Video Calls for Older Adults: A Narrative Review of Experiments Involving Older Adults in Elderly Care Institutions

Social isolation in geriatric institutions is a real threat to older adults' (OAs) well-being. Visits from family members, when they are not impacted by geographical distance or illness, sometimes fail to provide sufficient opportunities for social connectedness and interaction to prevent and/or combat OAs' loneliness and social isolation. Information and Communication Technologies (ICTs) offer promising solutions to this problem. Video calls provide a quick and convenient way for remote communication between OAs and their families, and a complement to face-to-face visits in geriatric settings. Over the last months, during the several confinements imposed to stop the transmission of COVID-19 over the world, several care homes and long-care facilities have equipped themselves with laptops, tablets and video call applications to help OAs remain in contact with their relatives. However, numerous technical and human-related factors may hinder the use of video calls in these settings. The complexity of technological devices, as well as OAs limited digital skills, low confidence and experience in the use of technology are some examples. Furthermore, the specific context of use and the required implication of multiple actors (care professionals, family members) should also be considered when examining the use and implementation of video calls in geriatric institutions. We conducted a narrative review of literature describing the use of video calls in geriatric institutions between 2000 and 2021, especially because of the little information related to OAs' use of video calls in geriatric settings. One thousand one hundred ninety-seven references were screened and 15 studies focusing on the usability, acceptability and effectiveness of video calls were included. A qualitative, deductive thematic analysis inspired by a Health Technology Assessment (HTA) multidimensional model was used to identify barriers, enablers and solutions to video calls implementation in geriatric institutions. The results from the HTA-based analysis provide encouraging evidence for the feasibility of video call use in geriatric settings, and its efficacy on reducing social isolation among residents. However, numerous technical, human-related, ethical and organizational barriers persist and should be addressed in future works. The present analysis has also allowed the identification of potential solutions to overcome these barriers, which are discussed in this publication.

Reconstructing transmission chains of SARS-CoV-2 amid multiple outbreaks in a geriatric acute-care hospital

Background There is ongoing uncertainty regarding transmission chains and the respective roles of healthcare workers (HCWs) and elderly patients in nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) in geriatric settings. Methods We performed a retrospective cohort study including patients with nosocomial coronavirus disease 2019 (COVID–19) in four outbreak–affected wards, and all SARS–CoV–2 RT–PCR positive HCWs from a Swiss university–affiliated geriatric acute–care hospital that admitted both Covid–19 and non–Covid–19 patients during the first pandemic wave in Spring 2020. We combined epidemiological and genetic sequencing data using a Bayesian modelling framework, and reconstructed transmission dynamics of SARS–CoV–2 involving patients and HCWs, in order to determine who infected whom. We evaluated general transmission patterns according to type of case (HCWs working in dedicated Covid–19 cohorting wards: HCWcovid; HCWs working in non–Covid–19 wards where outbreaks occurred: HCWoutbreak; patients with nosocomial Covid–19: patientnoso) by deriving the proportion of infections attributed to each type of case across all posterior trees and comparing them to random expectations. Results During the study period (March 1 to May 7, 2020) we included 180 SARS–CoV–2 positive cases: 127 HCWs (91 HCWcovid, 36 HCWoutbreak) and 53 patients. The attack rates ranged from 10–19% for patients, and 21% for HCWs. We estimated that there were 16 importation events (3 patients, 13 HCWs) that jointly led to 16 secondary cases. Most patient–to–patient transmission events involved patients having shared a ward (97.6%, 95% credible interval [CrI] 90.4–100%), in contrast to those having shared a room (44.4%, 95%CrI 27.8–62.5%). Transmission events tended to cluster by type of case: patientnoso were almost twice as likely to be infected by other patientnoso than expected (observed:expected ratio 1.91, 95%CrI 1.08 – 4.00, p = 0.02); similarly, HCWoutbreak were more than twice as likely to be infected by other HCWoutbreak than expected (2.25, 95%CrI 1.00–8.00, p = 0.04). The proportion of infectors of HCWcovid were as expected as random. The proportions of high transmitters (≥2 secondary cases) were significantly higher among HCWoutbreak than patientnoso in the late phases (26.2% vs. 13.4%, p<2.2e–16) of the outbreak. Conclusions Most importation events were linked to HCW. Unexpectedly, transmission between HCWcovid was more limited than transmission between patients and HCWoutbreak. This highlights gaps in infection control and suggests possible areas of improvements to limit the extent of nosocomial transmission.

Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2

Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

Posological review of dose extrapolation methodologies in animal studies, early-phase clinical trials and special populations

Identifying the right dose is arguably an essential step in the design of experiments related to drug discovery and development. Often, dose extrapolation is done to scale the doses of a drug from one species to another. However, literature is replete with cases that warrant against the careless and inadequate application of dose-extrapolation methodologies. Increasing costs of research and the development and ethical considerations of experimentation in animals and humans do not condone injudicious design of experiments. This call to caution forms the essential premise of the current review, which focuses on the methodology of the dose extrapolation and its place in early-phase clinical trials and animal studies. Furthermore, the review also provides an update on within-species dose extrapolation to address the issues of adapting adult human doses to pediatric and geriatric settings.

Lights and shadows on the last week of life of nursing home residents with advanced dementia: retrospective study

Background Barriers to palliative care still exist in geriatric settings, thus persons with advanced dementia may not receive adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The study aimed at evaluating the palliative appropriateness of clinical interventions and care at end of life in a cohort of NH residents with advanced dementia in a large Italian region (Lombardy Region). Methods Retrospective study in a convenience sample of 29 NHs. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the last week of life. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs was prescribed. The acknowledgement of worsening condition in clinical records was recorded for 57% of residents, a median of 4 days before death. Conclusions A full implementation of palliative care is not yet achieved possibly due to the insufficient acknowledgement of the inappropriateness of some drugs and interventions, and health professionals’ fears and prejudices regarding critical end-of-life decisions. Further studies should focus on how to improve care for NH residents.

Interprofessional Training and Practice: The Need for More Engagement, Training, and Research in Geropsychology

Interdisciplinary teams consisting of a variety of health professionals working toward common patient goals have become an important innovation in clinical practice. In many parts of the world interdisciplinary teams have become part of practice, including in geriatrics. However, many gaps and the need for further empirical research and translation into practice remain. This is particularly true for the discipline of psychology, as much of the extant literature in engagement, training and practice in geriatric settings or educational settings does not include psychologists. Many advances in interprofessional teams, in acute settings in particular, do not include psychologists as part of the team. With respect to training, educating trainee health professionals, including psychologists, in interdisciplinary practice has still not become a standard part of training curricula internationally. Several excellent models of interprofessional and interdisciplinary training, including international models of interdisciplinary team competencies, have been developed. However, both the empirical testing of these models and their implementation in educational and practice settings is lacking. Within the geriatric healthcare context, the evidence base for both interprofessional care and the need for enhanced training models incorporating interprofessional skills is evolving, and further research on efficacy in evolving clinical contexts and translation into educational contexts worldwide is required. Ultimately, psychology must increase its presence within both interprofessional research and applied contexts.

Reasons for presenteeism in nurses working in geriatric settings: A qualitative study

Objective: To explore the perceived causes of presenteeism in nurses on geriatric wards.Background: Presenteeism, defined as working when unwell, is associated with lost productivity and increased absenteeism. It is more commonly reported by employees in the healthcare sector than other sectors.Methods: An exploratory, qualitative study using semi-structured interviews, thematically analysed. Data collected via 18 recorded interviews with nurses working with patients on geriatric medical wards in Malta.Results: Four major themes emerged that related to nurses’ decisions to engage in presenteeism: illness perceptions, which included participants’ views and experiences of their own health complaints; attitudes to their employing organisation, co-workers and patients; organisational aspects such as culture and administrative arrangements; and personal reasons including illness behaviour preference and personal circumstances.Conclusions: Nurses’ decisions to attend work when unwell were reported as dependent upon four themes. Further studies are warranted to determine if findings are applicable to nurse populations other than those represented in this study.Implications: Workplace health promotion initiatives should target nurses’ management of their own health, particularly if they have chronic illnesses. Workplace policies and arrangements should be examined with a view to controlling presenteeism.