Experiences with COVID-19 cluster infections in geriatric care facilities.

Dear Editor,

Geriatric care facilities, where vulnerable older adults live, have struggled with the risk of coronavirus disease (COVID‐19) cluster infections and COVID‐19‐related death.1, 2 People with dementia (PWD), who constitute the majority of facility‐dwelling residents, are at high risk of COVID‐19 infection and worse outcomes. Facilities have made efforts, such as changing care methods while adhering to the infection prevention measures and visiting restrictions as needed.4, 5 However, to our knowledge, there are no reports on geriatric care facilities' experiences with COVID‐19 cluster infections or their difficulties with dementia care during such times. Therefore, we explored COVID‐19 cluster infection experiences in geriatric care facilities (medical and long‐term care facilities for older adults), including those of PWD, during the 2 years following the pandemic's onset. Sharing experiences with COVID‐19 cluster infections in geriatric care facilities provides a valuable resource in considering future measures for the prevention and early convergence of cluster infections.

In this study, an online self‐administered questionnaire survey of medical and long‐term care facilities was conducted from October to December 2021 by Hiroshima University and the Japan Geriatrics Society. Medical facilities included hospitals specializing in PWD treatment and recuperation, mental illness and chronic diseases requiring long‐term care. Of 686 facilities that participated, 16 (2.3%) responded that they had experienced COVID‐19 cluster infections; these included one medical facility (dementia treatment unit) and 15 long‐term care facilities (care homes for older people and group homes for PWD). Figure 1 shows the difficulties experienced while responding to cluster infections, and the greatest impact was on staff. The most frequent answer was psychological burden on staff, followed by physical burden on staff and lack of staff available to work. Among the 16 respondents, eight indicated that it was difficult for their facilities to cooperate with local governments and public health centers that were responsible for public health activities, such as surveillance, distribution of medical equipment, and coordinating admission of infected persons. Furthermore, five reported that their facilities cared for infected persons because local hospitals were overwhelmed and could not admit them. Difficulties in implementing infection control measures, such as a lack of personal protective equipment and difficulties with zoning, have also been reported.

Figure 1

Difficulties experienced while responding to cluster infections in medical and long‐term care facilities for older adults.

For the 14 facilities that answered that some cluster‐infected persons had dementia, we asked about the difficulties in caring for infected dementia residents. The most frequent answers were obtaining residents' cooperation in precautions, such as wearing masks and hand sanitation, and ensuring that staff were available to work. The second frequent answers were for care in individual residence rooms and responses to worsening dementia symptoms, followed by refusal of hospitalization due to the infected person having dementia and difficulties transporting the infected PWD for hospitalization.

The present study revealed that COVID‐19 cluster infections in medical and long‐term care facilities for older adults led to a serious disruption in typical individualized dementia care and forced the facilities to practice care for infected persons normally provided by specialized hospitals on site due to overwhelmed community healthcare systems. PWD are vulnerable to changes in dementia care and their environment, resulting in increased psychological stress and worsening dementia symptoms with cluster infections. The infection itself can also affect psychosomatic conditions of PWD. Our findings suggest the importance of simulating cluster infections, including responses regarding PWD, and developing business continuity planning for one facility, multiple facilities and regional units to ensure continuity of dementia care according to the symptoms and conditions of PWD.

Disclosure statement

The authors declare no conflict of interest.