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The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence

Chris Emmerson Orcid Logo, Joe Hollinghurst, Laura North, Rich Fry Orcid Logo, Ashley Akbari Orcid Logo, Ciarán Humphreys, Michael Gravenor Orcid Logo, Ronan Lyons Orcid Logo

Age and Ageing, Volume: 51, Issue: 12

Swansea University Authors: Joe Hollinghurst, Laura North, Rich Fry Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1093/ageing/afac250

Abstract

Backgrounddementia may increase care home residents’ risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors.Methodswe created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 3...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2022
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Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality.Resultsthe cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55&#x2013;13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05&#x2013;1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret.Discussionwhilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.</abstract><type>Journal Article</type><journal>Age and Ageing</journal><volume>51</volume><journalNumber>12</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0002-0729</issnPrint><issnElectronic>1468-2834</issnElectronic><keywords>COVID-19, dementia, care homes, SARS-CoV-2, frailty, older people</keywords><publishedDay>5</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-12-05</publishedDate><doi>10.1093/ageing/afac250</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research (HDR) UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR (Administrative Data Research) Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government&#x2019;s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence, which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded Administrative Data Research UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales.</funders><projectreference/><lastEdited>2023-01-09T10:14:38.4279958</lastEdited><Created>2022-12-06T17:38:44.0414890</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Chris</firstname><surname>Emmerson</surname><orcid>0000-0001-6112-7644</orcid><order>1</order></author><author><firstname>Joe</firstname><surname>Hollinghurst</surname><order>2</order></author><author><firstname>Laura</firstname><surname>North</surname><order>3</order></author><author><firstname>Rich</firstname><surname>Fry</surname><orcid>0000-0002-7968-6679</orcid><order>4</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>5</order></author><author><firstname>Ciar&#xE1;n</firstname><surname>Humphreys</surname><order>6</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>7</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>8</order></author></authors><documents><document><filename>62132__26209__cfb49254b5a144f5873acafc94716d84.pdf</filename><originalFilename>62132.pdf</originalFilename><uploaded>2023-01-09T10:12:16.1182236</uploaded><type>Output</type><contentLength>429382</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2022. 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spelling 2023-01-09T10:14:38.4279958 v2 62132 2022-12-06 The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence d7c51b69270b644a11b904629fe56ab0 Joe Hollinghurst Joe Hollinghurst true false a255822cf77a0184cb6922e9fbea39e9 Laura North Laura North true false d499b898d447b62c81b2c122598870e0 0000-0002-7968-6679 Rich Fry Rich Fry true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2022-12-06 FGMHL Backgrounddementia may increase care home residents’ risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors.Methodswe created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality.Resultsthe cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55–13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05–1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret.Discussionwhilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19. Journal Article Age and Ageing 51 12 Oxford University Press (OUP) 0002-0729 1468-2834 COVID-19, dementia, care homes, SARS-CoV-2, frailty, older people 5 12 2022 2022-12-05 10.1093/ageing/afac250 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research (HDR) UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR (Administrative Data Research) Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence, which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded Administrative Data Research UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. 2023-01-09T10:14:38.4279958 2022-12-06T17:38:44.0414890 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Chris Emmerson 0000-0001-6112-7644 1 Joe Hollinghurst 2 Laura North 3 Rich Fry 0000-0002-7968-6679 4 Ashley Akbari 0000-0003-0814-0801 5 Ciarán Humphreys 6 Michael Gravenor 0000-0003-0710-0947 7 Ronan Lyons 0000-0001-5225-000X 8 62132__26209__cfb49254b5a144f5873acafc94716d84.pdf 62132.pdf 2023-01-09T10:12:16.1182236 Output 429382 application/pdf Version of Record true © The Author(s) 2022. This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution Non-Commercial License true eng https://creativecommons.org/licenses/by-nc/4.0/ 158
title The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
spellingShingle The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
Joe Hollinghurst
Laura North
Rich Fry
Ashley Akbari
Michael Gravenor
Ronan Lyons
title_short The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
title_full The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
title_fullStr The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
title_full_unstemmed The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
title_sort The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence
author_id_str_mv d7c51b69270b644a11b904629fe56ab0
a255822cf77a0184cb6922e9fbea39e9
d499b898d447b62c81b2c122598870e0
aa1b025ec0243f708bb5eb0a93d6fb52
70a544476ce62ba78502ce463c2500d6
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv d7c51b69270b644a11b904629fe56ab0_***_Joe Hollinghurst
a255822cf77a0184cb6922e9fbea39e9_***_Laura North
d499b898d447b62c81b2c122598870e0_***_Rich Fry
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Joe Hollinghurst
Laura North
Rich Fry
Ashley Akbari
Michael Gravenor
Ronan Lyons
author2 Chris Emmerson
Joe Hollinghurst
Laura North
Rich Fry
Ashley Akbari
Ciarán Humphreys
Michael Gravenor
Ronan Lyons
format Journal article
container_title Age and Ageing
container_volume 51
container_issue 12
publishDate 2022
institution Swansea University
issn 0002-0729
1468-2834
doi_str_mv 10.1093/ageing/afac250
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Backgrounddementia may increase care home residents’ risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors.Methodswe created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality.Resultsthe cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55–13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05–1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret.Discussionwhilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.
published_date 2022-12-05T04:21:31Z
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