Clinical expressions, characteristics and treatments of confirmed COVID-19 in nursing home residents : a systematic review

Background: The coronavirus 2019 (COVID-19) pandemic has led to a high rate of infections, frequent outbreaks, and high mortality rates in nursing homes (NH) worldwide. To protect and improve the treatment and care of the vulnerable NH population, it is pivotal to systematise and synthesise data from cases of COVID-19 among NH residents. In our systematic review, we therefore aimed to describe the clinical expressions, characteristics, and treatments of NH residents confirmed to have COVID-19. Methods: We conducted two comprehensive literature searches in several electronic databases: (1) PubMed, (2) CINAHL, (3) AgeLine, (4) Embase, and (5) PsycINFO in April and July 2021. Of the 438 articles screened, 19 were included in our sample, and we used the Newcastle–Ottawa Assessment Scale to assess the quality of the reported studies. A weighted mean (Mweighted), was calculated to account for the large variation in sample sizes of the studies, and due to heterogeneity among the studies, we report our findings in a narrative synthesis. Results: According to the mean weights (Mweighted), common symptoms and signs in NH residents confirmed to have COVID-19 were fever (53.7%), cough (56.5%), hypoxia (32.3%), and delirium or confusion (31.2%). Common comorbidities were hypertension (78.6%), dementia or cognitive impairment (55.3%), and cardiovascular diseases (52.0%). Six studies presented data concerning medical and pharmacological treatments, such as inhalers, oxygen supplementation, anticoagulation, and parenteral/enteral fluids or nutrition. The treatments were used to improve outcomes, as part of palliative care, or as end-of-life treatment. Transfers to hospital for NH residents with confirmed COVID-19 were reported in six of the included studies, and the rate of hospital transfers ranged from 6.9% to 50% in this population. In the 17 studies reporting mortality, 40.2% of the NH residents died during the studies’ observation periods. Conclusions: Our systematic review allowed us to summarise important clinical findings about COVID-19 among NH residents and to identify the population’s risk factors for serious illness and death caused by the disease. However, the treatment and care of NH residents with severe COVID-19 warrant further investigation.publishedVersio

Nurses’ ethical challenges when providing care in nursing homes during the COVID-19 pandemic

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity anddeath from COVID-19. The social restrictions proved challenging for the residents, their relatives, and thecare staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge abouthow the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethicaldifficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban andrural areas. Ethical considerations: Oral and written information about the study was provided before the participantsgave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) usingmedication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact ondecision-making. Conclusions: The nurses’ethical challenges were intertwined with external factors, such as national andlocal guidelines, and the nurses’own internalized factors, which were connected to their subjective pro-fessionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in aprofessionally sound and safe manner. Keywords: COVID-19, nursing home, nursing, ethical challenges. © The Author(s) 2022, Article Reuse Guidelines: https://doi.org/10.1177/09697330221105631Nurses’ ethical challenges when providing care in nursing homes during the COVID-19 pandemicpublishedVersio

Body mass index in nursing home residents during the first year after admission

La desnutrición, que comprende tanto la desnutrición como el sobrepeso, debe ser abordada en el seguimiento médico de los adultos mayores debido a las consecuencias negativas para el estado funcional y la salud general. Aún así, se sabe poco sobre el estado nutricional de los residentes de hogares de ancianos (NH), especialmente con respecto al aumento o la pérdida de peso después de la admisión a NH. Por lo tanto, este estudio tiene como objetivo evaluar los cambios en el índice de masa corporal (IMC) durante el primer año posterior al ingreso a NH y explorar las características demográficas y clínicas relacionadas con los cambios en el IMC. Métodos Se combinaron los datos de dos estudios prospectivos que reclutaron participantes al ingreso a NH. Las características demográficas y clínicas, incluido el IMC, se evaluaron al inicio y después de un año. Se estimó un modelo de regresión lineal para explorar el impacto de las características demográficas y clínicas en el cambio del IMC. Resultados La cohorte del estudio constaba de 1044 participantes con una edad media de 84,3 años (DE 7,6) al inicio del estudio; El 64,2% eran mujeres. Al inicio del estudio, el 33% de los residentes de NH tenían desnutrición severa a moderada, mientras que el 10% eran obesos. Durante el primer año de su estadía en NH, los residentes con desnutrición severa a moderada tuvieron un aumento promedio en el IMC de 1,3 kg/m2 (DE 2,2; p < 0,001), mientras que los cambios de peso fueron muy pequeños o no significativos en los otros grupos de IMC . Las características relacionadas con el aumento de peso fueron una edad más joven y menos agitación. Conclusión La desnutrición es un desafío de salud común al momento de la admisión a NH, con un tercio de los residentes de NH con un peso bajo moderado a severo y un 10% con obesidad. Sin embargo, durante el primer año de estancia en NH, hubo una evolución favorable para los residentes de NH con bajo peso, ya que aumentaron su IMC, y el 43,6% cambió a una clasificación de mayor peso, mientras que no observamos cambios en el IMC en los residentes con obesidad. Dado que los residentes de NH se encuentran en la última fase de sus vidas, las intervenciones para prevenir la desnutrición o el sobrepeso deben iniciarse mientras aún viven en el hogar y luego continuar en los hogares de ancianos.Q2Q2Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes.https://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Internacional - IndexadaS

Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

Background: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Methods: Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95 confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own". Results: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95 CI 2.28-5.23). Conclusions: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe

Unburdening dementia a basic social process grounded theory – based on a primary care physician survey from 25 countries

OBJECTIVE: To explore dementia management from a primary care physician perspective.DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.SETTING: Twenty-five European General Practice Research Network member countries.SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines.RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories.CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders

The development and evaluation of TIME - Targeted Interdisciplinary Model for Treatment and Evaluation of Neuropsychiatric Symptoms: An effectiveness-implementation cluster randomised hybrid trial in nursing homes

This thesis describes how the use of TIME, a multicomponent interdisciplinary approach, reduced agitation in residents with dementia living in nursing homes, with a possible reduction in other neuropsychiatric symptoms (NPS) and an improvement in quality of life. It emphasizes that since NPS often represent complex problems with multifactorial causes, multicomponent interventions should allow for adaption and flexibility to various settings to ensure successful implementation. Using TIME, the nursing home staff’s way of learning shifted from a traditional to a more innovative and reflection-based learning process. This seemed to make translating knowledge into action easier. One important causal assumption of the effectiveness of TIME was staff members’ development of a new, shared, and situated knowledge about each individual resident. This new knowledge was created through systematic interdisciplinary group reflection based on principles from cognitive behavioural therapy and led to person-centred treatment actions.acceptedVersio

The development and evaluation of TIME - Targeted Interdisciplinary Model for Treatment and Evaluation of Neuropsychiatric Symptoms: An effectiveness-implementation cluster randomised hybrid trial in nursing homes

This thesis describes how the use of TIME, a multicomponent interdisciplinary approach, reduced agitation in residents with dementia living in nursing homes, with a possible reduction in other neuropsychiatric symptoms (NPS) and an improvement in quality of life. It emphasizes that since NPS often represent complex problems with multifactorial causes, multicomponent interventions should allow for adaption and flexibility to various settings to ensure successful implementation. Using TIME, the nursing home staff’s way of learning shifted from a traditional to a more innovative and reflection-based learning process. This seemed to make translating knowledge into action easier. One important causal assumption of the effectiveness of TIME was staff members’ development of a new, shared, and situated knowledge about each individual resident. This new knowledge was created through systematic interdisciplinary group reflection based on principles from cognitive behavioural therapy and led to person-centred treatment actions

Smittevern på sykehjem under covid-19- pandemien

Bakgrunn: Skrøpelige eldre med multisykdom er ekstra sårbare og har høyere risiko enn yngre for alvorlig sykdom og død ved covid-19. Alle helse- og omsorgsinstitusjoner skal ha et infeksjonskontrollprogram som skal gi skriftlige retningslinjer for generelle smitteverntiltak og for undersøkelse, behandling og pleie. De fleste som bor på norske sykehjem, er skrøpelige, sårbare og multisyke. Det har kommet signaler om at det er for lite smittevernutstyr i slike institusjoner. Vi har ikke konkrete tall på hvor stor eller prekær utstyrsmangelen er. Det har også vært hevdet at manglende opplæring og sviktende rutiner har ført til store utfordringer der de har hatt smitte. Hensikt: Vi ønsket å kartlegge hvordan avdelingsledere ved sykehjemmene selv vurderer evnen til å håndtere smittevern, tilgangen på smittevernutstyr, testingen av personale og pasienter samt rutiner for smittevern og kompetanse blant personalet. Videre ville vi sammenlikne avdelinger med og uten smitte. Metode: Vi benyttet et egenutviklet elektronisk spørreskjema til avdelingsledere og gjorde en tverrsnittsstudie med deskriptivt, eksplorativt design. Resultater: Åttito sykehjem sa ja til å delta i undersøkelsen, og vi fikk inn svar fra 93 avdelingsledere. Tilgangen på smittevernutstyr, bruken av utstyr og opplæringen er bedre enn det inntrykket som har kommet frem i mediene. Når det gjelder muligheten til å overholde smittevernreglene, som avstand, punktdesinfeksjon og personale som jobber på flere steder, hadde flere avdelinger utfordringer. Kun på få punkter skilte avdelinger med smitte seg fra de uten smitte. Konklusjon: Mye er bra når det gjelder smittevern på norske sykehjem, men det er likevel rom for forbedringer. Opplæring av personalet på viktige fagområder, som smittevern, bør gjøres obligatorisk og ikke overlates til den enkelte ansattes initiativ. Når det gjelder bemanningssituasjonen, er det fremdeles utfordringer med mangel på sykepleiere og små stillinger som medfører at mange pleiere arbeider flere steder. Slik bemanning kan medføre økt smitterisiko under den nåværende epidemien og i fremtidige epidemier

Smittevern på sykehjem under covid-19- pandemien

Bakgrunn: Skrøpelige eldre med multisykdom er ekstra sårbare og har høyere risiko enn yngre for alvorlig sykdom og død ved covid-19. Alle helse- og omsorgsinstitusjoner skal ha et infeksjonskontrollprogram som skal gi skriftlige retningslinjer for generelle smitteverntiltak og for undersøkelse, behandling og pleie. De este som bor på norske sykehjem, er skrøpelige, sårbare og multisyke. Det har kommet signaler om at det er for lite smittevernutstyr i slike institusjoner. Vi har ikke konkrete tall på hvor stor eller prekær utstyrsmangelen er. Det har også vært hevdet at manglende opplæring og sviktende rutiner har ført til store utfordringer der de har hatt smitte. Hensikt: Vi ønsket å kartlegge hvordan avdelingsledere ved sykehjemmene selv vurderer evnen til å håndtere smittevern, tilgangen på smittevernutstyr, testingen av personale og pasienter samt rutiner for smittevern og kompetanse blant personalet. Videre ville vi sammenlikne avdelinger med og uten smitte. Metode: Vi benyttet et egenutviklet elektronisk spørreskjema til avdelingsledere og gjorde en tverrsnittsstudie med deskriptivt, eksplorativt design. Resultater: Åttito sykehjem sa ja til å delta i undersøkelsen, og vi kk inn svar fra 93 avdelingsledere. Tilgangen på smittevernutstyr, bruken av utstyr og opplæringen er bedre enn det inntrykket som har kommet frem i mediene. Når det gjelder muligheten til å overholde smittevernreglene, som avstand, punktdesinfeksjon og personale som jobber på ere steder, hadde ere avdelinger utfordringer. Kun på få punkter skilte avdelinger med smitte seg fra de uten smitte. Konklusjon: Mye er bra når det gjelder smittevern på norske sykehjem, men det er likevel rom for forbedringer. Opplæring av personalet på viktige fagområder, som smittevern, bør gjøres obligatorisk og ikke overlates til den enkelte ansattes initiativ. Når det gjelder bemanningssituasjonen, er det fremdeles utfordringer med mangel på sykepleiere og små stillinger som medfører at mange pleiere arbeider ere steder. Slik bemanning kan medføre økt smitterisiko under den nåværende epidemien og i fremtidige epidemier.publishedVersio

Smittevern på sykehjem under covid-19- pandemien

Bakgrunn: Skrøpelige eldre med multisykdom er ekstra sårbare og har høyere risiko enn yngre for alvorlig sykdom og død ved covid-19. Alle helse- og omsorgsinstitusjoner skal ha et infeksjonskontrollprogram som skal gi skriftlige retningslinjer for generelle smitteverntiltak og for undersøkelse, behandling og pleie. De fleste som bor på norske sykehjem, er skrøpelige, sårbare og multisyke. Det har kommet signaler om at det er for lite smittevernutstyr i slike institusjoner. Vi har ikke konkrete tall på hvor stor eller prekær utstyrsmangelen er. Det har også vært hevdet at manglende opplæring og sviktende rutiner har ført til store utfordringer der de har hatt smitte. Hensikt: Vi ønsket å kartlegge hvordan avdelingsledere ved sykehjemmene selv vurderer evnen til å håndtere smittevern, tilgangen på smittevernutstyr, testingen av personale og pasienter samt rutiner for smittevern og kompetanse blant personalet. Videre ville vi sammenlikne avdelinger med og uten smitte. Metode: Vi benyttet et egenutviklet elektronisk spørreskjema til avdelingsledere og gjorde en tverrsnittsstudie med deskriptivt, eksplorativt design. Resultater: Åttito sykehjem sa ja til å delta i undersøkelsen, og vi fikk inn svar fra 93 avdelingsledere. Tilgangen på smittevernutstyr, bruken av utstyr og opplæringen er bedre enn det inntrykket som har kommet frem i mediene. Når det gjelder muligheten til å overholde smittevernreglene, som avstand, punktdesinfeksjon og personale som jobber på flere steder, hadde flere avdelinger utfordringer. Kun på få punkter skilte avdelinger med smitte seg fra de uten smitte. Konklusjon: Mye er bra når det gjelder smittevern på norske sykehjem, men det er likevel rom for forbedringer. Opplæring av personalet på viktige fagområder, som smittevern, bør gjøres obligatorisk og ikke overlates til den enkelte ansattes initiativ. Når det gjelder bemanningssituasjonen, er det fremdeles utfordringer med mangel på sykepleiere og små stillinger som medfører at mange pleiere arbeider flere steder. Slik bemanning kan medføre økt smitterisiko under den nåværende epidemien og i fremtidige epidemier