Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.

#Neverenough: Social Comparison By Young Women On Instagram

<div>As social media use continues to rise, studies have linked high social media use with rising levels of depression, particularly in young adults. This narrative has pervaded, yet in the research thus far, there is no general consensus as to causation or direction. What remains constant is that when mediators such as ‘comparison’ and ‘envy’ are introduced between social media use and depression, there is a negative correlation. In a qualitative study, I examine the connection between social comparison, Instagram use, and envy in young women. I conducted semi-structured interviews with a group of 10 female university students between the ages of 18-24. Interviews were analysed through qualitative descriptive analysis. Overwhelmingly, subjects engaged in frequent social comparison offline, which translated to frequent social comparison, made worse, on Instagram. As a result, participants admitted to feeling envious as well as other feelings like frustration, loneliness, anger, and overwhelm. However, users also reported positive experiences such as inspiration, humour, motivation, and happiness, when they are on Instagram Offline affect proved to be the biggest moderators and indicators of comparison and the positive or negative experiences of the participants. This research may suggest future care in this area should focus on offline affect rather than the social networks themselves.</div>

#Neverenough: Social Comparison By Young Women On Instagram

<div>As social media use continues to rise, studies have linked high social media use with rising levels of depression, particularly in young adults. This narrative has pervaded, yet in the research thus far, there is no general consensus as to causation or direction. What remains constant is that when mediators such as ‘comparison’ and ‘envy’ are introduced between social media use and depression, there is a negative correlation. In a qualitative study, I examine the connection between social comparison, Instagram use, and envy in young women. I conducted semi-structured interviews with a group of 10 female university students between the ages of 18-24. Interviews were analysed through qualitative descriptive analysis. Overwhelmingly, subjects engaged in frequent social comparison offline, which translated to frequent social comparison, made worse, on Instagram. As a result, participants admitted to feeling envious as well as other feelings like frustration, loneliness, anger, and overwhelm. However, users also reported positive experiences such as inspiration, humour, motivation, and happiness, when they are on Instagram Offline affect proved to be the biggest moderators and indicators of comparison and the positive or negative experiences of the participants. This research may suggest future care in this area should focus on offline affect rather than the social networks themselves.</div>

Future Eldercare Planning Among Chinese Aging Families in Hong Kong

Increasing attention has been paid to the potential role of care planning in buffering future eldercare challenges. However, little is known about the characteristics of care planning among Chinese ageing families. It is also of interest to reflect how recent events such as COVID-19 pandemic may affect their views of the future care planning. From a family systems perspective, this study explored the extent, processes, and contents of intergenerational care planning of Chinese ageing families in Hong Kong. Dyadic interviews were conducted with 60 adult child-older parent pairs, and individual interviews were conducted with another 33 adult children. Intergenerational discrepancies in extent and processes of care planning, intergenerational congruence of care expectations and struggles, facilitating role of family capital and hindering role of cultural capital in care planning were primary themes. Although both generations demonstrated strong awareness of future eldercare needs, they were found engaged in different levels and processes of care planning. Adult children’s level of engagement in planning activities may influence parents’ extent and contents of care planning. Intergenerational transmission of eldercare values contributed to intergenerational congruence of care expectations but also led to similar struggles and ambivalent attitudes toward future care. Moreover, family capital was found to facilitate family care planning while Chinese cultural values that emphasize family care may hinder both generations’ efforts in care planning. The findings will deepen our understanding on characteristics of intergenerational care planning in Asian Chinese communities and inform services to improve adult children and ageing parents’ preparation for future eldercare.

Patterns of Intergenerational Care Planning Among Chinese Aging Families in Hong Kong

Care planning before the onset of intensive care needs can increase families’ ability to manage caregiving crises and cope with care transitions. However, future care planning has not been substantially examined in a family context. Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs. Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong. Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns. Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal. Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities. Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level. Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning. The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children’s awareness and preparation toward future care. The findings will enhance professionals’ and service providers’ awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.

COVID-19 Impacts on Mental Health Care in Veterans Health Administration Community Living Centers

COVID-19 forced VHA Community Living Centers (CLC) to adjust how mental health (MH) care is provided. Beginning March 2020, admissions and staff entering CLC space were restricted in response to the pandemic. Some care shifted from in-person to virtual. Veterans were more isolated due to visitor restrictions and cancellation of communal activities. Pre-COVID, CLC teams cared for an already complex population – 80% of residents had a MH diagnosis (24% with serious mental illness). Changing resident composition and increased isolation may intensify challenges in providing MH care. Using VHA administrative data, we assess the impact of the changing CLC environment during the pandemic by comparing monthly average rates of MH diagnoses and provision of MH care and as-needed psychotropics to CLC residents pre-COVID (Oct 2019 – Feb 2020) to the COVID period (Mar 2020 – Feb 2021). CLCs experienced a 26% decline in the monthly resident census. However, the monthly percentage of residents with a serious mental illness increased 13%. Pre-COVID, virtual MH encounters were received by 2% of residents; 35% received an in-person MH encounter. During COVID, 8% received a virtual MH encounter and 33% received in-person. As-needed antipsychotics remained unchanged, while as-needed benzodiazepine prescriptions decreased 15%. Despite increased MH concerns, CLC teams did not appear to respond with increased pharmacological interventions. Rather, teams seem to have maintained clinical service connection for those with MH concerns. Documenting successful approaches for addressing MH needs during this challenging time will be instructive for future care during times of crisis.

Seven-State Study of Assisted Living and Healthcare Providers’ Responses to COVID-19

COVID-19 has inordinately affected assisted living (AL), such that the proportion of fatalities to cases has been 21% in AL versus 2.5% for the general population. Understanding how AL administrators and medical and mental health providers have responded to COVID-19 can inform health care going forward. Using a seven-state stratified random sample of 250 communities, administrators were interviewed and providers completed questionnaires regarding COVID-19 practices. Preliminary data indicate that 79%, 44%, and 62% of administrators reported serving meals in rooms to segregate residents, using telemedicine, and providing extra pay for staff, respectively. Perceived use/effectiveness of practices differed based on dementia case-mix (e.g., face coverings, social distancing). Providers reported less access to patients (82%), more telehealth (63%), and less ability to provide care (43%). However, they uniformly reported high confidence in AL staff ability to prevent (94%) and respond to outbreaks (96%). Discussion will summarize points important for future care.

Creating a Person- and Family-Centered Program of Research: Lessons Learned From Over 30 Years of Applied Research

Approximately 6 million Americans are living with Alzheimer’s Disease or related dementia. Due to these alarming statistics, there is an increased need for families to seek out services and supports to not only cope with these devastating diagnoses, but to plan effectively for their future care needs. A plethora of research has shown that both the family care partner and person living with dementia are at-risk for negative outcomes such as depression, anxiety, social isolation, and worsening physical and mental health. Moreover, further and encouraging research supports the development and implementation of empowerment-based, person- and family-centered interventions. When utilized effectively these interventions improve quality of care and well-being in persons living with dementia and their care partners. The purpose of this paper is to provide guidance for researchers interested in making their work more person- and family-centered. Strategies discussed are based on over 30 years of applied research and include: 1) placing individuals at the center of their own care, 2) including persons with dementia as co-investigators, 3) convening diverse professionals and individuals in advisory councils from the start, and 4) conducting focus groups to obtain participant and stakeholder feedback. Demonstrations of select person-and-family-centered, evidence-programs will be included and supplemented with case examples to illustrate person-centered principles in practice.

Refining Care to Plan: Delivering Personalized Recommendations to Support Dementia Caregivers

Caregivers of persons living with Alzheimer’s disease and Alzheimer’s disease-related dementias (PLWD; AD/ADRD) benefit from unique interventions to address their different needs. While information on which interventions best meet specific needs exists, less is known about how to match caregivers with those interventions. To address this research gap, we tested Care to Plan (CtP) within a large healthcare system. After care navigators guided caregivers through twenty CtP tailoring questions to identify caregivers’ greatest needs, the online tool provided the intervention type best suited to meet their needs, along with region-specific information on available programs. This mixed methods analysis evaluated the utility of the CtP tool with 20 family caregivers of PLWD after a 1 month follow-up. Most caregivers agreed that the CtP tool was helpful (85%) and would recommend the tool to other caregivers (90%). Caregivers also said they valued being able to discuss the CtP recommendations with the care navigator (95%). However, only 65% said they found services that met their needs or planned on using services recommended by CtP. Interview data indicate time constraints and restricted availability of resources due to COVID-19 precautions reduced caregivers’ abilities to pursue some recommendations. In addition, the stage of dementia experienced by their care recipient may explain why others found CtP less useful. However, these caregivers noted the potential utility of the resources for their future care planning needs. A larger evaluation of the CtP tool within the healthcare system is ongoing.