“It is important to evaluate the state-wide effort to reduce COVID-19 infections in MA nursing homes to determine what worked and in whom, so it can serve as a model for other states tackling this disease.”
Lewis Lipsitz, MD is the Director of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Chief of the Division of Gerontology at Beth Israel Deaconess Medical Center (BIDMC), and Professor of Medicine at HMS. His research is focused on age-related alterations in blood pressure and cerebral blood flow regulation and their relation to falls, syncope, and cognitive dysfunction. Dr. Lipsitz has served as Principal Investigator of an NIA-funded Program Project Grant for 26 years, an Older American Independence Center Grant for 15 years, and a Hartford Foundation Center of Excellence in Geriatric Medicine for 15 years. In these roles he has assembled multidisciplinary teams from multiple academic institutions and laboratories to study the mechanisms and management of several important clinical geriatric syndromes, including falls, syncope, dementia, delirium, and frailty. He is was Principal Investigator of an NIA Merit Award to study the physiologic mechanisms of frailty in old age, which led to his current NIA-funded clinical trial that examines the effect of Tai Chi exercises on physical function and health care costs in frail elderly residents of subsidized senior housing facilities. He is also Principal Investigator of an R01 from the NIA to study cerebrovascular mechanisms of falls. His recent translational research includes demonstrations that Tai Chi exercise can improve physical function and balance control in frail elderly people, vibrating insoles based on the principal of stochastic resonance can improve gait and balance in older people, and the treatment of hypertension with ACE inhibitors can improve cerebral blood flow and executive function.
RATIONALE: In April 2020, Massachusetts’ (MA) nursing homes (NH) became a national hotspot for COVID-19 infections with over 10,000 confirmed cases. More than half of the state’s COVID-19 deaths occurred among residents and staff of these facilities, particularly residents with Alzheimer’s disease and related dementias (ADRD). MA made $130 million of funding available for 2 months to NHs to improve infection control contingent on compliance with a new set of care criteria.
OBJECTIVE: Evaluate strategies to minimize spread of COVID-19 among older adults and their care providers within NHs, including mandatory testing of all residents and staff, a 28-point infection control check-list, and adherence to personal protective equipment (PPE) and resident cohorting requirements.
SETTING: NH facilities across Massachusetts compared to those in Connecticut, Rhode Island, New Hampshire, and Vermont.
POPULATION: All NH residents, including older adults with ADRD and/or Black race who are at greatest risk of morbidity and mortality from COVID-19.
DESIGN: Descriptive study using merged data from 4 MA NH audits (inspections); data sent by all MA NHs to the Massachusetts Center for Health Information Analysis (CHIA) regarding COVID infection rates, mortality, staffing, PPE, and hospitalizations; CHIA data on COVID-19 test results; and MDS data provided by Brown University's Gerontology Center. Compare rates of COVID-19 positive residents between NHs in Mass and other New England state settings stratified by the cumulative prevalence of SARS-CoV-2 in the area in which each facility is located, and by the facility distributions of ADRD diagnoses or Black race.
OUTCOMES: Primary outcomes will include changes in the weekly rates of new COVID-19 cases among facility residents and staff, and resident mortality rates associated with the infection over the 2-month intervention period.
IMPACT: The information garnered from this robust state-wide effort to manage COVID-19 in MA NHs could serve as a model for other states and health care systems. We will disseminate the MA experience through various modalities and national organizations, and ultimately leverage what is learned to help protect the millions of American nursing home residents, including those most vulnerable with ADRD and Black race.