COVID-19 in Long-Term Care Facilities: A Rapid Review of Infection Correlates and Impacts on Mental Health and Behaviors

Abstract

Background: Long-term care facilities (LTCFs) with compact, group-living arrangements have become COVID-19 hot spots during the pandemic. Systematic research is needed to understand factors associated with COVID-19 infections in LTCFs and the inadvertent effects of preventive measures adopted by LTCFs. Objectives: This rapid review identifies factors associated with LTCF residents’ COVID-19 infections and the impacts of the pandemic and the corresponding preventive measures on residents’ mental health and behavioral problems. Methods: Following the preferred reporting items for systematic reviews and meta-analyses guidelines, we identified and reviewed relevant literature in Medline, PsycINFO, and AgeLine. Results: Thirty-seven articles were identified and reviewed, including 30 reporting factors associated with COVID-19 infections in LTCFs and seven reporting the impact of the pandemic and corresponding prevention measures on LTCF residents. Results revealed four domains of factors associated with COVID-19 infections: facility physical environments, resident characteristics, facility management and testing, and community factors. The pandemic and infection control measures increased residents’ depression, anxiety, loneliness, and behavioral problems (e.g., agitation, hallucinations). Residents without cognitive impairments were more vulnerable to these adverse effects. Conclusion and implications: LTCF managers/policymakers and healthcare designers can help mitigate COVID-19 infections by (1) providing additional resources to vulnerable LTCFs; (2) enhancing the training of personal protective equipment use and guideline compliance; and (3) investing in amenities, such as sinks, quarantine rooms, and outdoor spaces. Digital activities and accessible green spaces can mitigate mental health and behavior issues. Future LTCF design can benefit from flexible spaces, natural ventilation, and reducing crowding.

Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: a prospective observational study

“…Interestingly, some of these features returned to their baseline values when the lockdown ended, and visits were allowed again. In contrast to some previous studies [ 27 , 28 ], our data do not suggest that lockdown in nursing homes had negative effects on residents’ mental health. It is tempting to speculate that a more peaceful environment caused by social restrictions might contribute to this finding.…”

Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID‐19 pandemic

“…In contrast to other studies suggesting that the pandemic increased the risk of depressive symptoms among NH residents, 41 we did not find evidence of this. Surprisingly, we found that at the start of the pandemic, the proportion with depressive symptoms significantly declined in AL.…”

Alten- und Pflegeheime – die COVID-19-Pandemie als Mahnung: Infektionshygienische Maßnahmen und Einflussfaktoren auf die Gesundheit der Bewohnenden

“…den Wegfall sozialer Aktivitäten [ 31 ]. Berichtet wurde vor diesem Hintergrund von verstärkten Gefühlen der Isolation, Macht- oder Hilflosigkeit unter den Bewohnenden sowie von Angstzuständen, Depressionen, aggressivem Verhalten und kognitiven Einschränkungen [ 31 , 32 ].…”

“…werden kann [ 4 , 24 ]. Damit übereinstimmend berichten Ergebnisse von internationalen Studien auch, dass eine hohe Bettenanzahl, limitierte Räumlichkeiten und Mehrbettzimmer zu einem gesteigerten Infektionsrisiko für Bewohnende beitragen [ 5 , 32 ].…”