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A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19
Open accessPublished version of a preprint
Abstract
OBJECTIVES: The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. SETTING: Long-term care facilities. PARTICIPANTS: Residents, staff and visitors of facilities. PRIMARY AND SECONDARY OUTCOME MEASURES: Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. RESULTS: The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents. CONCLUSIONS: Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF. PROSPERO REGISTRATION NUMBER: CRD42020191569.
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“Larger care homes, those who used more agency staff, transferred staff between settings, tested less for COVID19 and had less access to personal protective equipment (PPE) had higher levels of infection and mortality.(557)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [557]
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Metadata
- Authors
- Frazer, K., Mitchell, L., Stokes, D., Lacey, E., Crowley, E., & Kelleher, C. C.
- Affiliations
- University College Dublin (IE)
- Corresponding author
- Mitchell, Lachlan
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-10
- Volume
- 11
- Issue
- 10
- Pages
- e047012
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8523961
- OpenAlex
- W3207561172
- Cited by
- 70
- References
- 57
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 17 · 2023: 21 · 2022: 14 · 2021: 9
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (acceptedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Research Repository UCD (University College Dublin) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Keywords
- COVID-19 pandemic, long-term care facilities, nursing homes, infection control, transmission prevention, personal protective equipment, large-scale testing, visitor restrictions, hand hygiene, droplet precautions, cohorting, staff infection, facility size
- MeSH terms
- COVID-19, SARS-CoV-2, Aged, Humans, Long-Term Care, Nursing Homes, Pandemics
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