Department of Architecture, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA.
Department of Landscape Architecture and Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, TX, USA.
J Am Med Dir Assoc. 2022 Feb;23(2):272-279.e1. doi: 10.1016/j.jamda.2021.12.026. Epub 2021 Dec 24.
Nursing homes (NHs) are important health care and residential environments for the growing number of frail older adults. The COVID-19 pandemic highlighted the vulnerability of NHs as they became COVID-19 hotspots. This study examines the associations of NH design with COVID-19 cases, deaths, and transmissibility and provides relevant design recommendations.
A cross-sectional, nationwide study was conducted after combining multiple national data sets about NHs.
A total of 7785 NHs were included in the study, which represent 50.8% of all Medicare and/or Medicaid NH providers in the United States.
Zero-inflated negative binomial models were used to predict the total number of COVID-19 resident cases and deaths, separately. The basic reproduction number (R) was calculated for each NH to reflect the transmissibility of COVID-19 among residents within the facility, and a linear regression model was estimated to predict log(R - 1). Predictors of these models included community factors and NHs' resident characteristics, management and rating factors, and physical environmental features.
Increased percentage of private rooms, larger living area per bed, and presence of a ventilator-dependent unit are significantly associated with reductions in COVID-19 cases, deaths, and transmissibility among residents. After setting the number of actual residents as the exposure variable and controlling for staff cases and other variables, increased number of certified beds in the NH is associated with reduced resident cases and deaths. It also correlates with reduced transmissibility among residents when other risk factors, including staff cases, are controlled.
Architectural design attributes have significant impacts on COVID-19 transmissions in NHs. Considering the vulnerability of NH residents in congregated living environments, NHs will continue to be high-risk settings for infection outbreaks. To improve safety and resilience of NHs against future health disasters, facility guidelines and regulations should consider the need to increase private rooms and living areas.
养老院（NHs）是为数众多的体弱老年人的重要医疗保健和居住环境。随着 COVID-19 疫情的爆发，NHs 成为 COVID-19 的热点地区，这突显了它们的脆弱性。本研究考察了 NH 设计与 COVID-19 病例、死亡和传染性的关联，并提供了相关的设计建议。
在合并了多个关于 NH 的全国性数据集后，进行了一项横断面、全国性研究。
共有 7785 家 NH 被纳入研究，代表了美国所有 Medicare 和/或 Medicaid NH 提供者的 50.8%。
使用零膨胀负二项模型分别预测 COVID-19 居民病例和死亡的总数。为每个 NH 计算基本繁殖数（R），以反映 COVID-19 在设施内居民之间的传染性，并估计线性回归模型来预测 log(R-1)。这些模型的预测因子包括社区因素和 NH 的居民特征、管理和评级因素以及物理环境特征。
私人房间比例增加、每张床的居住面积增大以及存在依赖呼吸机的单元与 COVID-19 居民病例、死亡和传染性降低显著相关。在将实际居民人数设置为暴露变量并控制工作人员病例和其他变量后，NH 中增加的认证床位数量与居民病例和死亡减少相关。当控制工作人员病例等其他危险因素时，它还与居民之间的传染性降低相关。
建筑设计属性对 NH 中的 COVID-19 传播有重大影响。考虑到 NH 居民在集中居住环境中的脆弱性，NH 将继续成为感染爆发的高风险场所。为了提高 NH 对未来健康灾害的安全性和恢复能力，设施准则和法规应考虑增加私人房间和居住面积的需求。
