Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
J Am Med Dir Assoc. 2022 Sep;23(9):1608.e9-1608.e18. doi: 10.1016/j.jamda.2022.07.003. Epub 2022 Jul 13.
We aimed to explore the effects of the Dutch COVID-19 lockdown (March 20-May 25, 2020) on mood, behavior, and social and cognitive functioning of older residents of long-term care facilities (LTCFs) prospectively.
Mixed methods: historically controlled longitudinal cohort study and focus groups.
Residents of Dutch LTCFs.
Residents who were assessed during and prior to the lockdown were compared to residents of the same wards with 2 assessments prior to the lockdown. We used mixed models and generalized estimating equation analyses to explore differences in changes in mood, withdrawal and aggressive behavior, loneliness and conflict, and cognition and delirium. We also explored whether the effect of the lockdown differed for different subgroups. In 2 online focus groups, LTCF care professionals, ranging from care staff to physicians, reflected on their experiences of the effect of the lockdown and the cohort study results.
The lockdown group of 298 residents was compared to the control group of 625 residents. Self-reported mood symptoms showed a slightly greater increase during the lockdown. During the first half of the lockdown, the level of conflict with other residents decreased whereas it increased in the control group. The subgroup with moderate-severe cognitive impairment showed a decrease in withdrawal during the lockdown, whereas the group with no-mild cognitive impairment showed a statistically nonsignificant relative increase. Professionals described great individual variation in the effects of the lockdown on residents. Facilities attempted to preserve the experienced positive effects, for example, by promoting tranquility in shared rooms and continuing to organize individualized ward-based activities.
We did not find clinically relevant negative effects of the lockdown on mood, behavior, and social and cognitive functioning in older residents of LTCFs at the group level. Possibly, staff mitigated the negative effects at the group level. Meanwhile, they learned lessons that they continue to apply to enhance resident well-being.
本研究旨在前瞻性地探讨 2020 年 3 月 20 日至 5 月 25 日荷兰 COVID-19 封锁对长期护理机构（LTCF）中老年人的情绪、行为以及社会和认知功能的影响。
混合方法：历史性对照纵向队列研究和焦点小组。
荷兰 LTCF 的居民。
在封锁期间和之前接受评估的居民与在封锁之前接受过 2 次评估的同一病房的居民进行比较。我们使用混合模型和广义估计方程分析来探讨情绪、退缩和攻击行为、孤独和冲突以及认知和谵妄变化的差异。我们还探讨了封锁对不同亚组的影响是否不同。在 2 个在线焦点小组中，从护理人员到医生的 LTCF 护理专业人员反思了他们对封锁和队列研究结果的影响的经验。
298 名居民组成的封锁组与 625 名居民组成的对照组进行了比较。自我报告的情绪症状在封锁期间略有增加。在封锁的前半段，与其他居民的冲突水平下降，而对照组的冲突水平上升。认知障碍程度为中度至重度的亚组在封锁期间出现退缩减少，而认知障碍程度为无至轻度的亚组则出现相对增加，但无统计学意义。专业人员描述了封锁对居民的影响存在很大的个体差异。设施试图保持体验到的积极影响，例如通过促进共享房间的宁静并继续组织基于病房的个性化活动。
我们没有发现长期护理机构中老年人的情绪、行为以及社会和认知功能在封锁期间出现临床相关的负面变化。可能是工作人员在群体层面上减轻了负面影响。同时，他们吸取了教训，继续应用这些经验来提高居民的幸福感。
