The Situation with Institutionalized Elderly in Bulgaria during COVID-19 Pandemic
DOI:
https://doi.org/10.3889/oamjms.2023.11765Keywords:
COVID- 19 pandemic, Institutionalized elderly, Long-term care facilitiesAbstract
BACKGROUND: At the beginning of the pandemic, health authorities warned that the most vulnerable group of the coronavirus infection are persons over the age of 65 and in particular institutionalized elderly, as their mortality rate is growing exponentially. Therefore, the protection of old people living in social institutions during the periods of COVID-19 waves is an essential priority.
AIM: The study presents information from Bulgarian and foreign surveys and available data from regional, international social and health organizations, government institutions, and departments regarding the situation with institutionalized elderly in Bulgaria during COVID-19 pandemic.
MATERIALS AND METHODS: A systematic review was used by searching the Web of Science, Science Direct, Scopus, and PubMed online databases of various legal and scientific sources for relevant and reliable information.
RESULTS: Bulgarian old people inhabiting specialized social institutions are at a much higher risk of coronavirus infection and disease. A significant part of them has severe impairments and accompanying chronic conditions, which instantly make them potential, quick, and easy victims of the pandemic. Residents of social homes are isolated from the outside world. They are forced to eat in the common dining room and to share the personal room with another accommodated individual. Compliance with social and physical distancing, as well as hygienic and anti-epidemic measures, turns out to be impossible. They communicate daily with staff who care for them and who are in constant contact with the external environment, which inevitably contributes to the spread of the virus in social institutions.
CONCLUSION: The pandemic put institutionalized elderly, a very vulnerable population group, at health risk and affected their well-being. The presented results confirmed the need for urgent change of policies in the long-term care and nursing home sector not only in preparation for future pandemics but also for the overall improvement of the quality of care provided.
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Rangachev A Marinov GK, Mladenov M. The impact and progression of the COVID-19 pandemic in Bulgaria in its first two years. Vaccines (Basel). 2022;10(11):1901. https://doi.org/10.3390/vaccines/0111901 PMid 36366409 DOI: https://doi.org/10.3390/vaccines10111901
Alexander D. European and Mediterranean Major Hazards Agreement. Disabled Persons in Viral Pandemics: The Example of Covid-19. France: Council of Europe; 2021.
Utsumi M, Makimoto K, Quroshi N, Ashida N. Types of infectious outbreaks and their impact in elderly care facilities: A review of the literature. Age Ageing. 2010;39(3):299-305. https://doi.org/10.1093/ageing/afq029 PMid:20332371 DOI: https://doi.org/10.1093/ageing/afq029
Centers for Disease Control. How COVID-19 Spreads. Atlanta. GA: Centers for Disease Control; 2020. Available from: https://www.cdc.gov/coronavirus/2019-n cov/prepare/ transmission.html [Last accessed on 2023 May 21].
Gardner W, states D, Bagley N. The Coronavirus and the risks to the elderly in long-term care. J Aging Soc Policy. 2020;32(4-5):310-5. https://doi.org/10.10801/08959420.2020.1750543 PMid 32245346 DOI: https://doi.org/10.1080/08959420.2020.1750543
Louie JK, Schnurr DP, Pan CY, Kiang D, Carter C, Tougaw S, et al. A summer outbreak of human metapneumovirus infection in a long-term-care facility. J Infect Dis. 2007;196(5):705-8. https://doi.org/10.10861/519846 PMid 17674312 DOI: https://doi.org/10.1086/519846
European Centre for Disease Prevention and Control. Surveillance of COVID-19 in Long-term Care Facilities in the EUIEEA. 2021. Stockholm: ECDC; 2021.
De AraUjo PO. Freitas MY, de Santana Carvalho ES, Peixoto TM, Servo ML, da Silva Santana L. et al. Institutionalized elderly: Vulnerabilities and strategies to cope with Covid-19 in Brazil. Invest Educ Enferm. 2021;39(1):eO7. https://doi.org/10.17533/udea.iee.v39n1eO7 PMid 33687811 DOI: https://doi.org/10.17533/udea.iee.v39n1e07
European Centre for Disease Prevention and Control (ECDC). Surveillance of COVID-19 at Long-term Care Facilities in the EU/EEA. stockholm: ECDC: 2020.
The European Union Agency for Fundamental Rights (FRA). Center for the Study of Democracy. Coronavirus COVID-19 Outbreak in the EU-fundamental Rights Implications. Sofia: Center for the Study of Democracy; 2020.
Eurofound. COVID-19 and Older People: Impact on their Lives, Support and Care. Luxembourg: Publications Office of the European Union; 2022.
Hussien H, Nastasa A, Apetrii M, Nistor I, Petrovic M, Covic A. Different aspects of frailty and COVID-19: Points to consider in the current pandemic and future ones. BMC Geriatr. 2021:21(1) 389. https://doi.org/10.1186/s12877-021-02316-5 PMid:34176479 DOI: https://doi.org/10.1186/s12877-021-02316-5
Tosheva E.YordanovaG, Lyubenova ME. Beforeandduringthe outbreak: Prerequisites for the high Covid-19 mortality rate in Bulgaria. Empirical insights from SHARE data. Rev lnclusiones. 2021:8:44-61. https://doi.org/10.5281/zenodo.8009870
Nimbekar TP, Atanasova MD. lnkov I. Clinical characteristics. treatment and outcome of novel Coronavirus pneumonia (COVID-19). lnt J Med Rev Case Rep. 2020;4(9):52. https//doi.org/10.5455/ijmrcr.novel-corona-virus-pneumonia-covid-19-review DOI: https://doi.org/10.5455/IJMRCR.novel-corona-virus-pneumonia-COVID-19-review
Sáez-López P, Arredondo-Provecho AB. Experiencia de colaboraci6n entre hospital y centros socio-sanitarios para la atenci6n de pacientes con COVID-19 [Collaboration experience betrveen hospitals and long-term care facilities for the care of COVID-19 patients]. Rev Esp Salud Publica. 2021;95:e202104053. PMid:33850095
Roxby AC, Greninger AL. Hatfield KM. Lynch JB, Dellit TH. James A, et al. Detection of SARS-CoV-2 among residents and staff members of an independent and assisted living community for older adults-Seattle, Washington, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):416-8. https://doi.org/10.15585/mmwr.mm6914e2 PMid:32271726 DOI: https://doi.org/10.15585/mmwr.mm6914e2
Mannucci E. Nreu 8, Monami M. Factors associated with increased all-cause mortality during the COVID-19 pandemic in Italy. lnt J Infect Dis. 2020;98:121-4. https://doi.org/10.10161.ijid.2020.06.077 PMid:32599284 DOI: https://doi.org/10.1016/j.ijid.2020.06.077
Ballin M, Bergman J, Kivipelto M, Nordstrom A, Nordstrom P. Excess mortality after COVID-19 in Swedish long-term care facilities. JAm Med Dir Assoc. 2021:22(8):1574-80.e8. https://doi.org/10.1016/jamda.2021.06.010 PMid34174196 DOI: https://doi.org/10.1016/j.jamda.2021.06.010
Panagiotou OA, Kosar CM, White EM, Bantis LE, Yang X, Santostefano CM, et al. Risk factors associated with all-cause 30-day mortality in nursing home residents with COVID-19. JAMA Intern Med. 2021;181(4):439-48. https://doi.org/10.1001/jamainternmed.2020.7968 PMid:33394006 DOI: https://doi.org/10.1001/jamainternmed.2020.7968
Romero MM, Cespedes AA, Sahuquillo MT, Zamora EB, Ballesteros CG, Alfaro VS. et al. COVID-19 outbreak in long term care facilities from Spain. Many lessons to learn. PLoS One. 2020;15(1O):e0241030. https://doi.org/10.13711/journal.pone.0241030 PMid:33108381 DOI: https://doi.org/10.1371/journal.pone.0241030
Amore S, Puppo E. Melara J, Terracciano E, Gentili S, Liotta G. Impact of COVID-19 on older adults and role of long-term care facilities during early stages of epidemic in Italy. Sci Rep. 2021;11(1):12530. https//doi.org/10.10381/541598-021-91992-9 PMid34131216 DOI: https://doi.org/10.1038/s41598-021-91992-9
Vokó Z, Pitter JG. The effect of social distance measures on COVID-19 epidemics in Europe: An interrupted time series analysis. Geroscience. 2020;42(4):1075-82. https://doi.org/10.1007/s11357-020-00205-0 PMid:32529592 DOI: https://doi.org/10.1007/s11357-020-00205-0
Dimova R, Stoyanova R, Blagoeva V, Mavrov M, Doykov M. COVID-19 mortality and related comorbidities in hospitalized patients in Bulgaria. Healthcare (Basel). 2022;10(8):1535. https://doi.org/10.3390/healthcare10081535 PMid:36011192 DOI: https://doi.org/10.3390/healthcare10081535
Lai CC, Wang JH, Ko WC, Yen MY, Lu MC, Lee CM, et al. COVID-19 in long-term care facilities: An upcoming threat that cannot be ignored. J Microbiol Immunol Infect. 2020;53(3):444-6. https://doi.org/10.1016/j.jmii.2020.04.008 PMid:32303483 DOI: https://doi.org/10.1016/j.jmii.2020.04.008
Rainwater-Lovett K, Chun K, Lessler J. Influenza outbreak control practices and the effectiveness of interventions in longterm care facilities: A systematic review. Influenza Other Respir Viruses. 2014;8(1):74-82. https://doi.org/10.1111/irv.12203 PMid:24373292 DOI: https://doi.org/10.1111/irv.12203
Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility-King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-81. https://doi.org/10.15585/mmwr.mm6913e1 PMid:32240128 DOI: https://doi.org/10.15585/mmwr.mm6913e1
Childs A, Zullo AR, Joyce NR, McConeghy KW, van Aalst R, Moyo P, et al. The burden of respiratory infections among older adults in long-term care: A systematic review. BMC Geriatr. 2019;19(1):210. https://doi.org/10.1186/s12877-019-1236-6 PMid:31382895 DOI: https://doi.org/10.1186/s12877-019-1236-6
Rahi M, Le Pluart D, Beaudet A, Ismaël S, Parisey M, Poey N, et al. Sociodemographic characteristics and transmission risk factors in patients hospitalized for COVID-19 before and during the lockdown in France. BMC Infect Dis. 2021;21(1):812. https://doi.org/10.1186/s12879-021-06419-7 PMid:34388990 DOI: https://doi.org/10.1186/s12879-021-06419-7
Rada AG. Covid-19: The precarious position of Spain's nursing homes. BMJ. 2020;369:mi554. https://doi.org/10.1136/bmj.m1554 Erratum in: BMJ. 2020:369:m1586. PMid:32312710 DOI: https://doi.org/10.1136/bmj.m1586
Garcla PB. Caracterfsticas epidemiologicas de Ios casos de COVID-19 notificados en el Distrito Sanitaria Almerfa. Revista espar'ola de salud pUblica. 2021{95):179.
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-6. https://doi.org/10.1001/jama.2020.4683 PMid 32203977 DOI: https://doi.org/10.1001/jama.2020.4683
Krumova P, UzunovaA. Health care for the elderly and old people during the Covid pandemic. Knowllnt J. 2023;55(4):581-5.
Boyle CA, Fox MH, Havercamp SM, Zubler J. The public health response to the COVID-19 pandemic for people vvith disabilities. Disabil Health J. 2020;113:00943. https://doi.org/10.1016/dhjo.2020.100943 PMid 32499132 DOI: https://doi.org/10.1016/j.dhjo.2020.100943
McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M. Schwartz NG, et al. Epidemiology of Covid-19 in a longterm care facility in King County. Washington. N Engl J Med. 2020;382(21) 2005-11. https://doi.org/10.1056/NEJMoa2005412 PMid:32220208 DOI: https://doi.org/10.1056/NEJMoa2005412
Rocard E, Sillitti P, Llena-Nozal A. COVID-19 in Long-term Care: Impact, Policy Responses and Challenges. In: OECD Health Working Papers, No. 131. Paris: OECD Publishing; 2021. https://doi.org/10.1787/b966f837-en DOI: https://doi.org/10.1787/b966f837-en
Baughman RA, stanley B, Smith KE. Second job holding among direct care workers and nurses: Implications for COVID-19 transmission in long-term care. Med Care Res Rev. 2022:79(1):151-60. https//doi.org/10.1177/1077558720974129 DOI: https://doi.org/10.1177/1077558720974129
Allinger 8, Adam G. Impact of Covid-19 on the Social Services Sector and the Role of Social Dialogue (Research for FORESEE Project VS/2021/0054) Jahr; 2022 Available from: https://socialemployers.eu [Last accessed on 2023 May 21].
European Commission. 2021 Long-term Care Report. Trends. Challenges and Opportunities in an Ageing Society. Vol. 1. Brussels: European Commission: 2021a. Available from: https://ec.europa.eu/social/main. jsp?catld=738&.1angld=en&publd=8396 [Last accessed on 2023 May 21].
Grabowski DC, Mor V Nursing home care in crisis in the wake of COVID-19. JAMA. 2020;324(1):23-4 https://doi.org/10.1001/jama2020.8524 PMid:32442303 DOI: https://doi.org/10.1001/jama.2020.8524
Organisation for Economic Co-operation and Development. OECD Policy Responses to Coronavirus (COVID-19). Rising from the COVID 19 Crisis: Policy Responses in the Long-term Care Sector. Paris. France: Organisation for Economic Co-operation and Development; 2021. https://doi.org/10.1787/5b0fd8cd-en DOI: https://doi.org/10.1787/5b0fd8cd-en
Giri S. Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: A scoping review of challenges and responses. Eur Geriatr Med. 2021:12(6):1127-36. https://doi.org/10.1007/s41999-021-00531-2 PMid:34136990 DOI: https://doi.org/10.1007/s41999-021-00531-2
Yen MY, Schwartz J, King CC, Lee CM, Hsueh PR, Society of Taiwan Long-term Care Infection Prevention and Control. Recommendations for protecting against and mitigating the COVID-19 pandemic in long-term care facilities. J Microbial lmmunol Infect. 2020;53(3):447-53. https://doi.org/10.1016/jmii2020.04.003 PMid 32303480 DOI: https://doi.org/10.1016/j.jmii.2020.04.003
Moraes EN, Viana LG, Resende LM, Vasconcellos LS, Moura AS, Menezes A, et al. COVID-19 in long-term care facilities for the elderly: Laboratory screening and disease dissemination prevention strategies. Cien Saude Colet. 2020;25(9):3445-58. https://doi.org/10.1590/1413-81232020259.20382020 PMid:32876277 DOI: https://doi.org/10.1590/1413-81232020259.20382020
WiddersA. Broom A. Broom J. SARS-CoV-2: The viral shedding vs infectivity dilemma. Infect Dis Health. 2020:25(3):210-5. https://doiorg/10.1016/idh.2020.05.002 PMid:32473952 DOI: https://doi.org/10.1016/j.idh.2020.05.002
Gandhi M, Yokoe DS. Havlir DV. Asymptomatic transmission, the Achilles· heel of current strategies to control Covid-19. N Engl J Med. 2020:382(22) 2158-60. https://doi.org/10.1056/nejme.2009.758 PMid:32329972 DOI: https://doi.org/10.1056/NEJMe2009758
Comas-Herrera A, Zalakafn J, Lemmon E, Henderson D, Litwin C. Hsu AT. et al. Mortality Associated with COVI D-19Outbreaks in Care Homes: Early International Evidence. International Long-term Care Policy Network CPEC-LSE; 2020. Available from: https://www.ontario.ca/page/how-ontario is-responding-covid-19#section-1%0ALTCcovid.org [Last accessed on 2023 May 21].
Patel, MC, Chaisson LH, Borgetti S, Burdsall D, Chugh RK, Hoff CR, et al. Asymptomatic SARS-CoV-2 infection and COVID-19 mortality during an outbreak investigation in a skilled nursing facility. Clin Infect Dis. 2020;71(11):2920-6. https://doi.org/10.1093/cid/ciaa.63 PMid 32548628 DOI: https://doi.org/10.1093/cid/ciaa763
Janssens H, Heytens S, Meyers E, De Schepper E, De Sutter A, Devleesschauwer B. et al. Pre-vaccination SARS-CoV-2 seroprevalence among staff and residents of nursing homes in Flanders (Belgium) in fall 2020. Epidemiol Infect. 2022:150:1-25. https://doi.org/10.1017/S095026882200036X PMid:35234113 DOI: https://doi.org/10.1017/S095026882200036X
Arons MM, Hatfield KM. Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med. 2020:382(22):2081-90. https://doi.org/10.1056/ NEJMoa2008457 PMid:32329971 DOI: https://doi.org/10.1056/NEJMoa2008457
Guan WJ. Ni ZY. Hu Y, Liang WH, Ou CQ, He JX. et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382 1708-20. https //doiorg/10.1056/ NEJMoa2002032 DOI: https://doi.org/10.1056/NEJMoa2002032
Deng G, Yin M, Chen X, Zeng F. Clinical determinants for fatality of 44,672 patients with COVID-19. Crit Care. 2020;24(1):179. https://doi.org/10.1186/s13054-020-02902-w PMid 32345311 DOI: https://doi.org/10.1186/s13054-020-02902-w
Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-6. https://doi.org/10.1038/s41586-020-2521-4 PMid 32640463 DOI: https://doi.org/10.1038/s41586-020-2521-4
Tur-Sinai A. Bentur N, Fabbietti P, Lamura G. Impact of the outbreak of the COVI D-19 pandemic on formal and informal care of community-dwelling older adults: Cross-national clustering of empirical evidence from 23 countries. Sustainability. 2021;13(13)7277. https//doi.org/10.3390/su13137277 DOI: https://doi.org/10.3390/su13137277
BOrsch-Supan A. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 8. Release Version: 8.0.0. SHARE ERIC. Data Set. Germany: Survey of Health, Ageing and Retirement in Europe; 2022. https://doi.org/10.6103/SHARE.w8.800
Bergmann M, Börsch-Supan A, editors. SHARE Wave 8 Methodology: Collecting Cross-national Survey Data in Times of COVID-19. Munich: MEA, Max Planck Institute for Social Law and Social Policy; 2021.
Aguilar-Palacio I, Maldonado L. Marcos-Campos I, Castei Feced S, Malo S. Aibar C. et al. Understanding the COVID-19 pandemic in nursing homes (Arag6n, Spain): Sociodemographic and clinical factors associated with hospitalization and mortality. Front Public Health. 2022;10:928174. https://doi.org/10.3389/fpubh.2022.928174 PMid:35875036 DOI: https://doi.org/10.3389/fpubh.2022.928174
Shimizu K, Maeda H, Sando E. Fujita A. Tashiro M. Tan aka T. et al. Epidemiology of SARS-CoV-2 infection in nursing facilities and the impact of their clusters in a Japanese core city. J Infect Chemother. 2022;28(7) 955-61. https://doi.org/10.1016/jiac 2022 04.010 PMid 35461770
Borgoni S, Kudryashova KS, Burka K, de Magalh8.es JP. Targeting immune dysfunction in aging. Ageing Res Rev. 2021:70 101410. https://doi.org/10.1016/arr.2021.101410 PMid:34280555 DOI: https://doi.org/10.1016/j.arr.2021.101410
Martin DE. Torrance BL, Haynes L, Bartley JM. Targeting Aging: Lessons Learned From lmmunometabolism and Cellular Senescence. Front lmmunol. 2021:12:7147 42. https://doi.org/10.3389/fimmu.2021.714742 PMid 34367184 DOI: https://doi.org/10.3389/fimmu.2021.714742
Bulut 0, Kilic G, Domlnguez-Andres J, Netea MG. Overcoming immune dysfunction in the elderly: Trained immunity as a novel approach. lnt lmmunol. 2020;32(12):741-53. https://doi.org/10.1093/intimm/dxaa052 PMid 32766848 DOI: https://doi.org/10.1093/intimm/dxaa052
Anand JC, Donnelly S, Milne A, Nelson-Seeker H, Vingare EL. Deusdad B, et al. The Covid-19 pandemic and care homes for older people in Europe-deaths, damage and violations of human rights. Eur J Soc Work. 2021;25(5):804-15. https://doi.org/10.1080/13691457.2021.1954886 DOI: https://doi.org/10.1080/13691457.2021.1954886
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