# ent

id: cord-300620-scauefiv
type: WORK_OF_ART
entity:
  The Nuts and Bolts of Utilizing Telemedicine in Nursing HomesdThe GeriCare North Experience Virtually perfect Telemedicine for COVID 19 Physicians


id: cord-336467-w528t92h
type: WORK_OF_ART
entity:
  A Person Centred Framework for Assessment and Support Planning Disaster Preparedness for Seniors A Comprehensive Guide for Healthcare Professionals


id: cord-331520-o9e4qqn4
type: ORG
entity:
  the United States National Survey of Long Term Care Providers Long Term Care Providers and Services Users


id: cord-272772-zqmychmr
type: ORG
entity:
  LTCcovid International Long Term Care Policy Network Ontario Ministries of Health and Long Term Care COVID 19


id: cord-333153-hjgf3ay8
type: ORG
entity:
  Division of Nursing Homes Quality Safety and Oversight Group Center for Clinical Standards and Quality Special Programs


id: cord-345864-87b5qdjx
type: ORG
entity:
  Centers for Disease Control Evaluating and Testing Persons for Coronavirus Disease Department of Health and Human Services


id: cord-270935-t9pym9k0
type: WORK_OF_ART
entity:
  A Report of 1014 Cases Interpreting Diagnostic Tests for SARS CoV 2 Variation in False Negative Rate of 358 Reverse Transcriptase Polymerase Chain Reaction Based SARS CoV


id: cord-272995-yvj2pqh1
type: WORK_OF_ART
entity:
  Presymptomatic Transmission of SARS CoV 2 Amongst Residents and Staff at a Skilled Nursing Facility Results of Real Time PCR


id: cord-272995-yvj2pqh1
type: ORG
entity:
  LTCcovid International Long Term Care Policy Network Care Policy and Evaluation Centre CPEC Finding the Right Balance


id: cord-294423-3458rek8
type: ORG
entity:
  telehealth wellness system Informatics for Health and Social Care Factors Associated With Receipt of Training Among


id: cord-294423-3458rek8
type: ORG
entity:
  CHIP Payment and Access Commission Federal Medical Assistance Percentages and Enhanced Federal Medical


id: cord-325953-yvtyh27k
type: ORG
entity:
  Guidelines for Residential Care Homes for the Elderly or Persons 85 with Disabilities for the Prevention of Coronavirus


# bib

id: cord-254753-viz37rzv
title: COVID-19 collaborative model for an academic hospital and long-term care facilities
author: Archbald-Pannone, Laurie R.
date: 2020-05-25
txt: ./txt/cord-254753-viz37rzv.txt
cache: ./cache/cord-254753-viz37rzv.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1525861020304473?v=s5
doi: 10.1016/j.jamda.2020.05.044
summary:
  The mission of the geriatric engagement and resource integration in post-acute and long-term care facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. The prevention arm cultivates dialogue among an inter-23 professional academic clinical team (Geriatrics, Pulmonary, and Nursing), local government agencies 24 including our local health department and emergency management, and local organizations related to 25 prevention and treatment of COVID-19 in patients in PA/TLC facilities. The goal of the virtual meetings 53 was to connect long-term care facility administrators and directors of nursing to assess facility needs for 54 COVID-19 preparedness. From the relationships established via Project ECHO, academic nursing educators actively cultivated 65 relationships with local PA/LTC nursing leaders to determine facility needs for assistance with PPE, 66 improve care coordination between inpatient medical teams and facilities, and provide support to 67 optimize telemedicine consultation processes.

abstract:
  Abstract The COVID-19 pandemic is devastating post-acute and long-term care (PA/LTC). As geriatricians practicing in PA/LTC and a regional academic medical center, we created this program for collaboration between academic medical centers and regional PA/LTC facilities. The mission of the geriatric engagement and resource integration in post-acute and long-term care facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. There are 5 main components of our program: (1) Project ECHO; (2) Nursing liaisons; (3) Infection advisory consultation; (4) Telemedicine consultation; and (5) Resident social contact remote connections. Implementation of this program has had positive response from our local PA/LTC facilities. A key component of our program is our inter-professional team, which includes physicians, nursing, emergency response, and public health experts. With diverse professional backgrounds, our team have created a new model for academic medical centers to collaborate with local PA/LTC facilities.


id: cord-259787-2sjnsb7m
title: Essential Family Caregivers in Long-term Care during the COVID-19 Pandemic
author: Schlaudecker, Jeffrey D.
date: 2020-05-21
url: https://www.sciencedirect.com/science/article/pii/S1525861020304308?v=s5
doi: 10.1016/j.jamda.2020.05.027
abstract:
  Brief Summary: In the months stretching out ahead of us in the prevention of COVID-19, we must keep our residents safe from the risk of circulating virus, but we also must promote person-centered geriatric care allowing family presence as essential care partners.


id: cord-260110-8tud5fao
author: McArthur, Caitlin
date: 2020-10-26
txt: ./txt/cord-260110-8tud5fao.txt
cache: ./cache/cord-260110-8tud5fao.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1525861020309154?v=s5
doi: 10.1016/j.jamda.2020.10.028
summary:
  title: Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents'' mental health: a data driven approach in New Brunswick Long-term care (LTC) residents, isolated because of the COVID-19 pandemic, are at increased risk for negative mental health outcomes. We present a supporting analysis of the effects of lockdown in homes without COVID-19 outbreaks on depression, delirium, and behaviour problems in a network of seven LTC homes in New Brunswick, Canada where mitigative strategies were deployed to minimize poor mental health outcomes (e.g., virtual visits, increased student volunteers). The purpose of our article is to demonstrate how thoughtful use of mitigating strategies (e.g., 74 window visits, use of technology) and clinical information systems like the interRAI LTCF can 75 inform clinical care and prevent worsening mental health outcomes (depression, delirium, and 76 behavioural problems) during the COVID-19 pandemic.

title:
  Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents’ mental health: a data driven approach in New Brunswick

abstract:
  Long-term care (LTC) residents, isolated because of the COVID-19 pandemic, are at increased risk for negative mental health outcomes. The purpose of our article is to demonstrate how the LTCF can inform clinical care and evaluate the effect of strategies to mitigate worsening mental health outcomes during the COVID-19 pandemic. We present a supporting analysis of the effects of lockdown in homes without COVID-19 outbreaks on depression, delirium, and behaviour problems in a network of seven LTC homes in New Brunswick, Canada where mitigative strategies were deployed to minimize poor mental health outcomes (e.g., virtual visits, increased student volunteers). This network meets regularly to review performance on risk-adjusted quality of care indicators from the interRAI LTCF and share learning through a community of practice model. We included 4209 assessments from 765 LTC residents between January 2017 to June 2020 and modelled the change within and between residents for depression, delirium, and behavioural problems over time with longitudinal generalized estimating equations. Though the number of residents who had in-person visits with family decreased from 73.2% before to 17.9% during lockdown (chi square, p<0.0001), the number of residents experiencing delirium (4.5% to 3.5%, p=0.51) and behavioural problems (35.5% to 30.2%, p=0.19) did not change. The proportion of residents with indications of depression decreased from 19.9% before to 11.5% during lockdown (p<0.002). The final multivariate models indicate that the effect of lockdown was not statistically significant on depression, delirium, or behavioural problems. Our analyses demonstrate poor mental health outcomes associated with lockdown can be mitigated with thoughtful intervention and ongoing evaluation with clinical information systems. Policy makers can use outputs to guide resource deployment and researchers can examine the data to identify better management strategies for when pandemic strikes again.


id: cord-264059-jf4j00bp
author: Lee, Chien-Chang
date: 2019-11-30
url: https://www.ncbi.nlm.nih.gov/pubmed/31791902/
doi: 10.1016/j.jamda.2019.09.020
title:
  Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection

abstract:
  OBJECTIVES: Virus infection is underevaluated in older adults with severe acute respiratory infections (SARIs). We aimed to evaluate the clinical impact of combining point-of-care molecular viral test and serum procalcitonin (PCT) level for antibiotic stewardship in the emergency department (ED). DESIGN: A prospective twin-center cohort study was conducted between January 2017 and March 2018. SETTING AND PARTICIPANTS: Older adult patients who presented to the ED with SARIs received a rapid molecular test for 17 respiratory viruses and a PCT test. MEASURES: To evaluate the clinical impact, we compared the outcomes of SARI patients between the experimental cohort and a propensity score–matched historical cohort. The primary outcome was the proportion of antibiotics discontinuation or de-escalation in the ED. The secondary outcomes included duration of intravenous antibiotics, length of hospital stay, and mortality. RESULTS: A total of 676 patients were included, of which 169 patients were in the experimental group and 507 patients were in the control group. More than one-fourth (27.9%) of the patients in the experimental group tested positive for virus. Compared with controls, the experimental group had a significantly higher proportion of antibiotics discontinuation or de-escalation in the ED (26.0% vs 16.1%, P = .007), neuraminidase inhibitor uses (8.9% vs 0.6%, P < .001), and shorter duration of intravenous antibiotics (10.0 vs 14.5 days, P < .001). CONCLUSIONS AND IMPLICATIONS: Combining rapid viral surveillance and PCT test is a useful strategy for early detection of potential viral epidemics and antibiotic stewardship. Clustered viral respiratory infections in a nursing home is common. Patients transferred from nursing homes to ED may benefit from this approach.


id: cord-264479-s20oacr9
title: COVID-19 Highlights the Need for Trained Social Workers in Nursing Homes
author: Bern-Klug, Mercedes
date: 2020-05-25
txt: ./txt/cord-264479-s20oacr9.txt
cache: ./cache/cord-264479-s20oacr9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32561232/
doi: 10.1016/j.jamda.2020.05.049
abstract: nan
summary:
  This editorial provides examples of how nursing home social workers are adapting the way they connect with residents and families during the pandemic and concludes with suggestions. In nursing homes experiencing PPE shortages, the lack of equipment means activities and social services staff cannot safely enter resident rooms. While a core function of the social work role has always been to anticipate, assess and address resident psychosocial needs, social workers have also been key liaisons between the family and the facility. In nursing homes with multiple COVID deaths, social workers leave work with a pit in their stomach from the phone conversations with family members to discuss what to do with the decedent''s body and their belongings. Including degreed and licensed social workers as part of the core team is a basic way to provide psychosocial care in nursing homes and enhance resident quality of life.


id: cord-265830-6shiocwr
author: Frost, Rachael
date: 2020-05-25
url: https://www.ncbi.nlm.nih.gov/pubmed/32553491/
doi: 10.1016/j.jamda.2020.05.038
title:
  Using remote interventions in promoting the health of frail older persons following the COVID-19 lockdown: challenges and solutions

abstract:
  In light of the Covid-19 pandemic, many older people across the world are being asked to self-isolate to protect their health. This has led to a rapid reconfiguration of health promotion services, which are diverse in focus, and may include exercise, dietary interventions or psychosocial interventions, towards remote delivery, for example by phone or using computers. Whilst currently they are unable to be safely delivered any other way, there are concerns that these remote interventions may replace face-to-face interventions beyond the end of social restrictions. We advocate caution with taking this forward, particularly for frailer older people.


id: cord-270254-dp7z1kla
author: Inzitari, Marco
date: 2020-06-11
txt: ./txt/cord-270254-dp7z1kla.txt
cache: ./cache/cord-270254-dp7z1kla.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32674827/
doi: 10.1016/j.jamda.2020.06.015
summary:
  title: How a Barcelona post-acute facility became a referral center for comprehensive management of subacute patients with COVID-19 We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, healthcare, communication, psychological support and ethical frameworks. Brief Summary: The paper describes how a large post-acute care facility in 23 Barcelona, was adapted at the outbreak of the COVID 19 pandemic to become 24 a polyvalent reference center for older COVID-19 patients assessed as not 25 requiring intensive care. 26 Key word: COVID-19, post-acute care, older adults, geriatrics, geriatric 27 syndromes, palliative care 28 Funding source: This research did not receive any funding from agencies in 29 the public, commercial, or not-for-profit sectors. Geriatric screening tools to select older adults susceptible for direct transfer from the emergency department to subacute intermediate-care hospitalization Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care Skilled Nursing Facility

title:
  How a Barcelona post-acute facility became a referral center for comprehensive management of subacute patients with COVID-19

abstract:
  Abstract The COVID-19 pandemic’s greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become a site to treat COVID-19 older patients. Referrals come from the emergency department (ED) or COVID-19 wards of the acute reference hospitals, nursing homes or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, healthcare, communication, psychological support and ethical frameworks. We believe that the strategies we employed and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.


id: cord-270935-t9pym9k0
title: Does Universal Testing for COVID-19 Work for Everyone?
author: Dumyati, Ghinwa
date: 2020-08-15
url: https://www.sciencedirect.com/science/article/pii/S1525861020307039?v=s5
doi: 10.1016/j.jamda.2020.08.013
abstract:
  Abstract The COVID-19 pandemic has been especially devastating among nursing home residents, with both the health circumstances of individual residents as well as communal living settings contributing to increased morbidity and mortality. Preventing the spread of COVID-19 infection requires a multipronged approach that includes early identification of infected residents and healthcare personnel, compliance with infection prevention and control measures, cohorting infected residents, and furlough of infected staff. Strategies to address COVID-19 infections among nursing home residents vary based on the availability for SARS-CoV-2 tests, the incorporation of tests into broader surveillance efforts, and using results to help mitigate the spread of COVID-19 by identifying asymptomatic and presymptomatic infections. We review the tests available to diagnose COVID-19 infections, the implications of universal testing for nursing home staff and residents, interpretation of test results, issues around repeat testing, and incorporation of test results as part of a long-term response to the COVID-19 pandemic. We propose a structured approach for facility-wide testing of resident and staff and provide alternatives if testing capacity is limited, emphasizing contact tracing. Nursing homes with strong screening protocols for residents and staff, that engage in contact tracing for new cases, and that continue to remain vigilant about infection prevent and control practices, may better serve their residents and staff by thoughtful use of symptom- and risk-based testing strategies.


id: cord-272772-zqmychmr
author: Stall, Nathan M.
date: 2020-08-03
txt: ./txt/cord-272772-zqmychmr.txt
cache: ./cache/cord-272772-zqmychmr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jamda.2020.07.038
doi: 10.1016/j.jamda.2020.07.038
summary:
  Canada, and regions across the country begin phased re-openings, experts and advocates have 24 grown increasingly concerned that subsequent visiting policies and family caregiver access to 25 nursing home settings remain overly restrictive, causing substantial and potentially irreversible 26 harm to the health and wellbeing of residents. 4 A more balanced approach is needed that both 27 prevents the introduction of COVID-19 into nursing homes, but also allows family caregivers 28 and visitors to provide much needed contact, support and care to residents, to maintain their 29 overall health and wellbeing. These recommendations 68 focus on family caregivers and general visitors rather than essential support workers and nursing 69 home staff, and are made with the acknowledgement that the approach to visiting may need to be 70 dynamic based on the community prevalence of COVID-19.

title:
  Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian Nursing Homes to Family Caregivers and Visitors during the COVID-19 Pandemic

abstract:
  Abstract During the first few months of the COVID-19 pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable and potentially harmful. We reviewed the nursing home visitor policies for Canada’s ten provinces and three territories as well as international policies and reports on the topic to develop evidence-informed, data-driven and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.


id: cord-272995-yvj2pqh1
author: Bergman, Christian
date: 2020-10-07
txt: ./txt/cord-272995-yvj2pqh1.txt
cache: ./cache/cord-272995-yvj2pqh1.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1525861020308367?v=s5
doi: 10.1016/j.jamda.2020.09.036
summary:
  Regarding visitor guidance, the panel made five strong recommendations: 1) maintain strong infection prevention and control precautions, 2) facilitate indoor and outdoor visits, 3) allow limited physical contact with appropriate precautions, 4) assess individual residents'' care preferences and level of risk tolerance, and 5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial wellbeing of residents. We edited the final guidance statements for clarity, aiming to capture the consensus of the Delphi aspects of the following topics (see Table 1 ): testing of asymptomatic staff and residents, 111 surveillance testing, visitor guidance, immunity from prior COVID-19 infection and associated 112 risk of infecting others. The panel 144 strongly agreed on some preconditions that would be essential prior to welcoming back visitors, 145 such as universal masking for staff, sufficient disinfecting supplies, PPE, and written plans 146 around isolation, cohorting, screening, testing, and outbreak investigations.

title:
  Recommendations for Welcoming Back Nursing Home Visitors during the COVID-19 Pandemic: Results of a Delphi Panel

abstract:
  Objectives Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. Design A modified two-step Delphi process was used to generate consensus statements. Setting and Participants The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. Methods State and federal reopening statements were collected in June 2020 and the panel voted on these using a three-point Likert scale with consensus defined as ≥80% of panel members voting “Agree.” The consensus statements then informed development of the visitor guidance statements. Results The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made five strong recommendations: 1) maintain strong infection prevention and control precautions, 2) facilitate indoor and outdoor visits, 3) allow limited physical contact with appropriate precautions, 4) assess individual residents' care preferences and level of risk tolerance, and 5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial wellbeing of residents. Conclusions and Implications The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.


id: cord-274043-ifr0oo7u
title: The COVID Grim Reaper
author: Rozzini, Renzo
date: 2020-05-08
txt: ./txt/cord-274043-ifr0oo7u.txt
cache: ./cache/cord-274043-ifr0oo7u.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jamda.2020.05.001
doi: 10.1016/j.jamda.2020.05.001
abstract: nan
summary:
  key: cord-274043-ifr0oo7u authors: Rozzini, Renzo title: The COVID Grim Reaper date: 2020-05-08 journal: J Am Med Dir Assoc cord_uid: ifr0oo7u This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The COVID Grim Reaper Author: Head, Geriatric Dept Reference 23 COVID-19 in Italy: Ageism and Decision Making in a Pandemic The geriatrician: the frontline specialist in the treatment of 26 covid-19 patients -Gemelli against COVID-19 Geriatrics Team


id: cord-274508-nigru1o8
author: Lally, Michelle
date: 2020-10-26
url: https://api.elsevier.com/content/article/pii/S1525861020309245
doi: 10.1016/j.jamda.2020.10.031
title:
  Metformin is associated with Decreased 30-day Mortality among Nursing Home Residents Infected with SARS-CoV2

abstract:
  Objectives The COVID-19 pandemic presents an urgent need to investigate whether existing drugs can enhance or even worsen prognosis; metformin, a known mammalian target of rapamycin (m-TOR) inhibitor, has been identified as a potential agent. We sought to evaluate mortality benefit among older persons infected with SARS-CoV-2 who were taking metformin as compared to those who were not. Design Retrospective cohort study Setting and Participants: 775 nursing home residents infected with SARS-CoV-2 who resided in one of the 134 Community Living Centers (CLC) of the Veterans Health Administration (VHA) during March 1, 2020 to May 13, 2020 were included. Methods Using a window of 14 days prior to SARS-CoV-2 testing, bar coded medication administration records were examined for dispensing of medications for diabetes. The COVID-19 infected residents were divided into groups: 1) residents administered metformin alone or in combination with other medications, 2) residents who used long acting or daily insulin, 3) residents administered other diabetes medications, and 4) residents not administered diabetes medication, including non-diabetics and untreated diabetics. Proportional hazard models adjusted for demographics, hemoglobin A1c, body mass index, and renal function. Results Relative to those not receiving diabetes medications, residents taking metformin were at significantly reduced hazard of death (adjusted HR 0.48, 95%CI 0.28, 0.84) over the subsequent 30 days from COVID-19 diagnosis. There was no association with insulin (adjusted HR 0.99, 95% 0.60, 1.64) or other diabetes medications (adjusted HR 0.71, 95% CI 0.38, 1.32). Conclusions and Implications Our data suggests a reduction in 30-day mortality following SARS-CoV-2 infection in residents who were on metformin-containing diabetes regimens. These findings suggest a relative survival benefit in nursing home residents on metformin, potentially through its mTOR inhibition effects. A prospective study should investigate the therapeutic benefits of metformin among persons with COVID-19.


id: cord-276621-9exp8e7h
title: Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to Life
author: Jacobs, Jeremy M.
date: 2020-09-06
url: https://api.elsevier.com/content/article/pii/S1525861020306629
doi: 10.1016/j.jamda.2020.07.037
abstract:
  OBJECTIVE: Although prolonged mechanical ventilation (PMV) is increasingly common, little is known concerning patient symptom burden or attitudes toward PMV. This study aims to describe the mood, well-being, distressing symptoms, and attitudes toward prolonged ventilation among PMV patients treated either at home or long-term acute care (LTAC). DESIGN: An observational study. SETTING AND PARTICIPANTS: 62 communicative participants treated with PMV, aged ≥18 years, insurees of a single HMO, treated at home hospital or LTAC specializing in ventilation in Jerusalem. MEASURES: Sociodemographic characteristics; chronic conditions; functional status; symptom burden measured by revised Edmonton Symptomatic Assessment System (r-ESAS); attitudes toward PVM. RESULTS: Participants were aged 61.7 ± 20.7 years, commonly suffered progressive neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric Depression Scale identified depression among 38% of participants, and was less at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety (16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath (9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, and 15%, respectively. Only 1 patient had advance directives concerning ventilation prior to intubation, and when asked if they had to choose again today, 85% of patients would again opt for ventilation. CONCLUSIONS AND IMPLICATIONS: Few PMV patients reported distressing symptoms, and 85% would choose ventilation if asked again. These findings might be useful in clinical practice to assist in decision making concerning prolonged ventilation.


id: cord-277278-lg38l5gh
author: Tang, Olive
date: 2020-10-14
url: https://www.ncbi.nlm.nih.gov/pubmed/33153910/
doi: 10.1016/j.jamda.2020.10.011
title:
  Outcomes of nursing home COVID-19 patients by initial symptoms and comorbidity: Results of universal testing of 1,970 residents

abstract:
  Objective Clinical implications of asymptomatic cases of the novel coronavirus disease 2019 (COVID-19) in nursing homes remain poorly understood. We assessed the association of symptom status and medical comorbidities on mortality and hospitalization risk associated with COVID-19 in residents of a large nursing home system. Design Retrospective cohort study. Setting and Participants 1,970 residents from 15 nursing home facilities with universal COVID-19 testing in Maryland. Methods We used descriptive statistics to compare baseline characteristics, logistic regression to assess the association of comorbidities with COVID-19, and Cox regression to assess the association of asymptomatic and symptomatic COVID-19 with mortality and hospitalization. We assessed the association of comorbidities with mortality and hospitalization risk. Symptom status was assessed at the time of the first test. Maximum follow-up was 94 days. Results Among the 1,970 residents (mean age 73.8, 57% female, 68% Black), 752 (38.2%) were positive on their first test. Residents who were positive for COVID-19 and had multiple symptoms at the time of testing had the highest risk of mortality (HR 4.44; 95% CI: 2.97, 6.65) and hospitalization (SHR 2.38; 95% CI: 1.70, 3.33), even after accounting for comorbidity burden. Cases who were asymptomatic at testing had a higher risk of mortality (HR 2.92; 95% CI: 1.95, 4.35), but not hospitalization (HR 1.06; 95% CI: 0.82, 1.38) compared to those who were negative for COVID-19. Of 52 SARS-CoV-2 positive residents who were asymptomatic at the time of testing and were closely monitored for 14 days at one facility, only 6 (11.6%) developed symptoms. Conclusions and Implications Asymptomatic infection with SARS-CoV-2 in the nursing home setting was associated with increased risk of death suggesting a need for closer monitoring of these residents, particularly those with underlying cardiovascular and respiratory comorbidities.


id: cord-289018-6rnvwptr
title: Safe Inter-Organizational Health Information Exchange During the COVID-19 Pandemic
author: Wong, Serena P.
date: 2020-10-22
url: https://api.elsevier.com/content/article/pii/S1525861020308975
doi: 10.1016/j.jamda.2020.10.022
abstract:
  Accurate and timely transmission of medical records between skilled nursing facilities and acute care settings has been logistically problematic. Often people are sent to the hospital with a packet of paper records, which is easily misplaced. The COVID-19 pandemic has further magnified this problem by the possibility of viral transmission via fomites. To protect themselves, staff and providers were donning personal protective equipment to review paper records, which was time-consuming and wasteful. We describe an innovative process developed by a team of hospital leadership, members of a local collaborative of skilled nursing facilities, and leadership of this collaborative group, to address this problem. Many possible solutions were suggested and reviewed. We describe the reasons for selecting our final document transfer process and how it was implemented. The critical success factors are also delineated. Other health systems and collaborative groups of skilled nursing facilities may benefit from implementing similar processes.


id: cord-290836-jldfrec9
author: Laosa, Olga
date: 2020-10-08
url: https://www.sciencedirect.com/science/article/pii/S1525861020308471?v=s5
doi: 10.1016/j.jamda.2020.10.002
title:
  Rapid assessment at hospital admission of mortality risk from COVID-19: the role of functional status

abstract:
  Objective To evaluate the role of functional status along with other used clinical factors on the occurrence of death in patients hospitalized with COVID-19. Design Prospective Cohort study Setting Public University Hospital (Madrid) Participants and methods 375 consecutive patients with COVID-19 infection, admitted to a Public University Hospital (Madrid) between March 1 and March 31, 2020, were included in the Prospective Cohort study. Death was the main outcome. The main variable was disability in Activities of Daily Living (ADL) assessed with the Barthel index. Covariates included sex, age, severity index (Quick Sequential Organ Failure Assessment, qSOFA), polypharmacy (>5 drugs in the month before admission), and comorbidity (≥3 diseases). Multivariable logistic regression was used to identify risk factors for adverse outcomes. Estimated model coefficients served to calculate the expected probability of death for a selected combination of five variables: Barthel, sex, age, comorbidities and severity index (qSOFA). Results Mean age was 66 years (SD 15.33), 207 (55%) males. 74 patients died (19.8%). Mortality was associated to low Barthel index (OR per 5-point decrease 1.11; 95CI 1.03-1.20), male sex (0.23, 0.11-0.47), age (1.07, 1.03-1.10) and comorbidity (2.15; 1.08-4.30) but not to qSOFA (1.29, 0.87-1.93) or polypharmacy (1.54; 0.77-3.08). Calculated mortality risk ranged from 0 to 0.78. Conclusions and implications Functional status predicts death in hospitalized COVID-19 patients. Combination of five variables allows to predict individual probability of death. These findings provide useful information for the decision-making process and management of patients.


id: cord-294423-3458rek8
author: Boucher, Nathan A.
date: 2020-09-29
url: https://api.elsevier.com/content/article/pii/S1525861020308306
doi: 10.1016/j.jamda.2020.09.030
title:
  Older Adults Post-Incarceration: Restructuring Long-Term Services and Supports in the Time of COVID-19

abstract:
  Objectives To describe long-term care services and supports (LTSS) in the US, note their limitations in serving older adults post-incarceration, and offer potential solutions – with special consideration for the COVID-19 pandemic. Design Narrative review Setting and Participants: Long-term care services and supports for older adults post-incarceration Methods Literature review and policy analysis Results Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison. Conclusions and Implications Long-standing gaps in US LTSS are revealed by the coronavirus (SARS-CoV-2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults post-incarceration.


id: cord-302180-sgg8pvm8
author: Blain, Hubert
date: 2020-06-11
url: https://api.elsevier.com/content/article/pii/S1525861020305181
doi: 10.1016/j.jamda.2020.06.013
title:
  Efficacy of a Test-Retest Strategy in Residents and Health Care Personnel of a Nursing Home facing a COVID-19 Outbreak

abstract:
  Abstract Objective To assess the American Testing Guidance for Nursing Homes (NHs) - updated May 19, 2020 - with a new COVID-19 case. Design Case investigation. Setting and Subjects: All 79 residents and 34 Health Care Personnel (HCP) of a NH. Methods 7 days after identification of a COVID-19 resident, all residents and HCP underwent rRT-PCR testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for ELISA-based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. Results 36 residents had a positive RT-PCR at baseline and two at day 7. Six HCP had a positive RT-PCR at baseline and two at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2-positive cases, six residents (16%) and three HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive RT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%) developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. Conclusions and Implications This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative RT-PCR testing can develop antibodies against SARS-CoV-2.


id: cord-306421-r8wzvpn5
author: Sizoo, Eefje M.
date: 2020-10-23
txt: ./txt/cord-306421-r8wzvpn5.txt
cache: ./cache/cord-306421-r8wzvpn5.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1525861020308999?v=s5
doi: 10.1016/j.jamda.2020.10.024
summary:
  title: Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians Objectives To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. Thematic analysis revealed four major themes: (1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones; (2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented; (3) The profound emotional impact on ECPs; (4) Many alternatives for visits highlight the wish to compensate for the absence of face to face contact opportunities. Conclusions and Implications ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones and care professionals.

title:
  Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians

abstract:
  Objectives To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. The aim of this study was an exploration of dilemmas experienced by Elderly Care Physicians (ECPs) as a result of the COVID-19 driven restrictive visiting policy. Setting and Participants ECPs working in Dutch NHs. Methods A qualitative exploratory study was performed using an open-ended questionnaire. A thematic analysis was applied. Data was collected between April 17 and May 10, 2020. Results Seventy-six ECPs answered the questionnaire describing a total of 114 cases in which they experienced a dilemma. Thematic analysis revealed four major themes: (1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones; (2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented; (3) The profound emotional impact on ECPs; (4) Many alternatives for visits highlight the wish to compensate for the absence of face to face contact opportunities. However, given the diversity of NH residents, alternatives were often only suitable for some of them. Conclusions and Implications ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones and care professionals. The dilemmas encountered as a result of the policy highlight the wish by ECPs to offer solutions tailored to the individual residents. We identified an overview of aspects to consider when drafting future visiting policies for NHs during the COVID-19 pandemic.


id: cord-310123-h7i49pdb
title: Frailty and mortality in hospitalized older adults with COVID-19: retrospective observational study
author: De Smet, Robert
date: 2020-06-09
url: https://www.ncbi.nlm.nih.gov/pubmed/32674821/
doi: 10.1016/j.jamda.2020.06.008
abstract:
  ABSTRACT Objectives To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 (COVID-19). Design Retrospective single-center observational study. Setting and participants: N = 81 patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium. Measure ments: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical and radiological variables, co-morbidities, symptoms and treatment were extracted from electronic medical records. Results Participants (N = 48 women, 59%) had a median age of 85 years (range 65 – 97 years), median CFS score of 7 (range 2 – 9), and 42 (52%) were long-term care residents. Within six weeks, eighteen patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = 0.03) and CFS score (r = 0.282, P = 0.011), baseline lactate dehydrogenase (LDH) (r = 0.301, P = 0.009), lymphocyte count (r = -0.262, P = 0.02) and RT-PCR cycle threshold (Ct, r = -0.285, P = 0.015). Mortality was not associated with long-term care residence, dementia, delirium or polypharmacy. In multivariable logistic regression analyses, CFS, LDH and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH and viral load significantly predicted survival. Conclusions and implications Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.


id: cord-310961-e1mb7uuh
title: Point-of-care chest ultrasonography as a diagnostic resource for COVID-19 outbreak in nursing homes
author: Nouvenne, Antonio
date: 2020-05-25
url: https://www.sciencedirect.com/science/article/pii/S1525861020304539?v=s5
doi: 10.1016/j.jamda.2020.05.050
abstract:
  ABSTRACT Objective Bedside chest ultrasound, when integrated with clinical data, is an accurate tool improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasound screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents. Design Pragmatic, descriptive, feasibility study from April 2nd to April 9th, 2020. Setting and participants: A total of 83 older residents (age 85±8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in five nursing homes in Northern Italy. Methods Chest ultrasound was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring four different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations and pleural line indentation was detected. The specialist team integrated ultrasound data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. Results The most frequent reasons for ultrasound evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasound findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and six of them required hospitalization. Twelve patients had ultrasound patterns suggesting other respiratory diseases, and two patients with normal ultrasound findings were diagnosed with COPD exacerbation. Conclusions and implications In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.


id: cord-312394-djjarc0f
author: Lynch, Richard M.
date: 2020-04-10
url: https://api.elsevier.com/content/article/pii/S1525861020303200
doi: 10.1016/j.jamda.2020.04.001
title:
  Practical Steps to Improve Air Flow in Long-Term Care Resident Rooms to Reduce COVID-19 Infection Risk

abstract:
  Abstract The potential for spread of COVID-19 infections in Skilled Nursing Facilities and other Long-Term Care sites poses new challenges for Nursing Home Administrators to protect patients and staff. It is anticipated that as Acute Care Hospitals reach capacity, Nursing Homes may retain COVID-19 infected residents longer prior to transferring to an Acute Care Hospital. This article outlines 5 pragmatic steps that Long-Term Care facilities can take to manage airflow within resident rooms to reduce the potential for spread of infectious airborne droplets into surrounding areas including hallways and adjacent rooms, using strategies adapted from negative pressure isolation rooms in acute care facilities.


id: cord-320104-cgzqwbzs
author: Lester, Paula E.
date: 2020-06-02
url: https://www.ncbi.nlm.nih.gov/pubmed/32674814/
doi: 10.1016/j.jamda.2020.05.058
title:
  Policy Recommendations regarding Skilled Nursing Facility Management of COVID-19: Lessons From New York State

abstract:
  ABSTRACT To provide policy recommendations for managing COVID-19 in Skilled Nursing Facilities (SNFs), a group of certified medical directors from several facilities in New York state with experience managing the disease used email, phone, and video conferencing to develop consensus recommendations. The resulting document provides recommendations on screening, and protection of staff, screening of residents, management of COVID-19 positive and presumed positive cases, communication during an outbreak, management of admissions and readmissions, and providing emotional support for staff. These consensus guidelines have been endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society.


id: cord-321302-eowo2mt0
title: The Post-Acute and Long-Term Care Crisis in the Aftermath of COVID-19: a Dutch Perspective
author: Spaetgens, Bart
date: 2020-06-29
txt: ./txt/cord-321302-eowo2mt0.txt
cache: ./cache/cord-321302-eowo2mt0.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1525861020305685
doi: 10.1016/j.jamda.2020.06.045
abstract: nan
summary:
  authors: Spaetgens, Bart; Brouns, Steffie H.; Schols, Jos M.G.A. title: The Post-Acute and Long-Term Care Crisis in the Aftermath of COVID-19: a Dutch Perspective Morbidity and 7 mortality in nursing homes that suffered outbreaks of COVID-19 has been high 8 despite the fact that Dutch nursing home care benefits from well-developed care 9 infrastructures that are fully integrated in the national health sector. 2 Despite this, the 10 nursing home sector was overshadowed by the huge national attention for COVID-19 11 in acute hospital care, resulting in evident shortages of personal protective 12 equipment (PPE) and the inability to develop an adequate testing policy due to a too 13 low national test capacity as well. on behalf of AMDA -The Society for Post-acute 75 and Long-term Care Medicine. Allowing visitors back in the nursing home during the COVID-19 crisis -A Dutch 97 national study into first experiences and impact on well-being


id: cord-321606-o0gfukzg
author: Unruh, Mark Aaron
date: 2020-06-15
txt: ./txt/cord-321606-o0gfukzg.txt
cache: ./cache/cord-321606-o0gfukzg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32674812/
doi: 10.1016/j.jamda.2020.06.019
abstract: nan
summary:
  title: Nursing Home Characteristics Associated with COVID-19 Deaths in Connecticut, New Jersey, and New York 1 The objective of this study was to compare the characteristics 6 of nursing homes with COVID-19 deaths to other nursing homes using data from Connecticut, 7 New Jersey, and New York. 8 We merged data on nursing home characteristics from the 2017 LTCFocus database 9 (Long Term Care: Facts on Care in the US) with data on nursing homes with COVID-19 deaths 10 provided by the states of Connecticut , New Jersey, and New York. Data from Connecticut 11 included deaths as of April 16th, New Jersey as of April 20th, and New York as of April 15th. The results of our secondary analysis of nursing homes with 100 or more beds 46 (Table) were largely consistent with our primary analysis with one key exception; more direct 47 care hours per patient day were associated with a lower probability of COVID-19 deaths (-4 

title:
  Nursing Home Characteristics Associated with COVID-19 Deaths in Connecticut, New Jersey, and New York


id: cord-325128-r53up0ug
author: Diamantis, Sylvain
date: 2020-05-03
url: https://www.ncbi.nlm.nih.gov/pubmed/32507530/
doi: 10.1016/j.jamda.2020.04.023
abstract: nan
title:
  SARS-cov-2 related deaths in French long-term care facilities: the “confinement disease” is probably more deleterious than the COVID-19 itself


id: cord-325953-yvtyh27k
title: Maintaining zero COVID-19 infection among long term care facility residents in Hong Kong
author: Shea, Yat-Fung
date: 2020-05-29
txt: ./txt/cord-325953-yvtyh27k.txt
cache: ./cache/cord-325953-yvtyh27k.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1525861020304424
doi: 10.1016/j.jamda.2020.05.042
abstract: nan
summary:
  title: Maintaining zero COVID-19 infection among long term care facility residents in Hong Kong Maintaining zero COVID-19 infections among long term care facility residents in Hong Kong 3 4 1 In long-term care facilities (LTCFs), the risk of 6 serious outbreaks is great given a higher prevalence of dementia and potential poor resident 7 compliance with infection control measures such as hand hygiene and wearing of surgical masks. All staff (n=60) and most residents (n=102) in the involved 55 facilities were instructed to save deep throat secretions or throat swab for SARS-CoV-2 by real-time 56 reverse transcriptase polymerase chain reaction (rRT-PCR) and the tests were repeated 8-9 days apart 57 during the quarantine period. Conclusions and Implication: We achieved a zero COVID-19 infection rate among LTCF residents 64 because of strict hand hygiene, near 100% compliance among staff in wearing of surgical masks, 65 prohibition of visitors and reducing the frequency of on-site physician visits. Asymptomatic and Presymptomatic SARS-CoV-2 77 Infections in Residents of a Long-Term Care Skilled Nursing Facility -King County


id: cord-331520-o9e4qqn4
title: The Winter Respiratory Viral Season During the COVID-19 Pandemic
author: Kistler, Christine E.
date: 2020-10-26
url: https://api.elsevier.com/content/article/pii/S1525861020309221
doi: 10.1016/j.jamda.2020.10.030
abstract:
  The winter respiratory virus season always poses challenges for long-term care settings; this winter, SARS-CoV-2 will compound the usual viral infection challenges. This special article discusses unique considerations that COVID-19 brings to the health and well-being of residents and staff in nursing homes and other long-term care settings this winter. Specific topics include preventing the spread of respiratory viruses, promoting immunization, and the diagnosis and treatment of suspected respiratory infection. Policy-relevant issues are discussed, including whether to mandate influenza immunization for staff, the availability and use of personal protective equipment, supporting staff if they become ill, and the distribution of a COVID-19 vaccine when it becomes available. Research is applicable in all of these areas, including regarding the use of emerging electronic decision support tools. If there is a positive side to this year’s winter respiratory virus season, it is that staff, residents, family members, and clinicians will be especially vigilant about potential infection.


id: cord-333153-hjgf3ay8
author: Griffith, Matthew F.
date: 2020-10-21
url: https://api.elsevier.com/content/article/pii/S1525861020307933
doi: 10.1016/j.jamda.2020.09.010
title:
  Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

abstract:
  OBJECTIVES: Pneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Participants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. METHODS: Activities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. RESULTS: In 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. CONCLUSIONS AND IMPLICATIONS: Hospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.


id: cord-333960-pkpbts7s
title: COVID-19 in-hospital mortality and use of renin-angiotensin system blockers in geriatrics patients.
author: Genet, Bastien
date: 2020-09-09
url: https://www.ncbi.nlm.nih.gov/pubmed/33138935/
doi: 10.1016/j.jamda.2020.09.004
abstract:
  Objective The role of treatment with renin-angiotensin-aldosterone system blockers at the onset of COVID-19 infection is not known in geriatric population. The aim of this study was to assess the relationship between angiotensin receptor blockers (ARB) and an ACE inhibitor (ACEI) use and in-hospital mortality in geriatric patients hospitalized for COVID-19. Design This observational retrospective study was conducted in a French geriatric department. Patients were included between March 17 and April 18, 2020. Setting and Participants: All consecutive 201 patients hospitalized for COVID-19 (confirmed by RT-PCR methods) were included. All non-deceased patients had 30 days of follow-up and no patient was lost to follow-up. Methods Demographic, clinical, biological data and medications were collected. In-hospital mortality of patients treated or not by ACEI/ARB was analyzed using multivariate Cox models. Results Mean age of the population was 86.3 (8.0) years old, 62.7% of patients were institutionalized, 88.6% had dementia and 53.5% had severe disability (ADL score < 2). Sixty-three patients were treated with ACEI/ARB and 138 were not. Mean follow-up was 23.4 (10.0) days, 66 (33.8%) patients died after an average of 10.0 days (6.0). Lower mortality rate was observed in patients treated with ACEI/ARB compared with patients not treated with ARB nor ACEI (22.2% (14) vs. 37.7% (52), HR = 0.54 (95% CI = 0.30-0.97), p=0.03). In a multivariate Cox regression model including age, sex, ADL score, Charlson index, renal function, dyspnea, CRP and white blood cells count, use of ACEI/ARB was significantly associated with lower in-hospital mortality (HR = 0.52 (0.27−0.99), p=0.048). Conclusion and Implications In very old subjects hospitalized in geriatric settings for COVID-19, mortality was significantly lower in subjects treated with ARB or ACEI prior to the onset of infection. The continuation of ACEI/ARB therapy should be encouraged during periods of coronavirus outbreak in older subjects.


id: cord-335131-u33dkgr1
title: ‘New Normal’ in Covid-19 Era: A Nursing Perspective from Thailand
author: Gunawan, Joko
date: 2020-07-22
txt: ./txt/cord-335131-u33dkgr1.txt
cache: ./cache/cord-335131-u33dkgr1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32859516/
doi: 10.1016/j.jamda.2020.07.021
abstract: nan
summary:
  key: cord-335131-u33dkgr1 authors: Gunawan, Joko; Aungsuroch, Yupin; Marzilli, Colleen title: ''New Normal'' in Covid-19 Era: A Nursing Perspective from Thailand cord_uid: u33dkgr1 New Normal in Covid-19 Era. None Declared. This study was supported by the C2F Fund of Chulalongkorn University, Bangkok, Thailand. In conclusion, COVID-19 has brought many new features to life with both positive and 54 negative, or yin and yang effects. Human beings should learn from this phenomenon and use 55 creativity to find appropriate ways to adapt to the new reality. Like Nightingale said, the craving 56 Ministry of Public Health of Thailand. Thailand situation on Covid-19 Wash your hand!'': The old message from Florence Nightingale to battle 64 New concept of health with perspective of Chinese medicine Current mental health issues in the era of 68 What have we learned about nursing from the coronovirus pandemic All authors contributed equally in this work.Word counts: 721


id: cord-336467-w528t92h
title: Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience
author: Anderson, Diana C.
date: 2020-10-31
url: https://www.sciencedirect.com/science/article/pii/S152586102030788X
doi: 10.1016/j.jamda.2020.09.005
abstract:
  Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.


id: cord-339292-mhbwjwrg
title: THE IMPORTANCE OF PHYSICAL ACTIVITY TO CARE FOR FRAIL OLDER ADULTS DURING THE COVID-19 PANDEMIC
author: Aubertin-Leheudre, M.
date: 2020-04-30
url: https://doi.org/10.1016/j.jamda.2020.04.022
doi: 10.1016/j.jamda.2020.04.022
abstract:
  Summary COVID-19 restrictions could decreased physical and mental health. Simple, adapted and specific physical activities should be implemented and considered as the best solution to care for frail elderly during the COVID-19 pandemic.


id: cord-340701-eeqgtk34
title: COVID-19 and Nursing Home Residents’ Rights
author: Kusmaul, Nancy
date: 2020-07-29
txt: ./txt/cord-340701-eeqgtk34.txt
cache: ./cache/cord-340701-eeqgtk34.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32883598/
doi: 10.1016/j.jamda.2020.07.035
abstract: nan
summary:
  title: COVID-19 and Nursing Home Residents'' Rights Born from a time when nursing homes residents were subject to physical 30 restraints and sedation, these rights sought to give residents greater control over daily routines 31 and social interactions 2 . While the Covid-19 pandemic seemed urgent and the risks to nursing home residents 39 were real, these directives superseded and countered residents'' rights. To have visitors at any time, as long as you wish to see them, as long 42 as the visit does not interfere with the provision of care and privacy rights of other residents." 4 43 As defined in the 45 federal register, §483.24 "Quality of life is a fundamental principle that applies to all care and 46 services provided to facility residents. Empowering the elderly nursing home resident: The resident rights 86 campaign Protect Nursing Home Residents from COVID 19 Your Rights and Protections as a 92 Nursing Home Resident


id: cord-345725-8ijgmbmr
title: COVID-19 Preparedness in U.S. Home Healthcare Agencies
author: Shang, Jingjing
date: 2020-06-04
url: https://www.sciencedirect.com/science/article/pii/S1525861020304904?v=s5
doi: 10.1016/j.jamda.2020.06.002
abstract:
  Abstract Objectives In the U.S., home health agencies (HHAs) provide essential services for patients recovering from post-acute-care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of U.S. HHAs and compare results by urban/rural location. Design Cross-sectional study. Setting/Participants Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. Methods Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. Results Similar to national data, most responding HHAs (n=121, 12% response rate) were for-profit and located in the South. A majority of HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were impacted less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared to urban HHAs. Conclusions/Implications This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically impact agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


id: cord-345864-87b5qdjx
title: Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2
author: Rudolph, James L.
date: 2020-06-09
url: https://doi.org/10.1016/j.jamda.2020.06.009
doi: 10.1016/j.jamda.2020.06.009
abstract:
  Abstract Objectives Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever defined as a temperature of at least 38.0°C. The objective of this study is to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents. Design Cohort study Setting and Participants: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. Measures All CLC residents (n=7325) underwent SARS-CoV-2 testing. We report the temperature in window of the 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days prior to the study window. Results SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2 positive residents was 37.66 (0.69) compared to 37.11 (0.36) (p=0.001) in SARS-CoV-2 negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days prior to testing and remained elevated during the 14-day follow up. Among SARS-CoV-2 positive residents, only 26.6% (n=118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n=277) with confirmed SARS-CoV-2 did experience two or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents’ (20.3%, n=90) temperatures never deviated >0.5°C from baseline. Conclusions and Implications A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.


id: cord-353621-t5tev985
author: Gallina, Pasquale
date: 2020-05-21
txt: ./txt/cord-353621-t5tev985.txt
cache: ./cache/cord-353621-t5tev985.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jamda.2020.05.024
doi: 10.1016/j.jamda.2020.05.024
abstract: nan
summary:
  key: cord-353621-t5tev985 title: Covid-19: Decisions to offer interventions with limited availability should be decided based on chance of recovery. cord_uid: t5tev985 Dear Editor, 1 We read with interest the paper by Cesari and 2 Proietti 1 entitled "COVID-19 in Italy: ageism and decision making in 3 a pandemic", which rejects a priori discrimination of aged people in 4 access to care. COVID-19 in Italy: ageism and decision 89 making in a pandemic Universal 93 do-not-resuscitate orders, social worth, and life-years: opposing 94 discriminatory approaches to the allocation of resources during the 95 COVID-19 pandemic and other health system satastrophes Fair allocation of scarce 98 medical resources in the time of Covid-19 Clinical ethics 101 recommendations for the allocation of intensive care treatments in 102 exceptional, resource-limited circumstances: the Italian 103 perspective during the COVID-19 epidemic. SIAARTI 106 recommendations for the allocation of intensive care treatments in 107 exceptional, resource-limited circumstances Critical Care Beds During the COVID-19 Pandemic

title:
  Covid-19: Decisions to offer interventions with limited availability should be decided based on chance of recovery.


id: cord-354105-lgkfnmcm
title: Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact
author: Office, Emma E.
date: 2020-06-05
url: https://www.sciencedirect.com/science/article/pii/S1525861020304916?v=s5
doi: 10.1016/j.jamda.2020.06.003
abstract:
  Abstract Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears/insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable, and can be adopted by medical schools to leverage students to connect to socially-isolated seniors in numerous settings.


id: cord-355256-7ksbvisv
author: Sloane, Philip D.
date: 2020-04-30
url: https://api.elsevier.com/content/article/pii/S1525861020303509
doi: 10.1016/j.jamda.2020.04.020
abstract: nan
title:
  Cruise Ships, Nursing Homes and Prisons as COVID-19 Epicenters: A ‘Wicked Problem” with Breakthrough Solutions?


