The Relationship of Vaccine Uptake and COVID-19 Infections among Nursing Home Staff and Residents in Missouri

Introduction Older adults living in communal spaces, such as nursing or retirement communities are at greater risk of infection due to close proximity to others, advanced aging-related or medical conditions, and engagement with staff that support multiple clients and facilities. Mobility between residents and facilities may result in staff acting as vectors of COVID-19 infection in these spaces. Vaccine uptake has been shown to markedly reduce the spread of COVID-19, yet there is little data on vaccine uptake and the continued COVID-19 risk among residents. Methods Data for this study were extracted from two publicly available. First, Centers for Medicaid and Medicare Services (CMS) public data included characteristics of nursing homes, weekly reported observations of residential COVID-19 cases, and COVID-19 vaccine coverage of staff and residents. Second, the average weekly COVID-19 infection rates from the Missouri Department of Health and Senior Services (MDHSS) were extracted and aggregated. A zero-inflated Poisson (ZIP) regression model was constructed to predict (1) if COVID-19 infections were reported, and if so, (2) the number of cases reported using a priori variables as predictors. ZIP regression was used due to the count nature of the outcome and due to the pre-determined overdispersion of observations when zero COVID-19 cases were reported during the study period. Results A total of 504 nursing homes were included in the study and 1124 COVID-19 infections were reported during the study period. As the percent of vaccinated staff increased, the risk of COVID-19 infections among residents significantly decreased. Percent of residents vaccinated was not significantly associated with whether COVID-19 cases were reported, nor the number of cases reported. Other factors, such as county COVID-19 rate and CMS staff rating, were significantly associated with COVID-19 cases in nursing homes. Discussion This study identified that nursing home staff, likely due to greater mobility, are important to prioritize in vaccination efforts to protect themselves and residents of their facilities from COVID-19 infections. Further, the CMS staff ratings were significant predictors of infection as well, which highlight the structural challenges that exist within and outside the context of a highly infectious and deadly pandemic. These results also provide insights to optimizing vaccination roll-out to best protect vulnerable community residents

Understanding Drivers of COVID-19 Racial Disparities: A Population-Level Analysis of COVID-19 Testing among Black and White Populations

Background Disparities in COVID-19 testing—the pandemic’s most critical but limited resource—may be an important but modifiable driver of COVID-19 inequities. Methods We analyzed data from the Missouri State Department Health and Senior Services on all COVID-19 tests conducted in the St. Louis and Kansas City regions. We adapted a well-established tool for measuring inequity—the Lorenz curve—to compare COVID-19 testing rates per diagnosed case among Black and White populations. Results Between 3/14/2020 and 9/15/2020, 606,725 and 328,204 COVID-19 tests were conducted in the St. Louis and Kansas City regions, respectively. Over time, Black individuals consistently had approximately half the rate of testing per case compared to White individuals. In the early period (3/14/2020 to 6/15/2020), zip codes in the lowest quartile of testing rates accounted for only 12.1% and 8.8% of all tests in the St. Louis and Kansas City regions, respectively, even though they accounted for 25% of all cases each region. These zip codes had higher proportions of residents who were Black, without insurance, and with lower median incomes. These disparities were reduced but still persisted during later phases of the pandemic (6/16/2020 to 9/15/2020). Lastly, even within the same zip code, Black residents had lower rates of tests per case compared to White residents. Conclusions Black populations had consistently lower COVID-19 testing rates per diagnosed case compared to White populations in two Missouri regions. Public health strategies should proactively focus on addressing equity gaps in COVID-19 testing to improve equity of the overall response.

Professional Training and Personal Development: Lessons From 10 Years of Intergenerational Learning

This presentation will highlight a ten-year collaboration between the Nazareth College Gerontology Program and St. John’s Senior Services – the St. John’s Collaborative for Intergenerational Learning (SCIL). Specifically, semester-long intergenerational coursework (Adulthood & Late Life, Issues in Aging, Aging & Community Service) and community-based service projects will be showcased with a focus on design, implementation, assessment, and impact. Emphasis will be placed on the reciprocity of these collaborations, the personal and professional benefits of these exchanges for our students, and the subsequent impact on the community partners and the individuals they serve. Various models of intergenerational learning as well as our new intergenerational residency program will also be discussed.

Survey for a Vector of Zika Virus and Two Other Mosquito Species in Four Ecoregions of Missouri: An A Posteriori Analysis

In 2015, Zika emerged as a vector-borne disease in the Americas, causing a variety of health issues ranging from Guillain-Barre syndrome in adults to microcephaly in newborns. Following the documentation of mosquito-borne transmission of the disease in the southern United States, the Missouri Department of Health and Senior Services contracted with researchers at Missouri State University to complete a survey of possible mosquito vectors of the Zika in the state. The primary vector of the disease, Aedes aegypti, had been reported from Missouri in previous surveys from several decades ago, but a comprehensive survey of the state mosquitoes and never been completed. Researchers focused on mosquitoes that spend the immature stages in artificial containers because this is descriptive of the most important Zika vectors. The large survey over three years provided an opportunity for post hoc analysis of mosquito occurrence data across a variety of ecoregions inside the state, documenting changes in the vector populations as a result of invasive species. The survey also allowed an analysis of different trapping techniques for important species in the state. The results are reported in this chapter along with a discussion of the potential impact on human health of changes to the mosquito population.

ELDER VOICES NETWORK: PARTNERING WITH OLDER PEOPLE AND THEIR CAREGIVERS TO AVOID MEDICAL HARM

Team Alice, named after an older adult in our community who died as a result of medication harm, is an interdisciplinary team of prescribers, pharmacists, educators, advocates, and researchers with a mission to protect older people from medication-related harm across the continuum of care. In 2019, Team Alice partnered with the Erie County Department of Senior Services, older people, and caregivers to form the Elder Voices Network (EVN) as a vehicle for patient-driven deprescribing in the Western New York region. The objective of this presentation is to detail the planning and implementation of critical components of EVN’s formation, including outreach and engagement, funding development, community partnerships, roles and communication, and decision-making. Case study results demonstrate the capacity of community-based participatory research (CBPR) to empower older people and caregivers with knowledge, skills, and tools to promote self-advocacy across the system. Presenters will also discuss recommendations useful for future patient engagement initiatives.

SOCIAL HEALTH, MOBILITY, AND TECHNOLOGY: ACCESSIBILITY WITHIN AGE-FRIENDLY COMMUNITIES

To explore how access to transportation and technology/social media influence social connectivity among an ethnically diverse group of vulnerable low-income older adults, six focus groups were conducted (N=48) in English, Spanish, and Korean at a senior services agency. Qualitative thematic analyses revealed overarching themes that fit within the World Health Organization’s Age-Friendly Domains of Livability. The sub-theme “barriers and facilitators to accessibility” ran through each of the overarching themes, demonstrating how specific factors of the built, social, and community health environments intersect to promote or hinder social connection. Although transportation and technology uses were linked to social engagement, challenges with the built environment and limited financial resources hindered older adults’ abilities to remain engaged in their communities, both in-person and electronically. Age-Friendly initiatives must continue to consider the community-specific barriers and facilitators for older adults to remain physically and socially connected to the community.

Finding Chances to Intervene Before the Fatal Overdose: Linking ED and Mortality Data

ObjectiveLink emergency department (ED) with death certificate mortality data in order to examine the prior medical history of opioid overdose victims leading up to their death.IntroductionIn 2017, 951 Missouri residents died from an opioid overdose—a record number for the state.1 This continues the trend from 2016, which saw an increase of over 30% in opioid overdose deaths compared to 2015. The Missouri Department of Health and Senior Services (MDHSS) manages several public health surveillance data sources that can be used to inform about the opioid epidemic. Opioid overdose deaths are identified through death certificates which are collected through the vital records system. MDHSS also manages the Patient Abstract System (PAS), which contains ED and inpatient hospitalization data from approximately 132 non-federal Missouri hospitals. PAS contains about 130 variables, which include demographic data, diagnoses codes, procedures codes, and other visit information. Records can have up to 23 diagnosis fields, which are coded using ICD-10-CM (International Classification of Diseases, Clinically Modified). The first diagnosis field is the primary reason for a visit.MethodsLinkage and analysis of the data was performed using SAS Enterprise Guide 6.1. Opioid overdose deaths were identified through ICD-10 analysis looking for drug poisoning underlying cause of death codes and opioid-specific codes found in the multiple cause (contributing cause) of death fields. Table 1, below, summarizes the ICD-10 codes used. Mortality data from the 951 decedents were linked to ED data from 2016 and 2017. Records were linked using multiple passes over the ED records. Records were first linked on social security number. Following this linkage, ED records with no initial match went through a second pass and linked on name and date of birth. Finally, a third pass for records still without a match was conducted using date of birth, census tract, and sex. After these passes, the linkages were reviewed to identify any false positives. The 23 diagnosis fields contained in PAS were analyzed to look for patterns in diagnosis coding. ICD-10-CM codes were too broad so CCS (Clinical Classifications Software) categories were utilized.ResultsIn total, 3,500 ED records were linked to the 951 decedents. After removing false positives, the total number of ED records was 3,357. Approximately 70% (687) of decedents were linked to at least one ED record. One hundred and eighty-eight visits were due to drug overdose (153 opioid overdoses). The most common primary diagnosis CCS categories (category numbers in parentheses) were: substance-related disorders (661), Spondylosis; intervertebral disc disorders; other back problems (205), abdominal pain (251), and other nervous system disorders (95). Collectively, these four categories represented over 20% of all primary diagnoses. Across all 23 diagnosis fields there were similar results. The most common CCS categories were as follows: substance-related disorders (661), other aftercare (257), essential hypertension (98), and mood disorders (657). Pie charts (Fig. 1 and 2) below show proportions of CCS categories across all diagnoses fields and primary diagnosis broken into three major categories: pain/injury, substance abuse/mental health, and other. In order to reduce the impact of CCS categories with small numbers, these graphics represent only CCS categories that made up 1% or more of the total collection of diagnoses codes. Of the 687 decedents that were matched successfully to ED records, 96% had at least one pain/injury or one substance abuse/mental health ICD-CM code in at least one record, and 68% had both.ConclusionsThese findings suggest that many overdose decedents visited the ED in the years prior to death. Many of these visits were not due to an overdose; however, they could be indicative of a problem with opioids (i.e. pain, drug-seeking, substance use-related). ED staff and public health professionals could utilize these opportunities to refer patients to recovery services and recommend they heed caution when using opioids.References1. Missouri Department of Health and Senior Services. (2018). Missouri Resident Overdose Deaths by Opioid Type. Retrieved September 27, 2018 from https://health.mo.gov/data/opioids/pdf/opioid-dashboard-slide-9.pdf.

3310 A Community-Academic Partnership to Understand the Association Among Health Status and Senior Services Utilization to Improve Nutrition and Blood Pressure Control for Low Income Seniors Aging in Place

OBJECTIVES/SPECIFIC AIMS: The Rockefeller University Center for Clinical and Translational Science (RU-CCTS), Clinical Directors Network (CDN), and Carter Burden Network (CBN), a multi-site senior services organization serving East Harlem, NY, formed a community-academic research partnership to characterize the health of the CBN seniors (many who are racial/ethnic minorities, low-income, and suffering from multiple chronic conditions) and to explore the use and associations of a measure of overall health status and frailty in this population. A simple validated measure of health status could standardize and streamline community-based translational research to study the impact of CBN’s services on health outcomes. The CCTS-funded Pilot Project aims to: 1) Engage CBN seniors and stakeholders in priority-setting, joint protocol development, research conduct, analysis and dissemination; 2) Characterize the health status of the CBN seniors using validated measures; 3) Establish an electronic database infrastructure for current and future research; 4) Understand how health and senior activities information can be used to implement programs to improve senior health and well-being. METHODS/STUDY POPULATION: 1) We used Community Engaged Research Navigation (CEnR-Nav) methods to facilitate partnership development, and to engage CBN seniors and stakeholders in each step of the research; 2) Research staff conducted recruitment, informed consent, and physical assessments (e.g., pulse, blood pressure, BMI); and administered validated surveys to collect health status information. 3) Data were captured on a REDCap-based platform. The primary outcome, frailty, was measured by the validated Short Physical Performance Battery (SPPB). 4) Secondary outcomes include the association of use of services/activities with the primary outcome. Research participants consented to sharing of their health, demographic and services utilization data compiled by CBN staff and the NYC Department for the Aging (DFTA). DFTA provided comparison datasets of de-identified health and demographic data for clients attending other NYC DFTA-funded senior centers. RESULTS/ANTICIPATED RESULTS: 1) 43 residents and stakeholders engaged in partnership-building, study design and implementation. 2) 218 participants from two senior centers were enrolled. Mean age, 68 ± 11 years; 58% Hispanic; 33% African American, 23% White, 1% Asian, 18% Unknown, 17% Other; 69% reported <$20000 annual income; 40% had not completed high school; 30% scored as moderately or severely frail; 83% were overweight or obese; and 33% reported a history of diabetes. 84% had uncontrolled high blood pressure; many participants were previously aware of their hypertension diagnosis. 3) A REDcap database was developed to store historical and prospective data. 4) Across frailty categories, there was a significant difference in utilization of non-meal (p = 0.0237) and meal services (p = 0.0127) and there was an inverse proportional relationship between the number of meal and non-meal visits, and frailty. Additional associations among health status measures (e.g., SPPB, demographics, biological measures: pulse, blood pressure, BMI; psychosocial and nutritional scales) and CBN service utilization (i.e., meals vs. non-meals activities) will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: We developed a community-academic research partnership, infrastructure and capacity, built through our Community-Engaged (CEnR-Nav) model, to conduct a pilot study characterizing the health status and services utilization of low-income minority seniors. Our pilot study identified an urgent health priority, uncontrolled hypertension in 84% of CBN’s seniors. We then leveraged the team’s expertise and CBN’s meal services program to develop a research proposal for external funding to conduct a community-based multi-component intervention study. Replacement of a typical Western diet with the Dietary Approaches to Stop Hypertension (DASH) diet has been proven to reduce blood pressure in hypertensive and normotensive individuals in as little as 14 days, yet effective implementation has been lacking, and it is relatively untested in community-living seniors who receive their meals in settings such as CBN. We are also exploring mechanistic questions that relate to blood pressure control, such as the impact of the DASH diet on inflammation, which may lead to a better understanding of the underlying mechanism of action of the DASH diet. Our community partner, CBN, was awarded the DHHS-ACL nutrition innovation grant to conduct this 2-year study with CDN and RU-CCTS. The resulting study developed out of the community engaged pilot study represents a unique combination of community-centered care, within an implementation science framework (with embedded mechanistic measures under development). This is an example of the novel, full-spectrum approach to translational research that the RU-CCTS/CDN Community Engaged Research Core has been developing over the last decade. The research to characterize CBN clients’ health status is now being extended to address cardiovascular health by way of intervening on diet quality and food insecurity, a key component of the social determinants of health, in partnership with agencies outside of the healthcare delivery system. The outcomes of the DASH Diet implementation study will also serve to inform the broader aging service provider network and the healthcare community about the impact of senior center congregate meal composition and services on health outcomes.

Seasonality and trends in incidence of human ehrlichiosis in two Missouri ecoregions

Ehrlichiosis is a zoonotic illness caused by Ehrlichia pathogens transmitted by ticks. Case data from 1999 to 2015, provided by the Missouri Department of Health and Senior Services (DHSS), were used to compare the seasonality and the change in incidence over time of ehrlichiosis infection in two Missouri ecoregions, Eastern Temperate Forest (ETF) and Great Plains (GP). Although the number of cases has increased over time in both ecoregions, the rate of change was significantly faster in ETF region. There was no significant difference in seasonality of ehrlichiosis between ecoregions. In Missouri, the estimated ehrlichiosis season begins, on average, in mid-March, peaks in June, and concludes in mid-October. Our results show that the exposure and risk season for ehrlichiosis in Missouri is at least 7 months long.