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Responding to the Pandemic: Geriatric Care Models

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A topical collection in Geriatrics (ISSN 2308-3417).

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Dr. James S. Powers

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1. Professor of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
2. Clinical Associate Director, Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN 37232, USA
Interests: geriatrics education; long-term care; geriatric nutrition; frail elderly; quality improvement; geriatric care models
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Dear Colleagues,

I am delighted to edit this Topical Collection of Geriatrics focusing on “Responding to the Pandemic: Geriatric Care Models”. I invite you to contribute your innovative work focused on geriatric clinical care and caregiver support across the continuum of care.

Around the world, the coronavirus pandemic (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, COVID-19) has produced enormous economic, medical, political, and social changes. Older adults, especially those with chronic illness and residing in residential care facilities, have been disproportionately affected, accounting for over 50% of the mortality. Families, caregivers, medical systems, and support services have adapted processes to respond to this challenge. The responses to this crisis have created a defining time which will affect the provision of health care, as well as the attitudes and expectations of providers and society for decades to come. We are truly all in this together. The sharing of creative approaches to prevent, prepare, and respond to access, safety, and isolation in the care of older adults in response to the COVID pandemic is invited in this Topical Collection.

Potential contributors to this Topical Collection of Geriatrics may include investigators and participants in innovative models of care such as transitions of care models, telehealth programs, primary care, caregiver support, acute care for elderly units, person centered care, new payment and healthcare policy models, and quality assessment and performance improvement programs. Submissions with data and analyses are particularly welcome. Additionally, thoughtful descriptive proposals of best practices and new approaches to geriatric syndromes as well as the promotion of healthy aging and attitudes regarding aging and society, health policy concerns, and successful team-based and collaborative care models are welcome.

We hope you and your colleagues will be willing to submit your creative work for this exciting Topical Collection of Geriatrics. I look forward to hearing from you.

Dr. James S. Powers
Collection Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the collection website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

geriatric models of care
transitions of care
caregiver support
healthcare access
isolation
telehealth
health policy

Related Special Issue

Responding to the Pandemic: Geriatric Care Models in Geriatrics (24 articles)

Published Papers (12 papers)

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2023

Jump to: 2022, 2021, 2020

10 pages, 800 KiB

Open AccessArticle

Implementation of a Multicomponent Otago-Based Virtual Fall Reduction, Education, and Exercise Program (MOVing FREEly) in Older Veterans

by Katherine C. Ritchey, Amanda Olney, Sunny Chen, Erica Martinez, Michelle R. Paulsen, Jennifer Tunoa and James S. Powers

Geriatrics 2023, 8(6), 115; https://doi.org/10.3390/geriatrics8060115 - 28 Nov 2023

Viewed by 1668

Abstract

Purpose: The COVID-19 pandemic limited access to community fall prevention programs, thus establishing the need for virtual interventions. Herein, we describe the feasibility, effectiveness, and acceptability of a virtual, multicomponent fall prevention program (MOVing FREEly). Methods: A team of clinical falls prevention experts developed a six-week multicomponent fall prevention exercise and education class for older community-dwelling adults at risk of falling. Feasibility was measured through class attendance; effectiveness was measured through changes in performance measures, self-report of falling risk, and concern about falling; acceptability was assessed through questionnaires completed immediately upon program completion and at a three-month follow up. Results: A total of 32 patients participated in the MOVing FREEly program. Attendance for education and exercise classes on average was greater than 80% with little attrition. Patient reported reduced concern of falling, improvement in the falls efficacy scale—international (FES-I) short form, and had statistically significant improvement in 30 s sit-to-stand and single-leg balance tests. The program was well received by participants, saving them significant time and costs of travel. Conclusions: A virtual, multicomponent fall prevention program is feasible and acceptable and effective as reducing falling risk. Future studies can explore the ability of this program to reduce falling incident and injury. Full article

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12 pages, 258 KiB

Open AccessArticle

The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic

by Katherine Kortes-Miller, Maïa Natale, Kimberley Wilson and Arne Stinchcombe

Geriatrics 2023, 8(5), 90; https://doi.org/10.3390/geriatrics8050090 - 08 Sep 2023

Viewed by 1044

Abstract

Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners’ roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs. Full article

2022

Jump to: 2023, 2021, 2020

13 pages, 288 KiB

Open AccessFeature PaperArticle

The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine

by Julia Rozanova, Katherine M. Rich, Frederick L. Altice, Sheela V. Shenoi, Irina Zaviryukha, Tetiana Kiriazova, Elmira Mamedova, Oleksandr Shipunov, Volodymyr Yariy, Alexandra Deac and Oleksandr Zeziulin

Geriatrics 2022, 7(6), 138; https://doi.org/10.3390/geriatrics7060138 - 06 Dec 2022

Cited by 2 | Viewed by 2097

Abstract

Ukraine imposed a COVID-19 lockdown in March 2020. From April to June 2020, we surveyed 123 older people with HIV (OPWH) by phone to assess their mental health, engagement in HIV and other healthcare, and substance use using standardised scales. Variables of key interest were symptoms of depression and symptoms of anxiety. Univariate and multivariable Firth logistic regression models were built to assess factors associated with: (1) symptoms of depression, and (2) symptoms of anxiety. Findings indicated high suicidal ideation (10.6%); 45.5% met the screening criteria for moderate to severe depression; and 35.0% met the criteria for generalised anxiety disorder (GAD). Independent correlates of having moderate to severe depression included being female (AOR: 2.83, 95%CI = 1.19–7.05), having concerns about potential barriers to HIV treatment (AOR: 8.90, 95%CI = 1.31–104.94), and active drug use (AOR: 34.53, 95%CI = 3.02–4885.85). Being female (AOR: 5.30, 95%CI = 2.16–14.30) and having concerns about potential barriers to HIV treatment (AOR: 5.33, 95%CI = 1.22–28.45) were independently correlated with GAD, and over half (58.5%) were willing to provide peer support to other OPWH. These results highlight the impact of the COVID-19 restrictions in Ukraine on mental health for OPWH and support the need to screen for psychiatric and substance use disorders, potentially using telehealth strategies. Full article

17 pages, 292 KiB

Open AccessArticle

Experiences of Nurses in Nursing Homes during the COVID-19 Pandemic in Germany: A Qualitative Study

by Elisabeth Diehl, David Hiss, Aline Wege, Anna Hirschmüller, Albert Nienhaus and Stephan Letzel

Geriatrics 2022, 7(5), 94; https://doi.org/10.3390/geriatrics7050094 - 09 Sep 2022

Cited by 5 | Viewed by 2766

Abstract

(1) Background: The aim of this qualitative study was to examine pandemic-related changes in nursing work in nursing homes, the resulting work-related stresses and external as well as internal alleviating measures. (2) Methods: We conducted 10 interviews from March to June 2021 with nurses from eight facilities. Data were analysed according to qualitative content analysis. (3) Results: Nurses faced increased workloads due to regulations and guidelines paired with staffing shortages. Work became more difficult due to personal protective equipment (PPE), conflict with residents’ relatives and, in the case of outbreaks, excess death and suffering. Nurse-to-resident care work became more emotionally demanding, with residents more distressed due to the lockdown, while families and social workers were not allowed into the facility. Residents with dementia posed an additional challenge, as they did not remember hygiene and distancing rules. Internal and external measures were not sufficient to alleviate the situation. However, some measures, such as training programmes or existing palliative care concepts, were considered helpful. (4) Conclusions: Facing other possible upcoming pandemics, ways to improve facility administration to prepare for future pandemics are highly needed, such as regular training programmes to prepare for possible lockdown scenarios, PPE use or potential hygiene measures. Full article

11 pages, 610 KiB

Open AccessArticle

Comparative Outcomes and Surgical Timing for Operative Fragility Hip Fracture Patients during the COVID-19 Pandemic: A Retrospective Cohort Study

by Katherine A. Rowe, Kiryung Kim, Nathan H. Varady, Marilyn Heng, Arvind G. von Keudell, Michael J. Weaver, Ayesha Abdeen, Edward K. Rodriguez and Antonia F. Chen

Geriatrics 2022, 7(4), 84; https://doi.org/10.3390/geriatrics7040084 - 13 Aug 2022

Viewed by 1838

Abstract

The COVID-19 pandemic had wide-reaching effects on healthcare delivery, including care for hip fractures, a common injury among older adults. This study characterized factors related to surgical timing and outcomes, length-of-stay, and discharge disposition among patients treated for operative hip fractures during the first wave of the COVID-19 pandemic, compared to historical controls. A retrospective, observational cohort study was conducted from 16 March–20 May 2020 with a consecutive series of 64 operative fragility hip fracture patients at three tertiary academic medical centers. Historical controls were matched based on sex, surgical procedure, age, and comorbidities. Primary outcomes included 30-day mortality and time-to-surgery. Secondary outcomes included 30-day postoperative complications, length-of-stay, discharge disposition, and time to obtain a COVID-19 test result. There was no difference in 30-day mortality, complication rates, length-of-stay, anesthesia type, or time-to-surgery, despite a mean time to obtain a final preoperative COVID-19 test result of 17.6 h in the study group. Notably, 23.8% of patients were discharged to home during the COVID-19 pandemic, compared to 4.8% among controls (p = 0.003). On average, patients received surgical care within 48 h of arrival during the COVID-19 pandemic. More patients were discharged to home rather than a facility with no change in complications, suggesting an opportunity for increased discharge to home. Full article

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15 pages, 604 KiB

Open AccessArticle

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

by Leah M. Haverhals, Chelsea E. Manheim, Maya Katz and Cari R. Levy

Geriatrics 2022, 7(3), 66; https://doi.org/10.3390/geriatrics7030066 - 15 Jun 2022

Cited by 3 | Viewed by 3040

Abstract

The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic. Full article

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17 pages, 262 KiB

Open AccessArticle

Disaster Response in Italian Nursing Homes: A Qualitative Study during the COVID-19 Pandemic

by Barbara Plagg, Giuliano Piccoliori, Adolf Engl, Christian J. Wiedermann, Angelika Mahlknecht, Verena Barbieri, Dietmar Ausserhofer, Peter Koler, Sara Tauber, Manuela Lechner, Walter A. Lorenz, Andreas Conca and Klaus Eisendle

Geriatrics 2022, 7(2), 32; https://doi.org/10.3390/geriatrics7020032 - 17 Mar 2022

Cited by 1 | Viewed by 2168

Abstract

Nursing homes (NHs) have been among the care settings most affected by both the virus itself and collateral damage through infection protection and control measures (IPC). However, there is a paucity of research regarding disaster response and preparedness of these institutions. The present study aimed to analyze disaster response and management and to develop prospective strategies for disaster management in NHs. A qualitative survey including (i) residents, (ii) nursing staff, (iii) relatives of residents, and (iv) NHs’ medical leads was performed. Data were collected by 45 in-depth interviews. Our results indicate that the shift from resident-centered care towards collective-protective approaches led through the suspending of established care principles to an emergency vacuum: implementable strategies were lacking and the subsequent development of temporary, immediate, and mostly suboptimal solutions by unprepared staff led to manifold organizational, medical, and ethical conflicts against the background of unclear legislation, changing protocols, and fear of legal consequences. IPC measures had long-lasting effects on the health and wellbeing of residents, relatives, and professionals. Without disaster preparedness protocols and support in decision-making during disasters, professionals in NHs are hardly able to cope with emergency situations. Full article

2021

Jump to: 2023, 2022, 2020

8 pages, 365 KiB

Open AccessReview

Interventions against Social Isolation of Older Adults: A Systematic Review of Existing Literature and Interventions

by Jaya Manjunath, Nandita Manoj and Tania Alchalabi

Geriatrics 2021, 6(3), 82; https://doi.org/10.3390/geriatrics6030082 - 25 Aug 2021

Cited by 11 | Viewed by 6383

Abstract

Social isolation is widespread among older adults, especially those confined to living in nursing homes and long-term care facilities. We completed a systematic review evaluating the effectiveness of 20 interventions used to combat social isolation in older adults. A scoring mechanism based on the Joanna Briggs Appraisal Checklist was utilized to determine the quality of the studies. Searches were conducted in “MedLine”, “PubMed”, “PsycINFO” and “Aging and Mental Health”. Studies completed on group and person-centered interventions against social isolation were the highest quality as the social isolation experienced by older adults decreased after the intervention, and this effect continued in follow-up studies. Other interventions such as volunteering-based interventions also alleviated isolation; however, follow-up studies were not completed to determine long-term efficacy. Given the increase in social isolation faced by older persons during the pandemic, our review can be utilized to create effective interventions to reduce social isolation. Full article

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10 pages, 697 KiB

Open AccessArticle

The Impact of a Telehealth Intervention on Activity Profiles in Older Adults during the COVID-19 Pandemic: A Pilot Study

by Nathaniel Johnson, Adam Bradley, Lukus Klawitter, Jane Johnson, Lance Johnson, Grant R. Tomkinson, Kyle J. Hackney, Sherri Stastny, Diane K. Ehlers and Ryan McGrath

Geriatrics 2021, 6(3), 68; https://doi.org/10.3390/geriatrics6030068 - 30 Jun 2021

Cited by 6 | Viewed by 3038

Abstract

Background: Physical inactivity during the COVID-19 pandemic is a public health concern for older adults. Telehealth presents a safe platform for conducting health-related interventions that may have additional benefits such as widespread reach. Our pilot study sought to examine how a telehealth intervention changed activity profiles in older adults during the COVID-19 pandemic. Methods: There were n = 13 adults aged 70.6 ± 4.5 years that participated in a 6 week telehealth intervention during the COVID-19 pandemic. The didactic intervention contents were shared online, and participants worked with trained interviewers over the telephone to discuss physical activity. At baseline and post-intervention, the Multimedia Activity Recall for Children and Adults examined activity profiles, while accelerometry estimated time spent sedentary and in physical activity. Results: Relative to the baseline measures, there was an 88 min/day (95% confidence interval (CI): 39, 137) increase in computer time and 36 min/day (CI: 10, 62) reduction in time spent in active transport at post-intervention. Moderate-to-vigorous physical activity participation also increased by an estimated 2 min/day (CI: −21, 26) and 12 min/week (CI: −154, 180), but this trend was not statistically significant. Conclusion: We recommend that support be provided to older adults transitioning to telehealth, especially as migration to telehealth progresses. Full article

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29 pages, 676 KiB

Open AccessFeature PaperArticle

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

by Roger E. Thomas

Geriatrics 2021, 6(2), 48; https://doi.org/10.3390/geriatrics6020048 - 08 May 2021

Cited by 12 | Viewed by 4664

Abstract

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed. Full article

8 pages, 518 KiB

Open AccessFeature PaperArticle

COVID-19 Infection among Older People Admitted to Hospital: A Cross-Sectional Analysis

by Chiann Ni Thiam, Kejal Hasmukharay, Wan Chieh Lim, Chai Chen Ng, Gordon Hwa Mang Pang, Aimy Abdullah, Nor Izzati Saedon, Hui Min Khor and Terence Ong

Geriatrics 2021, 6(1), 25; https://doi.org/10.3390/geriatrics6010025 - 08 Mar 2021

Cited by 7 | Viewed by 3003

Abstract

(1) Background: Older people with COVID-19 infection report worse clinical outcomes. There is a paucity of local data and this study aimed to describe the clinical progression of older people admitted to a university hospital in Malaysia with COVID-19 infection. (2) Methods: Older people (≥60 years) admitted with COVID-19 infection confirmed with RT-PCR from 27 February 2020–25 May 2020 were included in this study. Data on patient characteristics, hospital treatment, and inpatient outcomes were collected via hospital-held electronic medical records. Analysis was done to describe the cohort and identify factors associated with inpatient mortality. (3) Results: 26 participants were included (mean age 76.2 years, female 57.7%). All had at least one comorbid condition and half were frail. About 19.2% had non-respiratory (atypical) symptoms; 23.1% had a severe disease that required intensive care unit monitoring; 46.2% were given COVID-19 targeted therapy. Inpatient mortality and overall complication rates were 23.1% and 42.3%, respectively. Delirium on presentation and lower Ct-value were associated with mortality. (4) Conclusions: Older people with COVID-19 infection have severe infection and poor hospital outcomes. Vigilant hospital care is necessary to address their multimorbidity and frailty, along with appropriate treatment for their infection. Full article

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2020

Jump to: 2023, 2022, 2021

11 pages, 260 KiB

Open AccessArticle

Acute Care of Older Patients with COVID-19: Clinical Characteristics and Outcomes

by Zara Steinmeyer, Sara Vienne-Noyes, Marc Bernard, Armand Steinmeyer, Laurent Balardy, Antoine Piau and Sandrine Sourdet

Geriatrics 2020, 5(4), 65; https://doi.org/10.3390/geriatrics5040065 - 27 Sep 2020

Cited by 20 | Viewed by 2987

Abstract

(1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (p = 0.03) and lymphopenia (p = 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality. Full article

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Responding to the Pandemic: Geriatric Care Models

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Published Papers (12 papers)

2023

Jump to: 2022, 2021, 2020

2022

Jump to: 2023, 2021, 2020

2021

Jump to: 2023, 2022, 2020

2020

Jump to: 2023, 2022, 2021

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