorization vaccination studies, even in an elderly study population.

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Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-215505 ◽

2021 ◽

pp. jech-2020-215505

Author(s):

Jose Manuel Aburto ◽

Ridhi Kashyap ◽

Jonas Schöley ◽

Colin Angus ◽

John Ermisch ◽

...

Keyword(s):

Life Expectancy ◽

Excess Mortality ◽

Prediction Interval ◽

Age Groups ◽

Population Level ◽

England And Wales ◽

Life Expectancy At Birth ◽

Using Data ◽

The Impact ◽

Excess Deaths

BackgroundDeaths directly linked to COVID-19 infection may be misclassified, and the pandemic may have indirectly affected other causes of death. To overcome these measurement challenges, we estimate the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality from week 10 of 2020, when the first COVID-19 death was registered, to week 47 ending 20 November 2020 in England and Wales through an analysis of excess mortality.MethodsWe estimated age and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality with a systematic comparison of four different models using data from the Office for National Statistics. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the SD in age at death.ResultsThere have been 57 419 (95% prediction interval: 54 197, 60 752) excess deaths in the first 47 weeks of 2020, 55% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 0.9 and 1.2 years for women and men relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period by 5 months for both sexes.ConclusionQuantifying excess deaths and their impact on life expectancy at birth provide a more comprehensive picture of the burden of COVID-19 on mortality. Whether mortality will return to—or even fall below—the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place.

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Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth - an exploratory qualitative pre-post study

BMC Health Services Research ◽

10.1186/s12913-021-06950-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Susann May ◽

Kai Jonas ◽

Georgia V. Fehler ◽

Thomas Zahn ◽

Martin Heinze ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Rural Areas ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Alternative Form ◽

Supporting Evidence ◽

List Type ◽

Existing Structures

Abstract Background Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? Methods Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. Results Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. Conclusions Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.

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A MIXED-METHODS STUDY OF NURSING HOME RESIDENTS’ EXPERIENCES OF RELATIONSHIPS AND DAY-TO-DAY SOCIAL INTERACTIONS

Innovation in Aging ◽

10.1093/geroni/igz038.2045 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S555-S555

Author(s):

Allyson M Washburn ◽

Susan Williams

Keyword(s):

Nursing Home ◽

Social Cognition ◽

Social Interactions ◽

Nursing Home Residents ◽

Social Experiences ◽

Cognitive Status ◽

Mixed Methods Study ◽

Conventional Content Analysis ◽

Using Data ◽

Nursing Home Stay

Abstract Nursing home residents with and without cognitive impairment (N=38) answered open-ended questions about their day-to-day social interactions and ongoing relationships with family and friends. One author (SW) completed a conventional content analysis of the transcripts and the other (AW), a phenomenological-hermeneutic analysis. Findings from these analyses were combined and examined further using data from measures of social cognition and staff ratings of social behavior. Participants’ social experiences appeared to be determined not only by long-established habits and preferences and length of nursing home stay but also by their cognitive status and social cognition competencies. A central theme was the importance of managing ongoing relationships and day-to-day interactions so as to reduce one’s own stress as well as the burden on others. This presentation details how findings from distinct analytic strategies were combined to characterize the researchers’ understanding of participants’ lives in their networks of care from their own perspective.

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Excess Deaths associated with the COVID-19 Pandemic in Ukraine in 2020

10.1101/2021.09.28.21264266 ◽

2021 ◽

Author(s):

Neil K. Mehta ◽

Ihor Honchar ◽

Olena Doroshenko ◽

Igor Brovchenko ◽

Khrystyna Pak ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

European Countries ◽

List Type ◽

Younger Age ◽

Influenza Activity ◽

Expected Mortality ◽

The Impact ◽

Excess Deaths

AbstractCOVID-19 related mortality has been understudied in Ukraine. As part of a World Bank project, we estimated excess mortality in Ukraine during 2020. Data on all deaths registered in government-controlled Ukraine from 2016-2020 (N=2,946,505) were utilized. We predicted deaths in 2020 by five-year age groups, sex, and month and calculated the number of deaths that deviated from expected levels (excess deaths). We compared excess deaths with the number of recorded COVID-19 deaths on death certificates and with published estimates for 30 European countries. We estimated 38,095 excess deaths in 2020 (6% of all deaths). Death rates were above expected levels in February and from June-December and lower in January and March-May. From June-December, we estimated 52,124 excess deaths with a peak in November (16,891 deaths). COVID-19 recorded deaths were approximately one-third of excess deaths in June-December (18,959 vs. 52,124). Higher than expected mortality was detected for all age groups 40-44 years and above and for those ages 0-4, 15-19, and 20-24. Ukraine’s excess mortality was about average compared to 30 other European countries. Excess deaths may be attributed directly to SARS-COV2 infection or indirectly to death causes associated with social and economic upheavals resulting in from the pandemic. Lower than expected mortality during the early part of 2020 is consistent with low influenza activity and reductions in deaths from restricted movement. Further studies are required to examine the causes of death that have contributed to positive excess mortality, particularly among younger aged groups.Key MessagesUkraine has experienced sizeable changes in its recent demography and the impact of the COVID-19 pandemic on the country’s aggregate mortality patterns is understudiedBased on recent death trends, we found that Ukraine experienced lower than expected mortality during the early part of 2020 and consistently higher than expected mortality from June-December with peak levels occurring in NovemberPositive excess mortality was observed for all age groups beginning at ages 40-44 as well as some younger age groups.

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