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Mass testing after a single suspected or confirmed case of COVID-19 in London care homes, April–May 2020: implications for policy and practice
- Authors:
- TANG Suzanne, et al
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.649-656.
- Publisher:
- Oxford University Press
Introduction: Previous investigations have identified high rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes reporting an outbreak of coronavirus disease 2019 (COVID-19). We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London. Methods: Between 18 and 27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by reverse transcription polymerase chain reaction and subsequent whole-genome sequencing. Residents and staff in two care homes were re-tested 8 days later. Results: Four care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3 and 59%. Among residents, positivity ranged between 3 and 76% compared with 3 and 40% in staff. Half of the SARS-CoV-2-positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introduction of the virus into care homes, and distinct clusters within three of the care homes. Conclusions: We found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. Although routine whole-home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures. (Edited publisher abstract)
COVID-19 testing in English care homes and implications for staff and residents
- Authors:
- MICOCCI Massimo, et al
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.668-672.
- Publisher:
- Oxford University Press
Introduction: Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods: A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. Results: Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion: Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes. (Edited publisher abstract)
Recognising and managing depression in residents of aged care homes: the final report of the Challenge Depression project
- Author:
- HAMMOND CARE GROUP
- Publisher:
- Australia. Department of Health and Ageing
- Publication year:
- 2004
- Pagination:
- 55p.
- Place of publication:
- Canberra, ACT
A survey of 1758 residents in 168 aged care homes from every state and territory in Australia was carried out to ascertain the scale of the problem of depression amongst residents. Results from residents able to complete the Geriatric Depression Scale indicate that 51% of high care and 30% of low care residents are depressed. Results from those only able to be assessed with the Cornell Rating Scale (the severely cognitively impaired) indicate that 38% of high care and 26% of low care residents are depressed. Under normal circumstances a significant proportion of depressed residents go unnoticed. Staff were often not aware of information that would help them to notice and understand the depression in the people around them. When staff are obliged to look at residents in a systematic way their recognition of the symptoms of depression improves.
Is point-of-care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of a Point-of-Care Polymerase Chain Reaction test for SARS-COV-2
- Authors:
- MICOCCI Massimo, et al
- Journal article citation:
- Age and Ageing, 50(5), 2021, pp.1464-1472.
- Publisher:
- Oxford University Press
Introduction: Reliable rapid testing for COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. This study aimed to examine the usability and test performance of a point of care polymerase chain reaction (PCR) test for detection of SARS-COV2 (POCKITTM Central) in care homes. Methods: POCKITTM Central was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and use errors were assessed. Results: No significant usability-related hazards emerged, and the sources of error identified were found to be amendable with minor changes in training or test workflow. POCKITTM Central has acceptable sensitivity and specificity based on RT-PCR as the reference standard, especially for symptomatic cases. Asymptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2%-99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932– 0.999). Symptomatic specimens showed 100% (95% CI: 2.5%-100%) positive agreement and 100% negative agreement (95% CI: 85.8%-100%), with overall PABAK of 1. Recommendations are provided to mitigate the frequency of occurrence of the residual use errors observed. Integration pathways were discussed to identify opportunities and limitations of adopting POCKIT™ Central for screening and diagnostic testing purposes. Conclusion: Point-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis. (Edited publisher abstract)
Delirium: a missing piece in the COVID-19 pandemic puzzle
- Authors:
- O’HANLON Shane, INOUYE Sharon K.
- Journal article citation:
- Age and Ageing, 49(4), 2020, pp.497-498.
- Publisher:
- Oxford University Press
This editorial argues that delirium is an important missing component in the assessment and management of older people for COVID-19. Guidelines should include delirium as a presenting feature, screening should be a standard of care, and non-pharmacological approaches for delirium prevention and management need to be implemented as early and often as possible. Resources to assist healthcare providers should be built into electronic medical records, order sets and protocols. Key points raised in this paper include: older people are most vulnerable to severe COVID-19 infections and mortality; current guidance for diagnosis does not routinely include delirium, which may lead to under-detection of COVID-19; the care home population is particularly at risk, as failure to promptly detect COVID-19 may lead to outbreaks; non-pharmacological approaches to management of delirium may be more difficult to implement but remain the priority. (Edited publisher abstract)
Content validity analysis of ISD-1: an instrument for social diagnosis in care homes for older persons
- Authors:
- CURY Silvia Patricia, ASTRAY Andres Arias, GOMEZ Jose Luis Palacios
- Journal article citation:
- European Journal of Social Work, 22(3), 2019, pp.526-540.
- Publisher:
- Taylor and Francis
This article presents the validity study for ISD-1 (Instrument for Social Diagnosis), designed to be used in the specialist field of intervention in care homes for older persons. The study has focused on the evidence regarding the validity of its content. The definition of the operative area of ISD-1 (social diagnosis in care homes), and its representativeness and relevance, are decisive aspects for its validity. Two validation procedures were used, with the participation of two independent groups of experts. Both procedures had the objective of obtaining a quantitative measure assessing the representation of the area and of the degree of association between the dimensions and the items of the instrument. This study suggests that there is a sufficient degree of evidence for the representativeness, relevance and usefulness of the content of ISD-1, meaning it may be considered a suitable instrument for the formulation of social diagnoses in care homes for older persons. (Edited publisher abstract)
A world of silence: the case for tackling hearing loss in care homes
- Author:
- ECHALIER Melissa
- Publisher:
- Action on Hearing Loss
- Publication year:
- 2012
- Pagination:
- 49
- Place of publication:
- London
Drawing of findings from visits to three care homes in England, this report explores carers’ and residents’ attitudes to hearing loss and how they manage it. Attributes particular to this setting, such as high levels of dementia and low levels of conversation, can work against residents recognising and taking action on their hearing loss. At the same time, the high incidence of other conditions, such as sight loss and dementia, mean that it’s extremely important that hearing loss is managed in these settings, as unmanaged hearing loss can make difficulties caused by such conditions much worse. Interviews and focus groups were carried out, and residents’ hearing screened to gauge how many people had hearing loss but had never been properly diagnosed. The research demonstrates that if care home residents’ hearing loss is managed effectively, there is a real chance of improving their quality of life but also identifies the worrying trend of hearing loss not being diagnosed and managed properly. The report sets out three major recommendations: intervene earlier in hearing loss; meet communication needs in care homes; and improve hearing aid use and management in care homes. (Edited publisher abstract)
Depression indicators in a national sample of older community and care home patients: applying the Quality and Outcomes Framework
- Authors:
- HARRIS Tess, et al
- Journal article citation:
- British Journal of General Practice, 61(583), February 2011, pp.135-138.
- Publisher:
- Royal College of General Practitioners
Depression is common and often under-recognised in older people, particularly care home residents and is associated with chronic health problems. The importance of detecting depression in these adults has been recognised by the UK Quality and Outcomes Framework (QOF) which rewards GPs for depression case finding in patients with diabetes and ischaemic heart disease. The objective of this study was to examine the use of case finding and assessment of depression in older community and care home patients. In a national primary care database sample of older people (65 years and over) depression screening was recorded in the last 15 months for 81% (83,588/103,821) of the community and 58% (1702/2940) of care home residents with diabetes or heart disease. Overall, 66% (1418/2145) of community and 22% (26/118) of care home residents with a new depression episode had a depression-severity assessment recorded. Age, sex, and higher care home dementia prevalence did not explain these differences. It appears that older people in general, and those in care homes in particular, are not being screened for depression or having their severity assessed as often as younger adults. The authors suggest that GPs need to consider how to improve their case finding in these groups, especially those in care homes, given their markedly increased risk of depression.
‘My Mum’s Story’: a Deaf daughter discusses her Deaf mother’s experience of dementia
- Authors:
- PARKER Jacqueline, YOUNG Alys, ROGERS Katherine
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 9(1), February 2010, pp.5-20.
- Publisher:
- Sage
This is the first person account of a daughter about her mother’s dementia. The story was signed to the writers in British Sign Language as the author is, and her mother was, Deaf (BSL users). A forward precedes the story in order to contextualise the significance of dementia and its effects for this community, focusing on; the problems of recognising dementia amongst deaf people; the paucity of diagnostic, care and support services; the different considerations for Deaf people approaching dementia as patient or carer; and the challenges to service providers and researchers. The personal story reflects these issues and describes the difficulty of accessing resources and funding, and finding appropriate care and staff that had the necessary skills and training to help Deaf people over 60 with dementia.
Risk indicators of depression in residential homes
- Authors:
- EISSES A. M. H., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.634-640.
- Publisher:
- Wiley
In a cross-sectional study risk indicators for depressive symptoms (Geriatric Depression Scale) were examined in bivariate and multivariate analyses, four hundred and seventy-nine elderly subjects from 11 residential homes took part in the study. Functional impairment, loneliness, higher education levels, a family history of depression and neuroticism are associated with depressive symptom. The risk indicators of depression found in residential homes are similar to those in the community.