Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, Jennifer Kim, DNP, GNP-BC, GS-C, FNAP, FAANP, GAPNA Treasurer, discusses insights into vaccine hesitancy among skilled-nursing facility (SNF) staff, a mobile unit for administering monoclonal antibody therapy to SNF residents with COVID-19, and strategies to help residents build and maintain social connections during the pandemic.

Lessons learned from frontline skilled nursing facility staff regarding COVID-19 vaccine hesitancy
J Am Geriatr Soc. 2021 Mar 25.

Summary: In town hall meetings with 196 front-line staff from 50 skilled-nursing facilities (SNFs), most staff reported getting information about the COVID-19 vaccine from friends or social media but were interested in learning more from experts. The most frequently reported concerns were how quickly the vaccine was developed and side effects, including infertility and pregnancy-related concerns.

Commentary by Dr Kim: Although large randomized trials have shown that COVID-19 vaccinations are safe and effective, a tsunami of vaccine misinformation has undermined these results and contributed to vaccine hesitancy and refusal, even among front-line workers in long-term care (LTC) facilities. Vaccination of residents and direct care workers is the linchpin of mitigating COVID-19 within LTC facilities. To improve COVID-19 vaccination rates among LTC front-line staff members, we must first understand what is driving them to refuse vaccination.

This article is important because it identifies the common questions and comments LTC staff members verbalized about the COVID-19 vaccination during town hall meetings. It also provides exemplar responses to common concerns that are grounded in evidence-based science and that also show respect for staff members’ concern. 

This intervention was cost-effective, and also provided a way in which geriatricians could respond to vaccination concerns and questions in real time. It is important to note that the geriatricians facilitating these town hall meetings stressed that the purpose of the sessions was to dispel vaccination myths and to answer questions, not to convince all front-line staff members to get vaccinated.

The nursing profession is consistently identified by Americans as the most ethical and honest profession in the annual Gallup Poll. Given the strength of the public’s trust, gerontological advanced practice registered nurses and all advanced practice providers should take an active role in dispelling myths about COVID-19 vaccinations.

A mobile unit overcomes the challenges to monoclonal antibody infusion for COVID-19 in skilled care facilities
J Am Geriatr Soc. 2021;69(4):868-873.

Summary: A mobile infusion unit staffed by registered nurses from an academic medical center and supported by SNF staff administered antispike monoclonal antibody treatment to 45 eligible residents (average age, 77.8 years) of SNFs at high risk for COVID-19 complications. The infusions were administered an average of 4.3 days (range, 1-8 days) after COVID-19 diagnosis. At 14-days postinfusion, no deaths or hospitalizations due to COVID-19 progression, 2 emergency department visits, and 3 hospitalizations occurred for a combined event rate of 11.1%. One adverse event was reported: a patient developed shortness of breath due to congestive heart failure during monoclonal antibody infusion.  

Commentary by Dr Kim: In November 2020, the US Food and Drug Administration granted Emergency Use Authorization for the use of monoclonal antibody infusions (bamlanivimab and casirivimab with imdevimab) in high-risk, nonhospitalized patients with COVID-19. Although older adults living in LTC settings carry the highest risk for COVID-19 morbidity and mortality, most do not have access to this therapy given the complicated logistics of transporting frail older adults to outpatient infusion centers and the risks of spreading infection within the community.

This article shows a model of care that included collaboration between an academic medical center and over 50 local SNFs. The medical center deployed a mobile interprofessional team (desk operator, nurse practitioner, physician, registered nurse, pharmacy) that provided monoclonal antibody infusions to 45 SNF residents with COVID-19 infections, most of whom would have otherwise been unable to access this therapy.

Although the sample size is very small (N=45), only 11.1% of residents who received monoclonal antibody therapy were hospitalized or presented to the emergency department within 14 days of infusion, which is below the predicted event rate for this population. Not only is this innovative strategy a way to reduce the viral load in those already infected with COVID-19, but also it is a means to mitigate the spread of COVID-19 within LTC facilities. As programs like this continue to be evaluated, it is important to consider how this mobile model can be adapted to other disease management strategies that commonly affect this population.

Social connection in long-term care homes: a scoping review of published research on the mental health impacts and potential strategies during COVID-19
J Am Med Dir Assoc. 2021;22(2):228-237.e25

Summary: Researchers identified 61 studies that tested associations between social connection and mental health outcomes in LTC residents and highlighted 12 strategies that could be adapted by LTC residents, families, and staff to help residents build and maintain social connections.

Commentary by Dr Kim: The COVID-19 pandemic has disproportionately affected the physical and mental health of older adults living in LTC facilities. This population’s elevated risk of COVID-19­–associated morbidity and mortality has necessitated implementation of strict infection control measures, including limitation and/or elimination of in-house group activities and prohibition of visitors. Although these infection control measures have been deemed essential, there is equal concern for the unintended consequences of decreased social connection among residents.  

This review article includes appraisal and summarization of 133 published research studies that quantify social connection in LTC residents. Nearly half of these studies (n=61) evaluated the association between social connection and mental health, the results of which propose that increased social connection in this population is associated with improved mental health. 

Within this review, the authors identified 12 strategies that have shown a statistically positive impact on social connection:

  • Pain management
  • Assessing hearing and vision loss
  • Sleeping at night (not during the day)
  • Finding opportunities for creative expression
  • Exercising
  • Maintaining religious and cultural practices
  • Gardening (indoor and outdoor)
  • Visiting with pets (including robotic pets)
  • Using technology to communicate
  • Laughing together
  • Reminiscing about events, people, and places
  • Addressing communication impairments and communicating nonverbally

It is important for gerontological APRNs and all advanced practice providers to advocate for use of these strategies that may be implemented or adapted in the midst of strict visitation and social activity guidelines.

References

1. Berry SD, Johnson KS, Myles L, et al. Lessons learned from frontline skilled nursing facility staff regarding COVID-19 vaccine hesitancy. J Am Geriatr Soc. 2021 Mar 25. doi:10.1111/jgs.17136

2. Tulledge-Scheitel S, Bell SJ, Larsen JJ, et al. A mobile unit overcomes the challenges to monoclonal antibody infusion for COVID-19 in skilled care facilities. J Am Geriatr Soc. 2021;69(4):868-873. doi:10.1111/jgs.17090

3. Bethell J, Aelick K, Babineau J, et al. Social connection in long-term care homes: a scoping review of published research on the mental health impacts and potential strategies during COVID-19. J Am Med Dir Assoc. 2021;22(2):228-237.e25. doi: 10.1016/j.jamda.2020.11.025