Depression in older adults during the COVID-19 pandemic: A systematic review

Background

Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID-19 pandemic.

Methods

Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID-19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria.

Results

Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress-related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID-19 through the media); factors directly related to COVID-19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID-19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS-SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness.

Conclusions

Improved understanding of pandemic-associated risk factors for depression can inform person-cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID-19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population.     

Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review

BackgroundThe world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak.MethodsWe systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic.ResultsThrough our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events.ConclusionDiabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions.     

Diabetes management and specific considerations for patients with diabetes during coronavirus diseases pandemic: A scoping review

Background and aimsThe global pandemic of coronavirus (COVID-19) affects almost all countries in the world, which potentially alter diabetes management. Many diabetes patients are experiencing barrier of care due to the policy related to COVID-19. This article aims to review the current evidence on diabetes management and specific considerations during the COVID-19 pandemic for people living with diabetes.MethodsWe conducted a scoping review in PubMed, Science Direct, DOAJ and Microsoft Academics databases from January 1 to April 17, 2020. Searching terms included “COVID-19”, “severe acute respiratory syndrome coronavirus 2”, and “Diabetes Mellitus” were used. Only scientific articles discussing diabetes management and specific considerations were selected and extracted.ResultsA total of 7 articles was selected in the analysis. Most were published in diabetes journals (85.71%). All articles (100%) discussed diabetes management and 71.43% of them provided diabetes care in specific considerations. We discussed issue of diabetes management in glycemic control and monitoring, dietary intake, physical activity, medication, education and prevention of COVID-19 infection that applicable for diabetes patients. In addition, specific considerations explored caring for diabetes in children and adolescents, pregnancy, elderly, emergency or critical care, to offer certain concern for raising the awareness.ConclusionsThis review specifies a summary of diabetes management as well as the particular considerations to care people living with diabetes during COVID-19 pandemic. Patients, health care providers, and policy makers could take advantage of the review to assist diabetic people passing through COVID-19 pandemic session with optimum glycemic outcome.     

Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis

Advance care planning is considered an important issue in end-of-life care for older adults. The ongoing COVID-19 pandemic has interrupted the healthcare system and end-of-life care tremendously. This review aimed to explore available articles on advance care planning amid the pandemic and analyze qualitatively. PubMed and Google Scholar were searched on February 2021 using the relevant keywords. Retrieved articles were screened applying inclusion criteria. Any article describing advance care planning during the COVID-19 era was included. A qualitative content analysis was conducted. In total, 20 articles incorporating 5542 participants from five countries were included. Among the articles, eight were primary studies and the rest were perspective papers or secondary analysis. From the qualitative content analysis six major themes emerged namely palliative care, lack of coordination among acute care, hospital palliative care, and long-term care, community-based advance care planning, real-time dissemination of scientific information on the regional pandemic situation, online system and legislation. The COVID-19 pandemic had decreased the uptake of advance care planning. Findings of the review suggested simplification of the procedure regarding advance care planning, implementation of community-based advance care planning and utilization of online resources to enhance the process. Geriatr Gerontol Int 2021; 21: 779–787 .     

The Experience of Homebound Older Adults During the COVID-19 Pandemic

BackgroundHomebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.Design/SettingCross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.ParticipantsA total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.MeasurementsHomebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts <once/week), as well as loneliness, anxiety, and depression.ResultsAmong homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this <once/week vs. 28.4% of the non-homebound. In adjusted analyses of those without limited social contact prior to the pandemic, the homebound had higher but not significantly different odds (OR 1.83; 95% CI 0.95–3.52) of limited social contact during COVID-19, with increased risk among the older individuals, those with dementia, and those in assisted living facilities. Of the homebound, 13.2% felt lonely every/most days during the pandemic vs. 7.7% of non-homebound older adults. Homebound and non-homebound older adults reported similar rates of increased loneliness, anxiety, or depression during COVID-19. Fewer homebound older adults learned a new technology during the pandemic (16.3%) vs. non-homebound older adults (30.4%).DiscussionIsolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07361-9.KEY WORDS: Homebound, COVID-19, NHATS, Isolation, Social contact     

Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis

BackgroundCoronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients.MethodsThe meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266.ResultsA total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth.ConclusionsPsychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients’ confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.     

The impact of COVID-19 on college students’ physical activity: A protocol for systematic review and meta-analysis

Background:We aimed to conduct a meta-analysis to assess the impact of coronavirus disease 2019 (COVID-19) on college students’ physical activity.Methods:All cohort studies comparing college students undertaking physical exercise at school before the COVID-19 pandemic and physical exercise at home during the COVID-19 pandemic will be included in this review. We will use index words related to college students, physical exercise, and COVID-19 to perform literature searches in the PubMed, Medline, Embase, and CNKI databases, to include articles indexed as of June 20, 2021, in English and Chinese. Two reviewers will independently select trials for inclusion, assess trial quality, and extract information for each trial. The primary outcomes are exercise frequency, duration, intensity, and associated factors. Based on the Cochrane assessment tool, we will evaluate the risk of bias of the included studies. Revman 5.3 (the Cochrane collaboration, Oxford, UK) will be used for heterogeneity assessment, data synthesis, subgroup analysis, sensitivity analysis, and funnel plot generation.Result:We will discuss the impact of COVID-19 on college students’ physical activity.Conclusion:Stronger evidence about the impact of COVID-19 on college students’ physical activity will be provided to better guide teaching practice.Systematic review registration:PROSPERO CRD42021262390.     

The impact of COVID-19 on sexual behaviors of young women and men: A protocol for systematic review and meta analysis

Background:The worldwide impact of COVID-19 has reached all spheres of human health. Individuals may also experience unique changes in their sexual behaviors during the COVID-19 self-isolation/social distancing period. Studies in many countries have assess the effects of the pandemic on sexual behavior, or quality of sexual life. However, no systematic review has comprehensively explored the association between COVID-19 and the sexual behaviors of young women and men to date. This systematic review and meta-analysis protocol aims to ascertain the association between COVID-19 and sexual behaviors of young women and men that may get targeted interventions to improve health and well-being of young people''s sexual health.Methods:This systematic review and meta-analysis will be reported following the PRISMA guidelines. Observational designs (including cross-sectional, case-control, and cohort) will be eligible. Studies eligible for inclusion must contain participants aged 15 to 45 in any country affected by the pandemic of COVID-19. The search will be conducted in the following databases, including PubMed, Cochrane Library, EMBASE, EBSCO, Ovid, WHO COVID-19 database, China National Knowledge Internet (CNKI), WanFang Data, Chinese Scientific and Technological Journal Database (VIP), and Chinese Biomedical Databases (CBM). A pre-designed search strategy of medical subject heading (MeSH) terms and free words for the concepts “COVID-19” and “sexual behaviors” will be used. Two authors will independently complete literature screening, data extraction, and risk of bias assessment. Disagreements will be resolved by consensus with a third reviewer. The reviewer will follow the PECOS steps (population, exposure, comparator, outcomes, and study design) to obtain eligible extraction items. The risk of bias and quality of included studies will be assessed using RevMan 5.3. We will assess heterogeneity according to the I² statistics. If there is substantial heterogeneity in the included trials, subgroup analysis will be carried out to seek the potential causes.Ethics and dissemination:It is not necessary to obtain ethical approval as we will use data from published articles. The findings of this systematic review will be published in a peer- reviewed journal.PROSPERO registration number:PROSPERO 2020: CRD42020190867.     

Social Media Responses to COVID-19: Impact of school closures and re-openings on COVID-19 transmission

BackgroundGlobally, the education of students at primary and secondary schools has been severely disrupted by the implementation of school closures to reduce the spread of coronavirus disease 2019 (COVID-19). The effectiveness of school closures in reducing transmission of COVID-19 and the impact of re-opening schools are unclear.MethodsResearch criteria for this rapid review included empirical studies, published or pre-published worldwide before January 25, 2021, that assessed the effectiveness of school closures in reducing the spread of COVID-19 and the impact of school re-openings on COVID-19 transmission.ResultsTwenty-four studies on the impact of school closures and re-openings on COVID-19 transmission were identified through the seven databases that were searched. Overall the evidence from these studies was mixed and varied due to several factors such as the time of implementation of public health measures, research design of included studies and variability among the levels of schooling examined.ConclusionPreliminary findings suggest that school closures have limited impact on reducing COVID-19 transmission, with other non-pharmaceutical interventions considered much more effective. However, due to the limitations of the studies, further research is needed to support the use of this public health measure in response to the COVID-19 pandemic.     

Social Media Responses to COVID-19: Impact of school closures and re-openings on COVID-19 transmission

BackgroundGlobally, the education of students at primary and secondary schools has been severely disrupted by the implementation of school closures to reduce the spread of coronavirus disease 2019 (COVID-19). The effectiveness of school closures in reducing transmission of COVID-19 and the impact of re-opening schools are unclear.MethodsResearch criteria for this rapid review included empirical studies, published or pre-published worldwide before January 25, 2021, that assessed the effectiveness of school closures in reducing the spread of COVID-19 and the impact of school re-openings on COVID-19 transmission.ResultsTwenty-four studies on the impact of school closures and re-openings on COVID-19 transmission were identified through the seven databases that were searched. Overall the evidence from these studies was mixed and varied due to several factors such as the time of implementation of public health measures, research design of included studies and variability among the levels of schooling examined.ConclusionPreliminary findings suggest that school closures have limited impact on reducing COVID-19 transmission, with other non-pharmaceutical interventions considered much more effective. However, due to the limitations of the studies, further research is needed to support the use of this public health measure in response to the COVID-19 pandemic.     

Industry 4.0 technologies and their applications in fighting COVID-19 pandemic

Background and aimsCOVID 19 (Coronavirus) pandemic has created surge demand for essential healthcare equipment, medicines along with the requirement for advance information technologies applications. Industry 4.0 is known as the fourth industrial revolution, which has the potential to fulfil customised requirement during COVID-19 crisis. This revolution has started with the applications of advance manufacturing and digital information technologies.MethodsA detailed review of the literature is done on the technologies of Industry 4.0 and their applications in the COVID-19 pandemic, using appropriate search words on the databases of PubMed, SCOPUS, Google Scholar and Research Gate.ResultsWe found several useful technologies of Industry 4.0 which help for proper control and management of COVID-19 pandemic and these have been discussed in this paper. The available technologies of Industry 4.0 could also help the detection and diagnosis of COVID-19 and other related problems and symptoms.ConclusionsIndustry 4.0 can fulfil the requirements of customised face masks, gloves, and collect information for healthcare systems for proper controlling and treating of COVID-19 patients. We have discussed ten major technologies of Industry 4.0 which help to solve the problems of this virus. It is useful to provide day to day update of an infected patient, area-wise, age-wise and state-wise with proper surveillance systems. We also believe that the proper implementation of these technologies would help to enhance education and communication regarding public health. These Industry 4.0 technologies could provide a lot of innovative ideas and solution for fighting local and global medical emergencies.     

Digital technologies for monitoring infected people,identifying contacts and tracking transmission chains in the corona virus disease 2019 pandemic: A protocol for a systematic review

Background:In times of the corona virus disease 2019 (COVID-19) pandemic, due to the urgent need to respond quickly to the challenges posed by the introduction of a new etiological agent and the peculiarity of the disease, which poses risks to people''s lives and health, the use of digital technologies for monitoring and surveillance have been used as a means of fighting coronavirus. Thus, this study will identify the use of digital technologies to monitor, identify contacts and track transmission chains of COVID-19 worldwide.Methods:The systematic review of this protocol will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Protocols. We will include studies that present digital technologies used in the monitoring of infected people, contact identification and the transmission chain of COVID-19 developed worldwide. For the selection of articles, the following databases will be consulted: PubMed, EMBASE, LILACS, Web of Science, Science Direct, Scopus, Livivo and CINAHL. In addition, we will conduct extensive research on selected sources of gray literature, including bibliographic databases, web-based search engines, practice-oriented magazines and government websites. Data extraction will take place in 2 stages (1- title and abstract screening and 2- full-text screening) and will be carried out independently by 2 reviewers, using the Mendeley software and the Rayyan QCRI application. The studies will be characterized as to the type and design of the study in relation to the ease in demonstrating the technologies used and the type of information produced. If it is necessary to synthesize quantitative data, the heterogeneity assessment will be performed using I2 statistics, and the meta-analysis will be processed using Review Manager 5.3.Results:The development of this research will allow the knowledge of how these technologies were applied according to each territory and their effectiveness in reducing cases of COVID-19.Conclusion:The results of this review can reveal the importance of modern technologies for reducing cases of COVID-19 and that these measures can be adopted by governments, organizations and for everyoneRecord of systematic review:CRD42020211744.     

Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review

BackgroundMalnutrition among older people is one of the serious public health problem worldwide. Nutritional status and levels of nutrients of older patients with COVID-19 effect on COVID-19 outcomes. The purpose of this systematic review was to identify the prevalence of malnutrition and levels of nutrients associated with outcomes of the older patients with COVID-19.Materials and MethodsA literature search was performed using PubMed, Science direct and Google scholar database using specific keywords related to the aims. All related articles published on COVID-19 during 2020 were retrieved. PRISMA Statement was followed. The quality of the study was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health.ResultsOf the 2979 studies found, a total of eight studies were included in this review. Of these studies, three provided data on nutritional status and outcomes of COVID-19 among older patients with COVID-19. The prevalence of malnutrition among older patients with COVID-19 was high and it was associated with negative outcomes including hospital deaths and transfer to intensive care units. Five studies provided data on nutrients and outcomes of COVID-19. Low albumin, vitamin D, magnesium ,vitamin B12, Se status were associated with malnutrition, oxygen therapy and/or intensive care support of the patients, survival of COVID -19.ConclusionsExtra care should be provided to older patients with COVID-19 to minimize the prevalence of malnutrition and negative outcomes of COVID-19.     

Application of Artificial Intelligence in COVID-19 drug repurposing

Background and aimCOVID-19 outbreak has created havoc and a quick cure for the disease will be a therapeutic medicine that has usage history in patients to resolve the current pandemic. With technological advancements in Artificial Intelligence (AI) coupled with increased computational power, the AI-empowered drug repurposing can prove beneficial in the COVID-19 scenario.MethodsThe recent literature is studied and analyzed from various sources such as Scopus, Google Scholar, PubMed, and IEEE Xplore databases. The search terms used are ‘COVID-19′, ’ AI ′, and ‘Drug Repurposing’.ResultsAI is implemented in the field design through the generation of the learning-prediction model and performs a quick virtual screening to accurately display the output. With a drug-repositioning strategy, AI can quickly detect drugs that can fight against emerging diseases such as COVID-19. This technology has the potential to improve the drug discovery, planning, treatment, and reported outcomes of the COVID-19 patient, being an evidence-based medical tool.ConclusionsThus, there are chances that the application of the AI approach in drug discovery is feasible. With prior usage experiences in patients, few of the old drugs, if shown active against SARS-CoV-2, can be readily applied to treat the COVID-19 patients. With the collaboration of AI with pharmacology, the efficiency of drug repurposing can improve significantly.     

Breast reconstruction during the COVID-19 pandemic: A systematic review

Background:The novel coronavirus disease 2019 (COVID-19) has changed people''s way of life and posed great challenges to plastic surgery. Most of plastic surgeries are considered elective surgeries and are recommended to be delayed. But breast reconstruction in plastic surgery is special. Doctors’ associations from different countries have different rules on whether breast reconstruction surgery should be delayed. For the controversial topic of immediate breast reconstruction in the COVID-19 pandemic, we conducted this study.Methods:We searched English databases such as PubMed, Cochrane Library, and Embase. The publication time of papers was set to be from the establishment of the databases to February 2021. All studies on immediate breast reconstruction in the COVID-19 pandemic were included in our study.Results:A total of 6 studies were included in this study. Four studies recommended the use of breast implants or tissue expansion for breast reconstruction surgery and had good results in their clinical practice. In addition, 1 study planned to use autologous free tissue transfer for breast reconstruction, and 1 study planned to use microsurgical techniques for breast reconstruction. But these 2 technologies are still in the planning stage and have not yet been implemented.Conclusions:In our opinion, breast cancer surgery belongs to confine operation, and breast reconstruction surgery should be performed immediately after the completion of breast cancer surgery. We recommend the use of breast implants for breast reconstruction surgery during the COVID-19 epidemic. Due to the limitations of the study, our proposed protocol for breast reconstruction surgery during the COVID-19 epidemic needs to be further validated in clinical studies.     

The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis

BackgroundThe effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection.MethodsPubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity.ResultsEleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI −0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI −0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride.ConclusionsThis review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research.Systematic review registrationPROSPERO CRD42022360433.     

Internet of things (IoT) applications to fight against COVID-19 pandemic

Background and aimThe current global challenge of COVID-19 pandemic has surpassed the provincial, radical, conceptual, spiritual, social, and pedagogical boundaries. Internet of Things (IoT) enabled healthcare system is useful for proper monitoring of COVID-19 patients, by employing an interconnected network. This technology helps to increase patient satisfaction and reduces readmission rate in the hospital.MethodsSearched the databases of Google Scholar, PubMed, SCOPUS and ResearchGate using the keywords “Internet of things” or “IoT” and “COVID-19”. Further inputs are also taken from blogs and relevant reports.ResultsIoT implementation impacts on reducing healthcare cost and improve treatment outcome of the infected patient. Therefore, this present study based research is attempted to explore, discuss, and highlight the overall applications of the well-proven IoT philosophy by offering a perspective roadmap to tackle the COVID-19 pandemic. Finally, twelve significant applications of IoT are identified and discussed. It has ultimately forced the researchers, academicians, and scientists to propose some productive solutions to overcome or confront this pandemic.ConclusionsIoT is helpful for an infected patient of COVID-19 to identify symptoms and provides better treatment rapidly. It is useful for patient, physician, surgeon and hospital management system.     

Outcomes related to nutrition screening in community living older adults: A systematic literature review

IntroductionNutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening.MethodsA systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines.ResultsFifty-four articles were eligible to be included in the review and malnutrition risk varied from 0% to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the’ nutritional status of older adults.ConclusionsTimely nutrition screening of older adults living in the community, if followed up with appropriate intervention and monitoring improves the nutritional status of older adults. This indicates that nutrition intervention should be considered a priority following nutrition screening for malnourished and at risk older adults. Further evaluation of outcomes of nutrition screening and associated interventions, using structured pathways of care, is warranted.     

Home Health Aides’ Increased Role in Supporting Older Veterans and Primary Healthcare Teams During COVID-19: a Qualitative Analysis

BackgroundHome health aides are important but often overlooked members of care teams, providing functional and emotional support to patients. These services became increasingly important during the COVID-19 pandemic as older adults faced disruptions in in-person medical services and family caregiving. Understanding how aides supported healthcare teams is important for informing emergency planning and better integrating home health services with primary care.ObjectiveTo describe aides’ roles in supporting veterans and working with primary care teams during COVID-19 and identify COVID-related changes in tasks.DesignSemi-structured interviews.ParticipantsEight home health aides, 6 home health agency administrators, and 9 primary care team members (3 RNs, 3 social workers, 3 MDs) serving veterans at a large, urban, Veterans Affairs medical center.ApproachCombined deductive and inductive analysis to identify a priori concepts (aide roles; changes in tasks and new tasks during COVID-19) and emergent ideas. Aide, administrator, and provider interviews were analyzed separately and compared and contrasted to highlight emergent themes and divergent perspectives.Key ResultsParticipants reported an increase in the volume and intensity of tasks that aides performed during the pandemic, as well as the shifting of some tasks from the medical care team and family caregivers to the aide. Four main themes emerged around aides’ roles in the care team during COVID-19: (1) aides as physically present “boots on the ground” during medical and caregiving disruptions, (2) aides as care coordination support, (3) aides as mental health support, and (4) intensification of aides’ work.ConclusionsHome health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. Integrating aides more formally into healthcare teams and expanding their scope of practice in times of crisis and beyond may improve care coordination for older veterans.KEY WORDS: home health, home health aides, primary care, geriatrics, COVID-19     

Multisystem Inflammatory Syndrome in Children: Rapid review of multisystem inflammatory syndrome in paediatrics: What we know one year later

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is an emerging condition that was first identified in paediatrics at the onset of the COVID-19 pandemic. The condition is also known as pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS or PIMS), and multiple definitions have been established for this condition that share overlapping features with Kawasaki Disease and toxic shock syndrome.Methods: A review was conducted to identify literature describing the epidemiology of MIS-C, published up until March 9, 2021. A database established at the Public Health Agency of Canada with COVID-19 literature was searched for articles referencing MIS-C, PIMS or Kawasaki Disease in relation to COVID-19.Results: A total of 195 out of 988 articles were included in the review. The median age of MIS-C patients was between seven and 10 years of age, although children of all ages (and adults) can be affected. Multisystem inflammatory syndrome in children disproportionately affected males (58% patients), and Black and Hispanic children seem to be at an elevated risk for developing MIS-C. Roughly 62% of MIS-C patients required admission to an intensive care unit, with one in five patients requiring mechanical ventilation. Between 0% and 2% of MIS-C patients died, depending on the population and available interventions.Conclusion: Multisystem inflammatory syndrome in children can affect children of all ages. A significant proportion of patients required intensive care unit and mechanical ventilation and 0%–2% of cases resulted in fatalities. More evidence is needed on the role of race, ethnicity and comorbidities in the development of MIS-C.