The Role of Nursing Homes Architectural Design in Mitigating the Risk of COVID-19 Pandemics: The Case of Slovenia

Currently, many older people live in institutions for various social and health reasons. In Slovenia, this proportion is almost 5% of the population aged 65 and over. In the COVID-19 pandemic, the elderly proved to be the most vulnerable social group, as they are exposed to a number of comorbidities that increase the risk of mortality. At that time, nursing homes represented one of the most critical types of housing, as seen from a disproportionate number of infections and deaths among nursing home residents worldwide, including Slovenia. During the emergency, a number of safety protocols had to be followed to prevent the spread of infection. Unfortunately, it turned out that while the safety measures protected the nursing home residents, they also had a negative effect on their mental health, mainly due to isolation and social distancing. It follows that especially in times of epidemics of infectious respiratory diseases, the quality of life in nursing homes requires special attention. In this context, it is also necessary to consider whether and how an appropriate architectural design can help mitigating the spread of infections, while at the same time enable older people to live in dignity and with a minimum of social exclusion. To this end, the present study examined 97 nursing homes in Slovenia, analysing the number of infections in nursing homes and their correlation with the degree of infection in the corresponding region in Slovenia. Additionally, 2 nursing homes were studied in more detail with the use of newly developed “Safe and Connected” evaluation tool, analysing the architectural features of each building. The advantages identified so far include living in smaller units, single rooms with balconies, the possibility of using green open spaces and the use of an adequate ventilation. Conclusions of this study are useful for further consideration of design of new nursing homes and the refurbishment of existing ones.

Family caregiver’s loneliness and related health factors: what can be changed?

Background Loneliness is a public health issue which may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue and increase the risk of obesity and diabetes. Risk factors for loneliness include poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods We performed a non-interventional observational cross-sectional study in south-eastern France. Family Caregivers caring for people aged 70 and over living at home were included. These older people were independent, without long-term conditions and who applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, frailty was measured through the Gerontopole Frailty Screening Tool. Results Of the 876 caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p<0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR=2.6). They were more likely to feel anxious (OR=5.6), to have sleep disorders (OR=2.4), to be frail (OR=2) and to feel their health as poor or bad (OR=2). Conclusions Loneliness has a negative impact on health, frailty and burden of family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

Reply to Inzitari et al. Comment on “Blancafort Alias et al. A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study. Int. J. Environ. Res. Public Health 2021, 18, 5979”

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Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the ‘front door’. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.