This page gathers information about completed or ongoing research projects on COVID-19 and long-term care. If you would like to to contribute information about your project, please complete our online submission form.
CovId-19 and SOcial isoLATion in dEmentia care (ISOLATE): impact and needs of people with dementia, informal and professional caregiversOngoing
Contact: Mandy Visser https://www.lumc.nl/org/unc-zh/onderzoek/Kwaliteit-van-leven/ISOLATE-Covid-19socialeisolatiedementie/
Host institution: Leiden University Medical Center, Department PHEG
Project team: Dr. Mandy Visser, Dr Hanneke Smaling, Dr. Bram Tilburgs, Prof. Wilco Achterberg
Funding information: This research was supported by the Netherlands Organisation for Health Research and Development (ZonMw) grant number 50-56300-98-533
Project summary:
Social isolation due to COVID-19 restrictive measures appear to have a major influence on the well-being of people with dementia, informal caregivers, and professional caregivers. While loneliness and challenging behavior may increase in people with dementia, social support for informal caregivers is reduced and their burden increases. In addition, rules regarding physical distance and the use of personal protective equipment complicates the work of healthcare professionals.
This study investigates the impact of social isolation during the COVID-pandemic on home- and long-term care for people with dementia, informal caregivers, and professional caregivers. Interviews with 20 informal caregivers and 20 professional caregivers about their concerns, problems, and needs regarding dementia care and social well-being in times of social isolation will be conducted.
Journal article:
Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519
Expected outputs of the project will be:
- Insight into the concerns, problems, and needs of people living with dementia, informal caregivers, and professional caregivers in times of social isolation during the COVID-pandemic, in both home- and long-term care.
- Recommendations for policy that can be applied to home- and long-term care, aimed to optimize social-wellbeing for people with dementia, their informal caregivers, and professional caregivers during isolation.
Project website:https://www.lumc.nl/org/unc-zh/onderzoek/Kwaliteit-van-leven/ISOLATE-Covid-19socialeisolatiedementie/
PUBLICATIONS & OTHER OUTPUTS
Covid-19 Management In NUrsing homes by outbreak TEamS (MINUTES) study: qualitative analyses on the impact of the pandemic in nursing homes (part 1)Ongoing
Host institution: Leiden University Medical Center, University Medical Center Groningen
Project team: Lisa van Tol MSc, Dr. Margot de Waal, Dr. Monique Caljouw, Dr. Hanneke Smaling, Arno Doornebosch MSc, Wendy Meester MSc, Janneke Groothuijse MSc, Dr. Sarah Janus, Prof Sytze Zuidema, Prof. Wilco Achterberg
Funding information: This research was supported by the Ministry of Public Health Welfare and Sport, the University Network of the Care Sector Zuid-Holland (UNC-ZH), and the University Network for care for Older persons of the University Medical Center Groningen (UNO-UMCG).
Project summary:
Dutch long term care organizations (LTC’s) installed outbreak management teams (OT’s) to coordinate covid-19 infection prevention and control. These LTC’s and relevant national policy organizations such as the ministry of health expressed the need to share experiences from these OT’s in order to learn and be inspired from each other. OT meeting minutes are next a valuable data source to monitor the impact of Covid-19 in nursing homes and source for creative ideas to tackle the challenges that arise.
The aim of the “Covid-19 Management In NUrsing homes by crisis TEamS” (MINUTES) study is to describe the challenges, impact and the response of the Covid-19 pandemic in Dutch nursing homes.
Participating LTC’s representing over 500 nursing home locations shared their OT’s’ minutes for thematic analysis. Minutes described crisis management, isolation and beds, personal protective equipment and hygiene, personnel, testing, vaccination, visiting, and wellbeing of residents and informal caregivers.
Journal articles:
, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study
van Tol LS, Smaling HJA, Meetser W, et al: Distancing Measures and Challenges Discussed by COVID-19 Outbreak Teams of Dutch Nursing Homes: The COVID-19 MINUTES Study. doi.org/10.3390/ijerph19116570
Smeitink MMP, Smaling HJA, van Tol LS, et al: Activities for Residents of Dutch Nursing Homes during the COVID-19 Pandemic: A Qualitative Study. doi.org/10.3390/ijerph19095465
Other outputs:
- Insight into the challenges, impact and the response of the pandemic in nursing homes from the perspective of crisis management teams; Themes extracted from their minutes will be analyzed more in depth.
- From March 2020 to June 2021 on a weekly to triweekly basis thematic summary reports were shared with national policy institutes and participating organizations as policy input.
Project website:https://www.lumc.nl/org/unc-zh/onderzoek/Kwaliteit-van-leven/Corona-onderzoekVerpleeghuizen/
PUBLICATIONS & OTHER OUTPUTS
UNC-ZH-UNO-UMCG-Factsheet-Corona-in-Nursing-Homes-in-NL-Minutes.pdf (860.4 KB)
Mc-COVID19 - Coordination mechanisms in Coronavirus management between different levels of government and public policy sectors in 15 European countriesOngoing
Contact: Francisco Javier Moreno Fuentes https://www.mc-covid.csic.es/english-version
Host institution: Institute of Public Goods and Policies, Spanish National Research Council (CSIC)
Project team: Project Coordinators o Eloísa del Pino o Francisco Javier Moreno Fuentes Research Team (alphabetical order) o Gibrán Cruz-Martínez o Jorge Hernández-Moreno o Luis Moreno o Manuel Pereira-Puga o Roberta Perna International team o Austria - Monika Riedel, Institute for Advanced Studies o Belgium - Jozef Pacolet, Research Institute for Work and Society, KU Leuven o Denmark - Tine Rostgaard, Roskilde University o Finland - Tyyne Ylinen, Vera Ylinen, Laura Kalliomaa-Puha, and Satu Ylinen. Tampere University & Social Insurance Institution of Finland - Kela o France - Arnaud Campéon, Blance Le Bihan, Michel Legros, and Claude Martin. EHESP French School of Public Health and CNRS. o Germany - Caspar Lückenbach, Eduard Klukas, Phillip Florian Schmidt and Thomas Gerlinger. Bielefeld University o Greece - Costis Prouskas, and Michael Goudoumas. Aktios SA o Ireland - Sara Burke, and Eimir Hurley. Centre for Health Policy and Management, Trinity College Dublin o Italy - Costanzo Ranci, and Marco Arlotti. Politecnico di Milano o Luxembourg - Robert Urbé. o Netherlands - María Bruquetas-Callejo, and Anita Böcker. Radboud University Nijmegen o Portugal - Luis Capucha, Nuno Nunes, and Alexandre Daniel Calado. Center for Research and Studies in Sociology (CIES-IUL) o Sweden - Lennarth Johansson (1) and Pär Schön (2). (1) Jönköping University, and Stockholm Gerontology Research Center. (2) Aging Research Center, Stockholm University, Karolinska Institutet o United Kingdom - England - Caroline Glendinning. University of York (emeritus).
Funding information: The Mc-COVID19 project has received funding from the Spanish National Research Council (CSIC) within the framework of the CSIC-COVID-19 program.
Project summary:
The Mc-COVID 19 project is set to analyse the socio-sanitary co-ordination procedures in the context of institutionalized older-age care (age group that appears particularly vulnerable in this epidemic context), in Spain as well as in the rest of the EU-15. This study focuses on the articulation of resources between health and social policies, and aim to contribute to improve the effectiveness of the decision-making process and crucial aspects in the fight against the pandemic. To better understand what happened in these centres and facilitate policy learning, this study identifies the difficulties faced by institutional actors and nursing homes’ managers between January and August 2020. To this end, the research team conducted 25 in-depth interviews with managers in such centres (directors, administrators, and medical supervisors) in various Spanish regions (Comunidades Autónomas). In addition, the research group interviewed high-ranking officials responsible for both social services and public healthcare at the central and regional levels, and representatives of the trade unions and the employers’ associations of the nursing homes. Furthermore, the team examined documents issued by governmental and independent sources, together with the results of a survey elaborated by the Institute for the Older-age and Social Services (IMSERSO) of the Ministry of Health. Findings aim to be useful to inform other public policy sectors involved in crisis-related situations.
- 6 October 2020 – First report on Spain (Spanish)
- Eloísa del Pino, Francisco Javier Moreno-Fuentes, Gibrán Cruz-Martínez, Jorge Hernánez-Moreno, Luis Moreno, Manuel Pereira-Puga, Roberta Perna (2020)Informe Gestión Institucional y Organizativa de las Residencias de Personas Mayores y COVID-19: dificultades y aprendizajes. Instituto de Políticas y Bienes Públicos (IPP-CSIC)Madrid. http://dx.doi.org/10.20350/digitalCSIC/12636
- 6 October 2020 – Executive Summary of the first report (English version) https://drive.google.com/file/d/1clo_SLmygv4BJPo8ptvN02NXJHc217oo/view
- A summary of the first report is also available here: https://ltccovid.org/2020/11/19/what-went-wrong-and-what-could-be-learned-from-the-institutional-and-organizational-management-of-care-homes-during-the-covid-19-pandemic-in-spain/
- 10 case studies have been published already: https://www.mc-covid.csic.es/english-version/publications and 5 more are expected to be published on the first trimester of 2021
- A comparative report highlighting the experiences, difficulties and lessons learned in 15 EU countries – expected to be published on the first trimester 2021.
Project website:https://www.mc-covid.csic.es/english-version
PUBLICATIONS & OTHER OUTPUTS
Prioritizing measures taken: Covid-19 Management In NUrsing homes by outbreak TEamS (MINUTES) follow-up study (Part 2)Ongoing
Host institution: Leiden University Medical Center, University Medical Center Groningen
Project team: Lisa van Tol MSc, Dr. Sarah Janus, Janneke Groothuijse MSc, Wendy Meester MSc, Dr. Monique Caljouw, Dr. Hanneke Smaling, Prof Sytze Zuidema, Prof. Wilco Achterberg
Funding information: This research was supported by the Ministry of Public Health Welfare and Sport, the University Network of the Care Sector Zuid-Holland (UNC-ZH), and the University Network for care for Older persons of the University Medical Center Groningen (UNO-UMCG).
Project summary:
Dutch long term care organizations installed outbreak teams to coordinate covid-19 infection prevention and control. Outbreak teams’ minutes described a large amount of divers measures that were taken.
The aim of this follow-up study on the “Covid-19 Management In NUrsing homes by crisis TEamS” (MINUTES) study is to prioritize measures taken and to reflect upon decision making by OTs.
Panels of 4 to 7 multidisciplinary nursing home professionals (managers, physicians, nurses, support services, client representatives..) selected, discussed and prioritized measures they found important and urgent with Covid-19 outbreaks. We organized separate panels about measures regarding isolation, residents’ wellbeing, and staff.
Expected outputs of the projects will be:
- Prioritized measures by multidisciplinary professionals. These important and urgent measures could be recommended to other LTCs.
- Insight into decision making by outbreak management teams
- Preliminary factsheets are shared with national policy institutes and participating organizations as policy input, and freely available on our website.
Project website:https://www.lumc.nl/org/unc-zh/onderzoek/Kwaliteit-van-leven/Corona-onderzoekVerpleeghuizen/
PUBLICATIONS & OTHER OUTPUTS
UNC-ZH-UNO-UMCG-Factsheet-Corona-in-Nursing-Homes-in-the-NL_Panels.pdf (776.9 KB)
The COVID-19 outbreak in the nursing home sector – does ownership matter?Ongoing
Contact: Florien Kruse https://betaalbaarheidvanzorg.nl/en/about
Host institution: Radboud Medical Centre, IQ healthcare
Project team: Amy Hsu (Canada) Marcello Marciano (England) Stephen Allan (England) Elizabeth Lemmon (Scotland) David Bell (Scotland) Maria Aurora Fenech (Malta) Sara Charlesworth (Australia) Patrick Jeurissen (The Netherlands) Adelina Comas-Herrera
Funding information: Not funded
Project summary:
This research project focuses on whether ownership is relevant to the severity of COVID-19 outbreaks in the nursing home sector. It carries the title ‘The COVID-19 outbreak in the nursing home sector – does ownership matter?’
This research consists of (at least) two parts. Firstly, it will provide a rapid review of the evidence available on this topic. Secondly, this project will follow a case-study approach to embed the findings in their respective national context. This part of the research project will be our main contribution. We will use input from various countries (e.g. Canada and Australia) to draw conclusions. If there is sufficient data, we will analyse the relationship between the composition of the long-term care sector (i.e. for-profit providers’ share of total beds in nursing homes and/or number of homes) and the share of COVID-19 deaths in the long-term care sector across different countries.
January/February 2021
PUBLICATIONS & OTHER OUTPUTS
Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid reviewComplete
Host institution: Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
Project team: Jan M Stratil Renke L Biallas Jacob Burns Laura Arnold Karin Geffert Angela M Kunzler Ina Monsef Julia Stadelmaier Katharina Wabnitz Tim Litwin Clemens Kreutz Anna Helen Boger Saskia Lindner Ben Verboom Stephan Voss Ani Movsisyan
Funding information: Federal Ministry of Education and Research of Germany, Germany This rapid review is conducted as part of the project COVID?19 evidence eco-system ("COVID-19 Evidenzökosystem" (CEO-sys)) under a funding scheme issued by the National Research Network of University Medical Centers on COVID-19 (Nationales Forschungsnetzwerk der Universitätsmedizin zu Covid-19) by the Federal Ministry of Education and Research of Germany (Bundesministerium für Bildung und Forschung, BMBF).
Project summary:
Overview
This project is a Cochrane rapid review focusing on the effects of non-pharmacological interventions implemented in LTCFs to prevent SARS-CoV-2 infections and their consequences.
Objectives
To assess the effects of non-pharmacological measures implemented in long-term care facilities to prevent or reduce the transmission of SARS-CoV-2 infection among residents, staff, and visitors.
Search methods
Systematic literature review with data base searches in the Cochrane COVID-19 Study Register, WHO COVID-19 Global literature on coronavirus disease, Web of Science, and CINAHL in combination with backward citation searches of existing reviews.
Type of studies
In the review, we included experimental, quasi-experimental, observational and modelling studies that assessed the effects of the measures implemented in long?term care facilities to protect residents and staff against SARS-CoV-2 infection.
Interventions of interest
- Entry regulation measures to prevent residents, staff or visitors introducing the virus into the facility.
- Contact-regulating and transmission-reducing measures to prevent people passing on the virus within the facility.
- Surveillance measures designed to identify an outbreak early.
- Outbreak control measures to reduce the consequences of an outbreak.
- A combination of these measures
Outcomes of interest
Primary outcomes were infections, hospitalisations and deaths due to COVID-19, contaminations of and outbreaks in long-term care facilities, and adverse health effects.
Data collection and analysis
Two review authors independently screened titles, abstracts and full texts. One review author performed data extractions, risk of bias assessments and quality appraisals, and at least one other author checked their accuracy. Risk of bias and quality assessments were conducted using the ROBINS-I tool for cohort and interrupted?time?series studies, the Joanna Briggs Institute (JBI) checklist for case-control studies, and a bespoke tool for modelling studies. We synthesised findings narratively, focusing on the direction of effect. One review author assessed certainty of evidence with GRADE, with the author team critically discussing the ratings.
Summary
The protocol of the Cochrane Review was published in May 2021. A first version of the review was published in September 2021.
In end of September, the work on an update of the review began, with an update expected by the end of the year.
Main results
We included 11 observational studies and 11 modelling studies in the analysis. All studies were conducted in high-income countries.
Most studies compared outcomes in long-term care facilities that implemented the measures with predicted or observed control scenarios without the measure (but often with baseline infection control measures also in place). Several modelling studies assessed additional comparator scenarios, such as comparing higher with lower rates of testing.
There were serious concerns regarding risk of bias in almost all observational studies and major or critical concerns regarding the quality of many modelling studies. Most observational studies did not adequately control for confounding. Many modelling studies used inappropriate assumptions about the structure and input parameters of the models, and failed to adequately assess uncertainty.
Overall, we identified five intervention domains, each including a number of specific measures.
Entry regulation measures (4 observational studies; 4 modelling studies)
Self-confinement of staff with residents may reduce the number of infections, probability of facility contamination, and number of deaths. Quarantine for new admissions may reduce the number of infections. Testing of new admissions and intensified testing of residents and of staff after holidays may reduce the number of infections, but the evidence is very uncertain. The evidence is very uncertain regarding whether restricting admissions of new residents reduces the number of infections, but the measure may reduce the probability of facility contamination. Visiting restrictions may reduce the number of infections and deaths. Furthermore, it may increase the probability of facility contamination, but the evidence is very uncertain. It is very uncertain how visiting restrictions may adversely affect the mental health of residents.
Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies)
Barrier nursing may increase the number of infections and the probability of outbreaks, but the evidence is very uncertain. Multicomponent cleaning and environmental hygiene measures may reduce the number of infections, but the evidence is very uncertain. It is unclear how contact reduction measures affect the probability of outbreaks. These measures may reduce the number of infections, but the evidence is very uncertain. Personal hygiene measures may reduce the probability of outbreaks, but the evidence is very uncertain.
Mask and personal protective equipment usage may reduce the number of infections, the probability of outbreaks, and the number of deaths, but the evidence is very uncertain. Cohorting residents and staff may reduce the number of infections, although evidence is very uncertain. Multicomponent contact-regulating and transmission-reducing measures may reduce the probability of outbreaks, but the evidence is very uncertain.
Surveillance measures (2 observational studies; 6 modelling studies)
Routine testing of residents and staff independent of symptoms may reduce the number of infections. It may reduce the probability of outbreaks, but the evidence is very uncertain. Evidence from one observational study suggests that the measure may reduce, while the evidence from one modelling study suggests that it probably reduces hospitalisations. The measure may reduce the number of deaths among residents, but the evidence on deaths among staff is unclear.
Symptom-based surveillance testing may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain.
Outbreak control measures (4 observational studies; 3 modelling studies)
Separating infected and non-infected residents or staff caring for them may reduce the number of infections. The measure may reduce the probability of outbreaks and may reduce the number of deaths, but the evidence for the latter is very uncertain. Isolation of cases may reduce the number of infections and the probability of outbreaks, but the evidence is very uncertain.
Multicomponent measures (2 observational studies; 1 modelling study)
A combination of multiple infection-control measures, including various combinations of the above categories, may reduce the number of infections and may reduce the number of deaths, but the evidence for the latter is very uncertain.
Authors’ conclusions
This review provides a comprehensive framework and synthesis of a range of non?pharmacological measures implemented in long?term care facilities. These may prevent SARS-CoV-2 infections and their consequences. However, the certainty of evidence is predominantly low to very low, due to the limited availability of evidence and the design and quality of available studies. Therefore, true effects may be substantially different from those reported here.
Overall, more studies producing stronger evidence on the effects of non?pharmacological measures are needed, especially in low- and middle-income countries and on possible unintended consequences of these measures. Future research should explore the reasons behind the paucity of evidence to guide pandemic research priority setting in the future
Project website:https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015085.pub2/full
PUBLICATIONS & OTHER OUTPUTS
Stratil_2021_NPI-LTCF_CD015085.pdf (2.9 MB)
Stratil_et_al-2021-Cochrane_Database_of_Systematic_Reviews.pdf (917.2 KB)