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Document Type
Evidence Search Report
Review Code
LTC042201-01 ESR
Question Submitted
April 22, 2020
Date Completed
24-Apr-2020
Status
3. Completed
Research Team
Long Term Care
.full.pdf Journal articles 1. Nursing home rules 'won't shield elderly'. Lamp. 2020;77(2):25
Document Type
Evidence Search Report
Review Code
LTC042201-01 ESR
Question Submitted
April 22, 2020
Date Completed
24-Apr-2020
Status
3. Completed
Research Team
Long Term Care
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
· Overall, there is a lack of high quality evidence to support recommended pandemic preparedness strategies (checklist items) to prevent or mitigate respiratory infection outbreaks in LTC. · In the absence of high-quality or mixed evidence to support strategies for pandemic preparedness, it is advisable to follow clinical practice guideline recommendations that have been based on expert opinion (key sources are identified in red). This is particularly the case for infection control interventions that are likely to have no negative impacts on LTC residents (e.g. hand hygiene, cough etiquette). Strategies that have a potential negative impact on LTC residents (e.g. visitor restrictions) must be handled with more flexibility and individual assessment to determine how infection control can be preserved while minimizing negative consequences for residents and families. · Internationally recognized pandemic/outbreak preparedness checklists for LTC (e.g. CDC 2020, Buynder et al. 2017) share many similarities to the current SHA Annex R checklists. · Consideration should be given to converting the checklist into a planner with accountabilities to demonstrate how each item is being addressed (similar to CDC 2020). Links can be embedded in the planner/checklist to more detailed information, such as the PPE burn calculator (CDC 2020), education/training materials (WHO 2020), and communication materials for families (CDC 2020, WHO 2020, Buynder et al. 2017). · Consider the addition of specific detail to the SHA pandemic preparedness checklists on the date of the next pandemic plan/checklist review, contact names for local resource acquisition or assistance with staffing, tracking forms for dates of education/training with staff and residents, tracking of audits/observation of infection control practices, surge capacity planning items, and expanded items for communication (see attached recommendations from family caregivers of the Saskatchewan LTC Network). · Discrepancies exist between reported (77-100%) and observed (25-63%) adherence to infection control practices, indicating a need for independent audits. Adherence rates improve with direct observation, frequent education reminders and prompts. · Even when there is not an outbreak in a home, the pandemic response results in increased workload demands on staff due to infection control practices (e.g. PPE and hand hygiene), loss of family caregiver assistance with resident care, enhanced care needs of residents due to anxiety, increased communication with family caregivers and other members of the care team, monitoring and restricting resident movement in the home, enhanced cleaning, staff absenteeism, and education/training. Consideration is needed for a provincial process for evaluation of needs within individual homes, and allocation of additional human resources, disposable supplies, equipment, or funding to ensure that both infection control and usual care needs of residents are consistently met. · Maintaining public confidence through communication is a defined infection control strategy. Communication strategies include individual communication between family members and staff, public communication strategies by individual facilities and provincially through dedicated pandemic information pertaining to LTC (e.g. dedicated LTC section on provincial websites).
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
EOC100801-01 ESR
Question Submitted
October 8, 2020
Date Completed
October 13, 2020
Status
3. Completed
Research Team
EOC
Document Type
Evidence Search Report
Review Code
EOC100801-01 ESR
Question Submitted
October 8, 2020
Date Completed
October 13, 2020
Status
3. Completed
Research Team
EOC
Category
Administration
Subject
Risk
Elderly
Facilities
Health Personnel
Population
Aged (80+)
Clinical Setting
Community
Primary care
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Miller, L; Mueller, M. What are the age restrictions for healthcare workers/volunteers? 2020 Oct 13; Document no.: EOC100801-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 5 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
EOC100801 RR
Question Submitted
October 8, 2020
Date Completed
October 19, 2020
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC100801 RR
Question Submitted
October 8, 2020
Date Completed
October 19, 2020
Status
3. Completed
Research Team
EOC
Key Findings
· Well established that older individuals, particularly those with pre-existing conditions are at increased risk of severe disease and/or complications with SARS-CoV-2 infection, and volunteers should take this into consideration · No other evidence specific to healthcare workers or volunteers to guide age restriction policies
Category
Administration
Subject
Risk
Elderly
Facilities
Health Personnel
Population
Aged (80+)
Clinical Setting
Community
Primary care
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Badea, A; Groot, G; Miller, L; Mueller, M. What are the age restrictions for healthcare workers/volunteer? 2020 Oct 19; Document no.: EOC100801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 8 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
LTC042201-03 ESR
Question Submitted
April 22, 2020
Date Completed
April 28, 2020
Status
3. Completed
Research Team
Long Term Care
are affected by the COVID-19 pandemic, the elderly, underrepresented minorities, and those with underlying
Document Type
Evidence Search Report
Review Code
LTC042201-03 ESR
Question Submitted
April 22, 2020
Date Completed
April 28, 2020
Status
3. Completed
Research Team
Long Term Care
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Elderly
Long Term Care
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Ellsworth, C. What characteristics of residents in LTC homes affect the ability to provide routine care during a COVID-19 or ILI outbreak? 2020 Apr 28; Document no.: LTC042201-03 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 5 p. (CEST evidence search report)
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Document Type
Evidence Search Report
Review Code
LTC060201-01 ESR
Question Submitted
June 2, 2020
Date Completed
June 8, 2020
Status
3. Completed
Research Team
Long Term Care
QUESTION: Case definition (signs and symptoms) for COVID-19 in the elderly UNIQUE IDENTIFIER: LTC060201
Document Type
Evidence Search Report
Review Code
LTC060201-01 ESR
Question Submitted
June 2, 2020
Date Completed
June 8, 2020
Status
3. Completed
Research Team
Long Term Care
Category
Clinical Presentation
Healthcare Services
Subject
Symptoms
Screening
Elderly
Priority Level
Level 4 completed within 1 week
Cite As
Dalidowicz, M; Ellsworth, C. What is the case definition for COVID-19 in elderly people? 2020 Jun 8; Document no.: LTC060201-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 43 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
LTC060201 RR
Question Submitted
June 2, 2020
Date Completed
June 12, 2020
Status
3. Completed
Research Team
Long Term Care
Review Title: What is the case definition for COVID-19 in elderly people? Keyword Title: Signs
Document Type
Rapid Review
Review Code
LTC060201 RR
Question Submitted
June 2, 2020
Date Completed
June 12, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
Clinical Presentation, Laboratory Findings, Imaging:
Signs and symptoms of COVID-19 are categorized as constitutional, respiratory, gastrointestinal, neurological, laboratory, imaging, and other.
Constitutional signs and symptoms include fever (Median=80% prevalence on cross-sectional retrospective chart reviews; range 30-98%), fatigue (M=41%; range 8-81%), myalgia or arthralgia (M=31%; range 5-63%), headache (M=9%; range 6-70%), sore throat (M=19%; range 11-53%), weight loss (M=31%; 23-50%), and hypotension (31%; Aggarwal et al., 2020).
Respiratory symptoms include cough (M=63%; range 33-88%), nasal congestion (M=41%; range 14-68%), rhinorrhea (M=7%; range 5-60%), dyspnea (M=53%; range 5-88%), phlegm (M=28%; range 18-40%), hemoptysis (5%; Xu et al., 2020) and chest tightness (M=40%; range 23-64%).
Gastrointestinal (GI) signs and symptoms include nausea and vomiting (M=14%; range 2-22%), diarrhea (M=18%; range 3-35%), and low appetite (M=21%; range 12-63%).
Approximately 36% of COVID-19+ patients present with neurological signs and symptoms which may include delirium, confusion, hallucinations, dizziness, seizure, or loss of senses of smell or taste. Presence of neurological findings is indicative of a worse outcome (Chen et al. 2020).
Abnormal laboratory findings are more common in older patients (Chen et al., 2020) and may include elevated C-reactive protein and erythrocyte sedimentation rate, lymphopenia, elevated D-dimer, leukopenia, elevated lactate dehydrogenase, lower white blood cell count, lower oxygen saturation (=94% or supplemental oxygen required), and hyponatremia (Duan et al., 2020; Ihle-Hansen, et al.2020; Xu et al., 2020; Fu et al., 2020).
The majority of COVID-19 + patients have abnormal imaging findings including multiple mottling and ground glass opacities (GGO) on chest CT scan. Bilateral pneumonia is present in between 73-98% of adults in critical care (Fu et al., 2020; Du et al., 2020).
Other signs and symptoms observed in LTC home residents with dementia include increased falls, change in behavior from the previous shift, more unsettled, and increased wandering (Ihle-Hansen et al., 2020).
The majority of patients (63%) of all ages present with symptoms that have lasted between 4 and 7 days (Buckner et al. 2020; Ihle-Hansen et al., 2020; Lin et al., 2020).
See Table 2 for a summary of infrequent (<10%), frequent (20-50%), and very frequent (>60%)clinical manifestations, laboratory test abnormalities and radiographic findings from a paper by Bonanad et al. 2020. Screening and Testing Considerations:
Although 90.5% of COVID-19 + patients of all ages present with cough, fever, and/or breathlessness (Baker et al., 2020), screening for typical symptoms alone will fail to identify approximately half of those with COVID-19 who are elderly, particularly those with frailty and other co-morbidities (Kimball et al., 2020).
The majority of recommendations favour a more sensitive threshold for fever detection in older adults, i.e. 37.5°C or an increase of >1.5°C from usual temperature (Holroyd-Leduc et al., 2020).
Screening of older adults or those with comorbidities should include supplemental questions to determine if atypical symptoms are present such as fatigue, myalgias, headache, conjunctivitis, tachycardia, hypotension, and hypoxia. Presence of atypical symptoms should trigger COVID testing.
Tools developed by the Ontario Ministry of Health (2020) and Alberta Health Services (2020) may be useful guides for healthcare provider screening of individuals at higher risk of COVID-19 infections (i.e. frail older adults with comorbidities).
Prioritization of mass testing should be for those with atypical presentations. Specifically, testing should be commenced first for older adults with changes in delirium, unexplained or increased numbers of falls, weight loss, change in appetite, acute functional decline, or worsening chronic conditions (ON Ministry of Health COVID Screening Guide, 2020).
Category
Clinical Presentation
Healthcare Services
Subject
Symptoms
Screening
Elderly
Priority Level
Level 4 completed within 1 week
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Ellsworth, C. What is the case definition for COVID-19 in elderly people? 2020 Jun 12; Document no.: LTC060201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 39 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
LTC090801-01 ESR
Question Submitted
September 8, 2020
Date Completed
October 2, 2020
Status
3. Completed
Research Team
Long Term Care
) ARTICLES Note: References are sorted by year (newest to oldest) 1. Ahc M. Discharging Elderly
Document Type
Evidence Search Report
Review Code
LTC090801-01 ESR
Question Submitted
September 8, 2020
Date Completed
October 2, 2020
Status
3. Completed
Research Team
Long Term Care
Category
Infection Prevention and Control
Administration
Subject
Facilities
Self-Isolation
Long Term Care
Health Planning
Elderly
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 5 completed within 2 weeks
Cite As
Mueller, M; Young, C. What is the evidence for a 14 day isolation period upon move-in to a continuing care environment during the COVID-19 pandemic? 2020 Oct 2; Document no.: LTC090801-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 29 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
No evidence was found as rationale for the 14-day isolation period on resident transition to LTC. This requirement likely arose from evidence that active monitoring for 14 days is sufficient to identify symptom onset in 99% of COVID-19+ cases (1).
No alternatives were found in Canada to a 14-day isolation period on transition of a resident into LTC. A rapid review of viral shedding and the need for isolation recommends a minimum 10-day isolation period, with additional consideration for high risk groups (36). The Centers for Disease Control and Prevention (2) in the US is considering decreasing the standard 14-day quarantine period to 7-10 days in recognition that the general two-week quarantine rule is onerous for many people and most of the benefit of quarantine to public health could be gained with a more flexible and contextual approach. Implications for changes in Public Health Agency of Canada’s (PHAC) policy on quarantine or duration of isolation for admission to LTC are not yet established.
The Canadian policies at the provincial government levels align with the PHAC’s recommendation of 14 days of isolation (14). Most jurisdictions across Canada follow guidelines requiring a resident to have a negative test on admission, and 14 days of self-isolation with contact and droplet precautions (4, 17).
However, a few jurisdictions stratify the level of precaution or need for isolation by community transmission (3, 5). For example, the Province of Alberta’s (5) Operational and Outbreak Standards for LTC recommends the following safety precaution: for residents with low or unknown risk of exposure, twice daily symptom checks for 14 days; for residents with medium risk, continuous use of a mask for 14 days while out of resident room; for residents with high risk, quarantine for 14 days. Best practices on transition to LTC to support residents’ well-being
Some Canadian policies state the importance of protecting resident well-being on transition to LTC but provide little guidance on how to ensure this is done. For residents who might find self-isolation challenging (e.g. those with cognitive challenges), Government of New Brunswick (18) recommends taking efforts to ensure adequate staffing level and support residents’ individualized care plan.
Residents in LTC who have cognitive impairments will have difficulties understanding the need for isolation and absence of families and friends, and complying with isolation procedures (31). There is little guidance for long-term care facilities on how to support safe isolation of those living with cognitive impairments, while maintaining the human dignity and personhood of the individual. Strategies need to be developed to have an isolation care planning that is effective, safe, and compassionate (31).
Maintaining connections between residents and their families should be supported under safety, socio-emotional, and ethical grounds (39). Several provinces and international jurisdictions designate Essential Family Caregivers (EFCs), who are present not for social visits but to provide services and brought into the facilities under the same specific protocols as staff (39, 49, 50, 51).
Category
Infection Prevention and Control
Administration
Subject
Facilities
Self-Isolation
Long Term Care
Health Planning
Elderly
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 5 completed within 2 weeks
Cite As
Gao, Y; Ward, H; Tupper, S; Boden, C; Miller, L; Mueller, M. What is the evidence for 14-day isolation upon move-in to long-term care during COVID-19 pandemic? 2020 Dec 13; Document no.: LTC090801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
LTC060202-01 ESR
Question Submitted
June 2, 2020
Date Completed
June 12, 2020
Status
3. Completed
Research Team
Long Term Care
of digging for information specific to the elderly population. There was only a few articles that did
Document Type
Evidence Search Report
Review Code
LTC060202-01 ESR
Question Submitted
June 2, 2020
Date Completed
June 12, 2020
Status
3. Completed
Research Team
Long Term Care
Category
Epidemiology
Healthcare Services
Subject
Clinical Presentation
Transmission
Infection Prevention and Control
Elderly
Priority Level
Level 5 completed within 2 weeks
Cite As
Dalidowicz, M; Ellsworth, C. What is the incubation period, rate of spread, and duration of infectivity of COVID-19 in older adults? 2020 Jun 12; Document no.: LTC060202-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 25 p. (CEST evidence search report)
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11 records – page 1 of 2.