Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

被引:26
作者
Dyer, Adam H. [1 ,2 ]
Fallon, Aoife [1 ,2 ]
Noonan, Claire [1 ]
Dolphin, Helena [1 ]
O'Farrelly, Cliona [3 ,4 ]
Bourke, Nollaig M. [2 ,5 ]
O'Neill, Desmond [1 ,2 ]
Kennelly, Sean P. [1 ,2 ]
机构
[1] Tallaght Univ Hosp, Dept Age Related Healthcare, Dublin, Ireland
[2] Trinity Coll Dublin, Sch Med, Discipline Med Gerontol, Dublin, Ireland
[3] Trin Biomed Sci Inst, Sch Biochem & Immunol, Comparat Immunol, Dublin, Ireland
[4] Trinity Coll Dublin, Sch Med, Dublin, Ireland
[5] Trin Translat Med Inst, Inflammageing Res Grp, Dublin, Ireland
基金
英国惠康基金; 爱尔兰科学基金会;
关键词
COVID-19; SARS-CoV-2; vaccine; nursing home; long-term care; SYNDROME CORONAVIRUS 2; SARS-COV-2; INFECTION; HEALTH-CARE; VACCINATION COVERAGE; NATIONAL-HEALTH; UNITED-STATES; EXCESS DEATHS; STAFF MEMBERS; RISK-FACTORS; OF-LIFE;
D O I
10.1016/j.jamda.2022.06.028
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
引用
收藏
页码:1590 / 1602
页数:13
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