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意大利养老院在新冠疫情期间的不良事件:一项全国性调查。

Adverse Events in Italian Nursing Homes During the COVID-19 Epidemic: A National Survey.

作者信息

Lombardo Flavia L, Salvi Emanuela, Lacorte Eleonora, Piscopo Paola, Mayer Flavia, Ancidoni Antonio, Remoli Giulia, Bellomo Guido, Losito Gilda, D'Ancona Fortunato, Canevelli Marco, Onder Graziano, Vanacore Nicola

机构信息

National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.

National Center for Drug Research and Evaluation, Italian National Institute of Health, Rome, Italy.

出版信息

Front Psychiatry. 2020 Sep 30;11:578465. doi: 10.3389/fpsyt.2020.578465. eCollection 2020.

Abstract

Older people living in nursing homes (NHs) are particularly vulnerable in the ongoing COVID-19 pandemic, due to the high prevalence of chronic diseases and disabilities (e.g., dementia). The phenomenon of adverse events (AEs), intended as any harm or injury resulting from medical care or to the failure to provide care, has not yet been investigated in NHs during the pandemic. We performed a national survey on 3,292 NHs, either public or providing services both privately and within the national health system, out of the 3,417 NHs covering the whole Italian territory. An online questionnaire was addressed to the directors of each facility between March 24 and April 27, 2020. The list of NHs was provided by the Dementia Observatory, an online map of Italian services for people with dementia, which was one of the objectives of the implementation of the Italian National Dementia Plan. About 26% of residents in the Italian NHs for older people listed within the Dementia Observatory site had dementia. The objective of our study was to report the frequency of AEs that occurred during the months when SARS-CoV-2 spreading rate was at its highest in the Italian NHs and to identify which conditions and attributes were most associated with the occurrence of AEs by means of multivariate regression logistic analysis. Data are referred to 1,356 NHs that participated in the survey. The overall response rate was 41.2% over a time-period of six weeks (from March 24 to May 5). About one third of the facilities (444 out of 1,334) (33.3%) reported at least 1 adverse event, with a total of 2,000 events. Among the included NHs, having a bed capacity higher than the median of 60 beds (OR=1.57, CI95% 1.17-2.09; p=0.002), an observed increased in the use of psychiatric drugs (OR=1.80, CI95% 1.05-3.07; p=0.032), adopting physical restraint measures (OR=1.97, CI95% 1.47-2.64; p<0.001), residents hospitalized due to flu-like symptoms (OR =1.73, CI95% 1.28-2.32; p<0.001), and being located in specific geographic areas (OR=3.59, CI95% 1.81-7.08; OR = 2.90, CI95% 1.45-5.81 and OR = 4.02, CI05% 2.01-8.04 for, respectively, North-West, North-East and Centre vs South, p<0.001) were all factors positively associated to the occurrence of adverse events in the facility. Future recommendations for the management and care of residents in NHs during the COVID-19 pandemic should include specific statements for the most vulnerable populations, such as people with dementia.

摘要

由于慢性病和残疾(如痴呆症)的高患病率,住在养老院的老年人在当前的新冠疫情中尤其脆弱。不良事件(AE)是指因医疗护理或未能提供护理而导致的任何伤害或损伤,在疫情期间养老院中的这一现象尚未得到调查。我们对意大利全国3417家覆盖全境的养老院中的3292家进行了调查,这些养老院既有公立的,也有在国家卫生系统内提供私人服务的。2020年3月24日至4月27日期间,我们向每家养老院的院长发送了一份在线问卷。养老院名单由痴呆症观察站提供,它是意大利为痴呆症患者提供服务的在线地图,也是意大利国家痴呆症计划实施的目标之一。痴呆症观察站网站列出的意大利养老院中,约26%的老年居民患有痴呆症。我们研究的目的是报告在意大利养老院中新冠病毒传播率最高的几个月里发生的不良事件的频率,并通过多因素回归逻辑分析确定哪些情况和特征与不良事件的发生最相关。数据来自参与调查的1356家养老院。在六周的时间里(从3月24日至5月5日),总体回复率为41.2%。约三分之一的养老院(1334家中的444家)(33.3%)报告了至少1起不良事件,共计2000起事件。在纳入的养老院中,床位容量高于60张床位中位数(OR=1.57,95%CI 1.17-2.09;p=0.002)、观察到精神科药物使用增加(OR=1.80,95%CI 1.05-3.07;p=0.032)、采取身体约束措施(OR=1.97,95%CI 1.47-2.64;p<0.001)、因流感样症状住院的居民(OR =1.73,95%CI 1.28-2.32;p<0.001)以及位于特定地理区域(与南部相比,西北部、东北部和中部的OR分别为3.59,95%CI 1.81-7.08;OR = 2.90,95%CI 1.45-5.81和OR = 4.02,95%CI 2.01-8.04,p<0.001)都是与养老院中不良事件发生呈正相关的因素。关于新冠疫情期间养老院居民管理和护理的未来建议应包括针对最脆弱人群(如痴呆症患者)的具体说明。

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