Journal Article > ResearchFull Text
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, et al.
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
INTRODUCTION
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
Journal Article > LetterFull Text
Lancet. 2023 October 20; Volume S0140-6736 (Issue 23); 02355-3.; DOI:10.1016/S0140-6736(23)02355-3
van Boetzelaer E, Franco OH, Moussally K, Khammash U, Escobio F
Lancet. 2023 October 20; Volume S0140-6736 (Issue 23); 02355-3.; DOI:10.1016/S0140-6736(23)02355-3
Journal Article > CommentaryFull Text
Lancet Healthy Longev
Healthy longevity. 2024 January 1; Volume 5 (Issue 1); e76-e82.; DOI:10.1016/S2666-7568(23)00244-1
van Boetzelaer E, van de Kamp J, Keating P, Sharma SK, Pellecchia U, et al.
Lancet Healthy Longev
Healthy longevity. 2024 January 1; Volume 5 (Issue 1); e76-e82.; DOI:10.1016/S2666-7568(23)00244-1
Journal Article > CommentaryFull Text
PLOS Med. 2012 December 18; Volume 9 (Issue 12); e1001357.; DOI:10.1371/journal.pmed.1001357
Karunakara U, Stevenson F
PLOS Med. 2012 December 18; Volume 9 (Issue 12); e1001357.; DOI:10.1371/journal.pmed.1001357
Other > Journal Blog
Conflict in eastern Ukraine is a reminder that older people are especially vulnerable in emergencies
BMJ Opinion (blog). 2019 June 4
Simonyan G
BMJ Opinion (blog). 2019 June 4
Other > Journal Blog
BMJ Opinion (blog). 2020 July 15
Simonyan G
BMJ Opinion (blog). 2020 July 15
Journal Article > CommentaryFull Text
Trans R Soc Trop Med Hyg. 2013 October 10; Volume 107 (Issue 11); 669-671.; DOI:10.1093/trstmh/trt085
du Cros PAK, Venis S, Karunakara U
Trans R Soc Trop Med Hyg. 2013 October 10; Volume 107 (Issue 11); 669-671.; DOI:10.1093/trstmh/trt085
Data on the elderly are rarely collected in humanitarian emergencies. During a refugee crisis in South Sudan, Médecins Sans Frontières developed a prospective mortality surveillance system collecting data for those aged ≥50 years and found that the elderly were dying at five times the rate of those aged 5-49 years. Practical and ethical issues arose. Were reported ages accurate? Since no baseline exists, what does the mortality rate mean? Should programmatic changes be made without evidence that these would reduce the elderly mortality rate? We outline issues to be addressed to enable informed decisions on response to elderly populations in emergency settings.