Residents Of Long-term Care Facilities Research Articles

Value-based care of older people-The impact of an acute outreach service unit on emergency medical service missions: A quasi-experimental study.

Transfers to the emergency department can be burdensome for the residents of long-term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse-led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on-site care to LTRCF residents to reduce transfers to the emergency department. This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six-month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A-D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%-22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%-30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%-41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs.

Disparities in COVID-19 Vaccination Status Among Long-Term Care Facility Residents - United States, October 31, 2022-May 7, 2023.

Residents of long-term care (LTC) facilities constitute a population that is vulnerable to SARS-CoV-2 infection; COVID-19 vaccination effectively reduces severe COVID-19 in these settings. To examine demographic differences in primary and up-to-date vaccination status against COVID-19 among LTC facility residents, a descriptive analysis of COVID-19 vaccination data from the National Healthcare Safety Network (NHSN) COVID-19 vaccination data from October 31, 2022, to May 7, 2023, were analyzed. Being up to date was defined as having received a bivalent COVID-19 vaccine dose or having completed a primary vaccination series <2 months earlier. Geographic disparities in vaccination coverage were identified, with substantially lower prevalences of up-to-date status among LTC facility residents in the South (Region 6) (37.7%) and Southeast (Region 4) (36.5%) than among those in the Pacific Northwest (Region 10) (53.3%) and Mountain West (Region 8) (59.6%) U.S. Department of Health and Human Services regions. Up-to-date status was lowest among Black or African American (39.9%) and multiracial (42.2%) LTC facility residents. Strategies to increase up-to-date COVID-19 vaccination among LTC facility residents could include and address these geographic and racial differences.

Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus - RSV-NET, 12 States, July 2022-June 2023.

Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. In May 2023, two RSV vaccines were approved for prevention of RSV lower respiratory tract disease in adults aged ≥60 years. In June 2023, CDC recommended RSV vaccination for adults aged ≥60 years, using shared clinical decision-making. Using data from the Respiratory Syncytial Virus-Associated Hospitalization Surveillance Network, a population-based hospitalization surveillance system operating in 12 states, this analysis examined characteristics (including age, underlying medical conditions, and clinical outcomes) of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022-June 2023. Among a random sample of 1,634 older adult patients with RSV-associated hospitalization, 54.1% were aged ≥75 years, and the most common underlying medical conditions were obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. Severe outcomes occurred in 18.5% (95% CI=15.9%-21.2%) of hospitalized patients aged ≥60 years. Overall, 17.0% (95% CI=14.5%-19.7%) of patients with RSV infection were admitted to an intensive care unit, 4.8% (95% CI=3.5%-6.3%) required mechanical ventilation, and 4.7% (95% CI=3.6%-6.1%) died; 17.2% (95% CI=14.9%-19.8%) of all cases occurred in long-term care facility residents. These data highlight the importance of prioritizing those at highest risk for severe RSV disease and suggest that clinicians and patients consider age (particularly age ≥75 years), long-term care facility residence, and underlying medical conditions, including chronic obstructive pulmonary disease and congestive heart failure, in shared clinical decision-making when offering RSV vaccine to adults aged ≥60 years.

Characteristics of and Deaths among 333 Persons with Tuberculosis and COVID-19 in Cross-Sectional Sample from 25 Jurisdictions, United States.

Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB-COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 [95% CI 0.8‒1.4]). Among TB-COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB-COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.

Staff Perceptions of the Impact of the COVID-19 Pandemic on Older Adults Living in a Residential Long-Term Care Facility.

Older adults residing in long-term care facilities (LTCFs) were an at-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Actions to prevent transmission in LTCFs included visitation restrictions, suspension of group activities, and isolating residents in their rooms. Despite these measures, this vulnerable cohort experienced high levels of infection and mortality. The current article reports RNs' and health care assistants' perceptions of the impact of COVID-19 on residents in a LTCF. Using a descriptive qualitative design, semi-structured interviews, which were conducted with seven RNs and four health care assistants, were thematically analyzed. Three themes emerged: Impact on Daily Routine, Disruption to Relationships With Staff, and Vulnerability. Staff perceived residents were negatively impacted physically, emotionally, and socially as a direct consequence of COVID-19 and by strategies introduced to protect them contracting the virus. It is recommended that the long-term impact of the COVID-19 pandemic on this cohort be evaluated from the perspective of all stakeholders (i.e., residents, staff, and families) using a longitudinal research design. [Journal of Gerontological Nursing, 49(10), 44-50.].

Acute Health Care Provision in Rural Long-Term Care Facilities: AScoping Review of Integrated Care Models.

We aimed to map integrated care models for acute health care in rural long-term care facilities (LTCFs) for future investigation. Systematic scoping review. Residential LTCFs in rural areas worldwide. The common health-related online databases were systematically searched complemented by a manual search of gray literature. Following the 5-stage framework of Arksey and O'Malley, the extent of included literature was identified and findings were summarized using qualitative meta-summary. A total of 35 references were included for synthesis, predominantly primary research on completed and ongoing projects reporting on integrated health care services in rural LTCFs. Incorporating previous research, we extracted 5 approaches of integrated acute-health care models: (1) Availability of Specialists, (2) Networks, (3) Quality Management (QM) and Organization, (4) Telemedicine, and (5) Telehealth. This research presents the result of a literature review examining integrated care models as a way to improve acute health care in LTCFs in rural areas. Integrated care models in rural settings can help face the challenging situation and fulfil the complex health care needs of LTCF residents by reducing fragmentation and thereby improve continuity and coordination of acute health care services. These results can guide policy making in creating interventions and support adequate implementation of care models by knowledge translation in health care.

A-287 Evaluation of Urinalysis Reflex to Culture in Long-Term Care Facilities: Is It Worth it?

Abstract Background Urinary Tract Infection (UTI) is one of the second common infections among the geriatric population. It is more common in women than men and the incidence increases with age. UTI can cause serious complications and it is a significant cause of morbidity and death. The high mortality rate is largely due to delayed presentation and the development of bacteremia/sepsis. Physicians rely heavily on urinalysis to diagnose UTI, and it is one of the most frequently requested tests; however, the need to reflect to urine culture became more in demand to cut the cost of test not needed without the sacrificing of patient care. Methodology 4307 urine samples were collected for urinalysis and culture from residents in Long-Term Care Facilities (LTCF) over a period of 5 weeks. Urinalysis and microscopy were done using IQ WORKCELL automated system. All the specimens were cultured; the culture was done using MicroScan Walkaway96 conventional panels. We used urine culture as the reference standard, no growth or &amp;lt;10 000 colony-forming unit/mL were considered negative, cultures with &amp;gt;50 000 colonies colony-forming unit/mL were considered positive. UA is considered positive if it was positive leukocyte esterase, WBC &amp;gt; 5, nitrate, or had &amp;gt;moderate bacteria. We compared positive UA to the culture outcome. Statistical analyses were done using Analyse-it. Results Women represented 64.7% of the samples tested; the positivity rate was 49.2% (52.3% for women and 43.4% for men) and 7.0% of the all the cultures had mixed flora. Urinalysis identified 3038 as positive UA, only 1941 (63.9%) had positive culture and 846 (43.6%) had negative culture. Urinalysis identified 1269 samples as negative, 176 samples (13.9%) of them had positive culture. Conclusion The use of negative urinalyses to reflex to culture would help eliminating the majority of the cultures that are not necessary. However, avoiding the culture will risk missing infection in 13.9% of the negative urinalysis samples. In addition, more than one third of the positive urinalysis will require unnecessary cultures. Although the use of reflex will help eliminating the unnecessary culture, we have to remember that urinalysis and microscopy still lack the sensitivity and specificity to be used alone to diagnose urinary tract infection; urinalysis should not be the only marker for UTI, it should be used in conjunction with patients clinical diagnosis. The high positivity rate for UTI in LTCF adds to the complication of the reflex testing. More work needed to establish better parameters and algorithm to be used when screening patients for UTI using urinalysis.

A-286 Performance Evaluation of Molecular Clostridium Difficile Assay using BD MaxTM System

Abstract Background Clostridium difficile (C.Diff) is a gram positive anaerobe producing Enterotoxin and Cytotoxin (toxin A and B respectively); toxin B has been reported to be essential for its virulence. It is estimated that C. Diff will cause over half a million infection yearly and one in 11 people over the age of 65 diagnosed with healthcare-associated C.Diff infection die within one month. It is the most common cause of acute diarrhea; residents in Long-Term Care Facilities (LTCF) are more prone to have C. Diff infection (CDI) because of their age, the frequent use of antibiotics, fragilities, co-morbidity, and living environment. Diagnosing CDI is based on clinical signs and symptoms as well as laboratory tests. Several tests available for diagnosing the infection which include: enzyme immunoassays, tissue culture cytotoxicity, anaerobic culture, glutamate dehydrogenase antigen and nucleic acid amplification. The BD MAX™ System is a PCR based assay that provides the sensitivity, specificity and faster turnaround. Methods The MAX™ System is an automated in vitro diagnostic test for the direct qualitative detection of the C. difficile toxin B gene (tcdB) in human liquid or soft stool specimens from patients suspected of having Clostridium difficile Infection (CDI).The test is performed directly on the specimen, utilizing real-time polymerase chain reaction (PCR) for the amplification of C. difficile toxin B gene (tcdB). The test utilizes fluorogenic sequence-specific hybridization probes for detection of the amplified DNA. The test was validated for accuracy, precision, and patient correlation to enzyme-immunoassay using Premier Toxins A &amp; B is an enzyme immunoassay for the direct detection of Clostridium difficile toxin A and toxin B in stool samples. Statistical analyses were done using Analyse-it. Results The percentage agreement for precision, reproducibility, and accuracy were 100%. We had 100% agreement for positive patients on EIA and 85% for negative patients on EIA; however, upon investigation we found the discrepancies were due to false negative EIA results. Conclusion The BD Max gave the benefit of a fully automated with high sensitivity and specificity for the presence of toxin B producing C. Diff. The faster turnaround gives the physician the ability to diagnose CDI and prevent spreading of the disease to other patients. It is very important to remember that C.diff infection can be prevented with appropriate use of antibiotics and implementing antibiotic stewardship and infection control plan to prevent and stop spreading of the infection.

Systematic Review on the Positive Mental Health Impact of Older Adults Participation in Horticultural Activities in Long Term Care Facilities

The present research study focuses on exploring the effects of horticultural activities on the health outcomes of residents of long-term care facilities (LTCFs). The study utilizes evidence-based nursing and a systematic literature review. A search for relevant articles was conducted on databases such as PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane. Randomized controlled trials in English and Chinese were included in the analysis, with two researchers independently evaluating the selected articles. The synthesis of results revealed that horticultural activities for residents of LTCFs had positive effects on physical aspects, such as increasing physical agility and aerobic endurance. Moreover, they had positive influences including happiness, positive mental health. In terms of social aspects, horticultural activities for older adults helped reduce aggressive behaviors, promoted goal-oriented living, and enhanced quality of life. Evidence of the impact of horticultural activities on the positive mental health of residents of LTCFs is relatively scarce compared to community-dwelling older adults, where psychological states are often studied in negative contexts. It has been suggested that LTCFs should integrate horticultural activities into their regular programs to foster positive mental health outcomes. Horticultural activities show promise in promoting positive mental health among residents of LTCFs and warrant further exploration.

Relationship between oral frailty, health-related quality of life, and survival among long-term care residents

Key summary pointsAimWe evaluated oral frailty (OFr) with six signs and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among long-term care facilities.FindingsHRQoL decreased linearly with increasing number of OFr signs. OFr was not associated with energy and protein intake, and lower OFr category significantly predicted better survival.MessageThe six signs of OFr used in this study are easy to employ in long-term care at the bedside. Oral health of older residents in long-term care facilities should be given more attention.

Influenza epidemics in Europe, nursing homes and vaccination of healthcare workers

During the 2022-2023 season, influenza circulation levels in the European Union (EU) have increased substantially compared to the 2021-2022 season but were still generally somewhat lower compared to pre-pandemic influenza seasons. Studies have shown that influenza epidemics in the EU countries were associated with a heavy toll of mortality for different principal causes of death including respiratory, cardiac and other causes. Mortality data also suggest that residents of long-term care facilities represent a sizeable share of all cases of death in the EU, and an even higher share among deaths stemming from infections with respiratory viruses, including influenza. Influenza vaccination coverage for healthcare workers in nursing homes in many EU countries is moderate to low, whereas evidence in the literature suggests that higher influenza vaccination coverage levels for healthcare workers result in a significant reduction in all-cause mortality during influenza seasons, both in nursing home residents as well as in hospital patients, though the magnitude of that effect varies with influenza season. Here, we review the above evidence, and as well as the effect of different strategies for boosting influenza vaccination coverage in healthcare workers, such as mandatory vaccination, educational initiatives/outreach activities and availability of on-sight vaccination.

189 Incidence of hospital admission among Long-Term Care Facility residents versus Community Dwelling older adults: a population based observational study

Abstract Background Long-Term Care Facility (LTCF) residents are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. This study aims to determine the incidence of hospital admission among LTCF residents in comparison to their Community Dwelling (CD) counterparts, and to describe reasons for hospitalisation, and admission-related adverse outcomes. Methods Hospital In-Patient Enquiry (HIPE) data was obtained for all LTCF residents and CD adults over the age of 75 residing in Waterford County, Ireland, who were acutely admitted in 2022. This included demographic data, International Classification of Diseases (ICD-10) diagnosis, Length of Stay (LoS), and discharge outcome. Incidence was calculated by dividing the number of persons admitted to hospital by the total population at risk over a one-year period. Chi-squared test was used to determine significant difference between the two groups. Results Admission incidence was 0.40 for LTCF residents and 0.28 for CD (p &amp;lt; 0.001). Average age was 83 years, and median LOS was seven days in both groups. The most common causes for admission among LTCF residents were infection (56%, n = 147) and falls (12%, n = 31). CD were mostly admitted with infection (31%, n = 805), cardiac issues (16%, n = 414), and falls (12%, n = 303). LTCF residents were more likely than CD to be admitted with Covid-19 infection (9% vs 4%, p = 0.003). There was no difference in mortality rates (8% LTCF vs 6% CD, p = 0.33). LTCF residents were more likely to have a diagnosis of dementia (43% vs 11%, p &amp;lt; 0.001) and develop delirium during admission (30% vs 16%, p &amp;lt; 0.0001). Conclusion LTCF residents are significantly more likely to be hospitalised than CD, and to experience delirium during admission. Proper advanced care planning and provision for treatment with intravenous antibiotics in the LTCF may reduce admissions to hospital, but more importantly will provide person-centred care and potentially improve clinical outcomes.

188 Characteristics and outcomes of long-term care facility residents acutely admitted to hospital

Abstract Background Long-term care facility (LTCF) residents represent the frailest members of society and are three times more likely to attend the Emergency Department (ED) than older persons residing in the community. They are also more likely to suffer adverse events when admitted to hospital. This study aims to describe the profile of LTCF residents admitted to hospital in order to inform the implementation of a new nursing home liaison service as part of the Enhanced Community Care program. Methods All LTCF residents with acute admission to a model four hospital in 2022 were identified through the Hospital In-patient Enquiry (HIPE) database, and address of residence was verified using the Integrated Patient Management System (IMPS). Demographic and outcome data including International Classification of Diseases (ICD-10) diagnosis, Length-of-Stay (LoS), in-hospital complications, and mortality were analysed retrospectively. Results There were 724 ED attendances, resulting in 447 acute admissions by 327 residents. The majority of residents (63%, n = 281) arrived to the ED outside of normal working hours. The average age was 84 (range 46–102), and 60% (n = 194) were female. Most were admitted with infection (50%, n = 225), followed by fall with a fracture (16%, n = 70). The median LOS was 8 days (range 0.5–112), and 11% (n = 37) of residents died in hospital. Complications were common with 27% (n = 120) suffering from delirium, 8% (n = 37) falling, and 7% (n = 33) contracting Covid-19 in hospital. Conclusion LTCF residents frequently present with acute unscheduled care episodes. Around 40% of LTCF residents attending ED are not admitted, but those who are have a significant LoS fraught with complications. This study will inform the implementation of the nursing home liaison service with strategies aimed at reduction in potentially avoidable admissions, and alternative provisions of care targeted at common reasons for hospitalisation in this group.

Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities

ObjectiveWith the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. MethodUsing the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. ResultsOf the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77–1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28–0.89) among the LTCF residents. ConclusionsAlthough ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.

Humoral and Cellular Immune Response Elicited by the BNT162b2 COVID-19 Vaccine Booster in Elderly.

Although the safety and efficacy of COVID-19 vaccines in older people are critical to their success, little is known about their immunogenicity among elderly residents of long-term care facilities (LTCFs). A single-center prospective cohort study was conducted: a total IgG antibody titer, neutralizing antibodies against Wild-type, Delta Plus, and Omicron BA.2 variants and T cell response, were measured eight months after the second dose of BNT162b2 vaccine (T0) and at least 15 days after the booster (T1). Forty-nine LTCF residents, with a median age of 84.8 ± 10.6 years, were enrolled. Previous COVID-19 infection was documented in 42.9% of the subjects one year before T0. At T1, the IgG titers increased up to 10-fold. This ratio was lower in the subjects with previous COVID-19 infection. At T1, IgG levels were similar in both groups. The neutralizing activity against Omicron BA.2 was significantly lower (65%) than that measured against Wild-type and Delta Plus (90%). A significant increase of T cell-specific immune response was observed after the booster. Frailty, older age, sex, cognitive impairment, and comorbidities did not affect antibody titers or T cell response. In the elderly sample analyzed, the BNT162b2 mRNA COVID-19 vaccine produced immunogenicity regardless of frailty.

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation.

Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6% (95% CI 24.4%-36.8%) sensitive and 79.7% (95% CI 76.4%-82.9%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8% (95% CI 27.9%-41.7%) at >0 RNA copies/mL and increased to 75% (95% CI 60%-90%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US $144.50, which included transportation, labor, and materials expenses. The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data.

The effects of therapeutic virtual reality experience to promote mental well-being in older people living with physical disabilities in long-term care facilities

BackgroundMental well-being is poor in long-term care facilities (LTCF) residents. Physical disabilities, impaired social engagement, and environmental stress are also common in LTCF which exacerbate the decline of the mental well-being of older people living in LTCF. Protective elements, including nature-based, reminiscence, outdoor, and group activities, are known to be effective to promote the mental well-being of older people living in LTCF. However, limited by their physical disabilities and poor social support, older people living in LTCF are not likely to benefit from these effective measures. Virtual reality has been proven to be feasible to be environmentally unrestricted to providing LTCF residents with all protective elements promoting mental well-being. However, its effects on the mental well-being of LTCF residents living with physical disabilities are unclear.MethodsThis study employs a single-blinded, two-parallel-group (intervention-to-control group ratio = 1:1), non-inferiority, randomized controlled trial. Eligible participants are aged 60 years or above, LTCF residents, and living with physical disabilities. The study will be conducted in LTCF. In the intervention group, participants will receive a 6-week VR experience program. In the control group, participants will receive the usual care provided by the LTCF. The primary outcome is mental well-being, as measured by World Health Organization Five Well-being Index at the time point of baseline (i.e., week 0) and after completion of the intervention (i.e., week 7). This study aims to recruit a total of 216 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.Trial registrationThe trial has been registered at ClinicalTrials.gov (Identifier: NCT05818579), Registered on April 5, 2023. The latest version of the protocol was published online on 19 April 2023. All items come from the World Health Organization Trial Registration Data Set. This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023158). The findings will be disseminated in peer-reviewed journals, presented at international and local conferences with related themes, and shared in local media.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

ObjectiveThe Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study designPoint prevalence survey. MethodsA pilot PPS was conducted between May–June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. ResultsAmong 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%–3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%–4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. ConclusionsA national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Role of Interleukin 6 as Predictive Factor for the Severity of COVID 19

Abstract Background Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. Excessive interleukin-6 signaling is a key factor contributing to the cytokine release syndrome implicated in clinical manifestations of COVID-19. Aim of the Work To determine the Role of interleukin 6 as predictive factor for the severity of Covid-19. Patients and Methods This was Case Control study, conducted at Abassia Fever hospital and El Demerdash University Hospital on 75 participants (50 patients with Covid-19 disease manifestation and 25 controls) during a period of 6 months. Results There was no statistically significant difference between cases with less than 50% and more than 50% lung affection among mild cases groups as regard serum IL-6. Conclusion The concentration of IL-6 &amp;gt; 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.

Kinetics of COVID-19 mRNA primary and booster vaccine-associated neutralizing activity against SARS-CoV-2 variants of concern in long-term care facility residents: a prospective longitudinal study in Japan

BackgroundCoronavirus disease 2019 (COVID-19) remains a threat to vulnerable populations such as long-term care facility (LTCF) residents, who are often older, severely frail, and have multiple comorbidities. Although associations have been investigated between COVID-19 mRNA vaccine immunogenicity, durability, and response to booster vaccination and chronological age, data on the association of clinical factors such as performance status, nutritional status, and underlying comorbidities other than chronological age are limited. Here, we evaluated the anti-spike IgG level and neutralizing activity against the wild-type virus and Delta and Omicron variants in the sera of LTCF residents, outpatients, and healthcare workers before the primary vaccination; at 8, 12, and 24 weeks after the primary vaccination; and approximately 3 months after the booster vaccination. This 48-week prospective longitudinal study was registered in the UMIN Clinical Trials Registry (Trial ID: UMIN000043558).ResultsOf 114 infection-naïve participants (64 LTCF residents, 29 outpatients, and 21 healthcare workers), LTCF residents had substantially lower anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant than outpatients and healthcare workers over 24 weeks after the primary vaccination. In LTCF residents, booster vaccination elicited neutralizing activity against the wild-type virus and Delta variant comparable to that in outpatients, whereas neutralizing activity against the Omicron variant was comparable to that in outpatients and healthcare workers. Multiple regression analyses showed that age was negatively correlated with anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant after the primary vaccination. However, multivariate regression analysis revealed that poor performance status and hypoalbuminemia were more strongly associated with a lower humoral immune response than age, number of comorbidities, or sex after primary vaccination. Booster vaccination counteracted the negative effects of poor performance status and hypoalbuminemia on the humoral immune response.ConclusionsLTCF residents exhibited suboptimal immune responses following primary vaccination. Although older age is significantly associated with a lower humoral immune response, poor performance status and hypoalbuminemia are more strongly associated with a lower humoral immune response after primary vaccination. Thus, booster vaccination is beneficial for older adults, especially those with a poor performance status and hypoalbuminemia.