Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study

ObjectivesTo evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility in Japan.DesignCohort study.SettingA nationwide questionnaire survey across 3598 Roken in Japan in 2015 (up to five randomly selected residents per facility).ParticipantsThis study included 1201 residents from 343 Roken (response rate: 10%). We determined the presence and severity of dementia using a nationally standardised measure.Primary and secondary outcome measuresPrescriptions of PD and DAP at admission and 2 months after admission were evaluated. Multivariable logistic regression was used to evaluate the associations of residents’ baseline characteristics with prescriptions or discontinuation.ResultsPrescription rates decreased for antidementia drugs (19.4% to 13.0%), hypnotics (25.1% to 22.6%) and anxiolytics (12.3% to 10.7%), whereas those for other PD, such as antipsychotics (13.2% to 13.6%), antidepressants (7.4% to 6.7%), antiepileptic drugs (7.1% to 7.8%) and DAP (35.2% to 36.6%) did not statistically significantly decrease. Some factors were associated with the prescriptions, for example, for antipsychotics, older age (≥85 years) (adjusted OR (aOR), 0.60; 95% CI 0.43 to 0.85) and being bedridden (aOR 0.67; 95% CI 0.47 to 0.97) were associated with a lower use of antipsychotics, whereas severe dementia was associated with a higher use of antipsychotics (aOR 3.26; 95% CI 2.26 to 4.70). At an individual level, a quarter of residents prescribed PD or DAP at admission had discontinued at least one PD or DAP, respectively, 2 months after admission. Antidementia drug use in severe dementia (aOR 1.86; 95% CI 1.04 to 3.31) and PD use in older age (aOR 1.61; 95% CI 1.00 to 2.60; in residents with disabling dementia) were associated with discontinuation.ConclusionsThere is possible scope for deprescribing PD and DAP in Roken residents with dementia to mitigate the risks of adverse events.

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Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-020-1457-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Patience Moyo ◽

Andrew R. Zullo ◽

Kevin W. McConeghy ◽

Elliott Bosco ◽

Robertus van Aalst ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Long Term Care ◽

Care Facility ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility

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Centenarians and extremely old people living with frailty can elicit durable SARS-CoV-2 spike specific IgG antibodies with virus neutralization functions following virus infection

10.1101/2021.03.05.21252707 ◽

2021 ◽

Author(s):

Mary K. Foley ◽

Samuel D. Searle ◽

Ali Toloue ◽

Ryan Booth ◽

Alec Falkenham ◽

...

Keyword(s):

Long Term Care ◽

Age Groups ◽

Care Facility ◽

Older Age ◽

Virus Neutralization ◽

Term Care ◽

Long Term Care Facility ◽

Care Facilities ◽

Humoral Responses

AbstractBackgroundThe SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 114 million COVID-19 cases and >2.5 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities being affected by SARS-CoV-2 and COVID-19, very little is understood about the immune responses and development of humoral immunity in the extremely old person after SARS-CoV-2 infection. Here we investigated the development of humoral immunity in centenarians following a SARS-CoV-2 outbreak in a long-term care facility.MethodsExtreme aged individuals and centenarians who were residents in a long-term care facility and infected with or exposed to SARS-CoV-2 were investigated for the development of antibodies to SARS-CoV-2. Blood samples were collected from positive and bystander individuals 30 and 60 days after original diagnosis of SARS-CoV-2 infection. Plasma was used to quantify IgG, IgA, and IgM isotypes and subsequent subclasses of antibodies specific for SARS-CoV-2 spike protein. The function of anti-spike was then assessed by virus neutralization assays against the native SARS-CoV-2 virus.FindingsFifteen long-term care residents were investigated for SARS-CoV-2 infection. All individuals had a Clinical Frailty scale score ≥5 and were of extreme older age or were centenarians. Six women with a median age of 98.8 years tested positive for SARS-CoV-2. Anti-spike IgG antibody titers were the highest titers observed in our cohort with all IgG positive individuals having virus neutralization ability. Additionally, 5 out of the 6 positive participants had a robust IgA anti-SARS-CoV-2 response. In all 5, antibodies were detected after 60 days from initial diagnosis.InterpretationExtreme older frail individuals and centenarians were able to elicit robust IgG and IgA antibodies directed toward SARS-CoV-2 spike protein. The antibodies were able to neutralize the virus. Humoral responses were still detectable after 60 days from initial diagnosis. Together, these data suggest that recovered participants who are of extreme old age would be protected if re-exposed to the same SARS-CoV-2 viral variant. Considering the threat of SARS-CoV-2 and COVID-19 to older age groups and long-term care facilities, the humoral responses to SARS-CoV-2 in older age groups is of public health importance and has implications to vaccine responses.FundingCanadian Institutes of Health Research (CIHR), NIH/NIAID, Genome Atlantic. VIDO receives operational funding from the Canada Foundation for Innovation through the Major Science Initiatives Fund and by Government of Saskatchewan through Innovation Saskatchewan.

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Long-Term Care Facility Ownership and Acute Hospital Service Use in British Columbia, Canada: A Retrospective Cohort Study

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.04.034 ◽

2020 ◽

Vol 21 (10) ◽

pp. 1490-1496

Author(s):

Jeffrey Poss ◽

Kimberlyn McGrail ◽

Margaret J. McGregor ◽

Lisa A. Ronald

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Service Use ◽

Long Term Care ◽

Care Facility ◽

Acute Hospital ◽

Hospital Service ◽

Term Care ◽

Long Term Care Facility

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Risk Factors and Outcomes Associated with Community-Onset and Hospital-Acquired Co-infection in Patients Hospitalized for COVID-19: A Multi-Hospital Cohort Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.341 ◽

2021 ◽

pp. 1-28

Author(s):

Lindsay A. Petty ◽

Scott A. Flanders ◽

Valerie M. Vaughn ◽

David Ratz ◽

Megan O’Malley ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Care Facility ◽

Term Care ◽

Long Term Care Facility ◽

Mechanical Ventilation Duration ◽

Increased Risk ◽

Hospital Acquired ◽

Future Work ◽

Community Onset

Abstract Background: We sought to determine the incidence of community-onset and hospital-acquired co-infection in patients hospitalized with COVID-19 and evaluate associated predictors and outcomes. Methods: Multicenter retrospective cohort study of patients hospitalized for COVID-19, 3/2020 to 8/2020, across 38 Michigan hospitals assessed for prevalence, predictors, and outcomes of community-onset or hospital-acquired co-infection. In-hospital and 60-day mortality, readmission, discharge to long-term care facility (LTCF), and mechanical ventilation duration, were assessed for patients with vs. without co-infection. Results: Of 2205 patients with COVID-19, 6.4% (N=141) had a co-infection (3.0% community-onset, 3.4% hospital-acquired). 64.9% of patients without co-infection received antibiotics. Community-onset co-infection predictors include admission from LTCF (OR 3.98, 95% CI 2.34-6.76, p<0.001) and admission to intensive care (OR 4.34, 95% CI 2.87-6.55, p<0.001). Hospital-acquired co-infection predictors include fever (OR 2.46, 95% CI 1.15-5.27, p=0.02) and advanced respiratory support (OR 40.72, 95% CI 13.49-122.93, p<0.001). Patients with (vs. without) community-onset co-infection had longer mechanical ventilation (OR 3.31, 95% CI 1.67-6.56, p=0.001) and higher in-hospital (OR 1.90, 95% CI 1.06-3.40 p=0.03) and 60-day mortality (OR 1.86, 95% CI 1.05-3.29 p=0.03). Patients with (vs. without) hospital-acquired co-infection had higher discharge to LTCF (OR 8.48, 95%CI 3.30-21.76 p<0.001), in-hospital (OR 4.17, 95% CI 2.37-7.33, p=<.001) and 60-day mortality (OR 3.66, 95% CI 2.11-6.33, p=<.001). Conclusion: Despite community-onset and hospital-acquired co-infection being uncommon, most patients hospitalized with COVID-19 received antibiotics. Admission from LTCF and to ICU were associated with increased risk of community-onset co-infection. Future work should prospectively validate predictors of COVID-19 co-infection to facilitate antibiotic reduction.

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