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1. Efficacy of COVID-19 control measures on post-vaccination outbreak in Italian Long Term Care Facilities: implications for policies

Author

Alba Malara, Marianna Noale, Caterina Trevisan, Angela Marie Abbatecola, Gilda Borselli, Carmine Cafariello, Pietro Gareri, Stefano Fumagalli, Enrico Mossello, Stefano Volpato, Fabio Monzani, Alessandra Coin, Chukwuma Okoye, Giuseppe Bellelli, Stefania Del Signore, Gianluca Zia, Raffaele Antonelli Incalzi, Annapina Palmieri, Giorgio Fedele, Graziano Onder, and The GeroCovid Vax Working Group

Subjects
Long Term Care Facilities (LTCFS), outbreak control measures, COVID-19 vaccination, SARS CoV-2 infection, pandemic fatigue, Public aspects of medicine, RA1-1270
Abstract

BackgroundNumerous individual and organizational factors can influence the spread of SARS-CoV-2 infection in Long Term Care Facilities (LTCFs). A range of outbreak control measures are still implemented in most facilities involving administrations, staff, residents and their families. This study aims to evaluate which measure could influence the transmission of SARS-CoV-2 infection among residents during the period March 2021-June 2022.MethodsWe enrolled 3,272 residents aged ≥60 years. The outbreak control measures adopted to prevent or manage the infection included entry regulations, contact-regulating procedures, and virological surveillance of residents and staff. The association between LTCFs' and participants' characteristics with new cases of COVID-19 infections was analyzed using multilevel logistic regression models.ResultsIn 33.8% of the facilities 261 cases of SARS-CoV-2 infection were reported. Among participant characteristics, gender and age were not associated with SARS-CoV-2 infection, while having received the vaccine booster dose was protective against infection [Odds Ratio (OR) = 0.34, 95% Confidence Interval (CI) 0.12–0.99, p = 0.048]. In addition, the implementation of protected areas for family visits was associated with a significant reduction of the probability of infections (OR = 0.18, 95% CI 0.03–0.98, p = 0.047). Overall, about 66% of the variability in the probability of SARS-CoV-2 infection during the observational period may be due to facility structure characteristics and 34% to the participant characteristics.ConclusionsThese data showed that vaccination booster doses and family visit restriction-control are still needed to make the LTCFs safer against SARS-CoV-2 infection.

Published
2023
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2. COVID-19 Signs and Symptom Clusters in Long-Term Care Facility Residents: Data from the GeroCovid Observational Study

Author

Alba Malara, Marianna Noale, Angela Marie Abbatecola, Gilda Borselli, Carmine Cafariello, Stefano Fumagalli, Pietro Gareri, Enrico Mossello, Caterina Trevisan, Stefano Volpato, Fabio Monzani, Alessandra Coin, Giuseppe Bellelli, Chukwuma Okoye, Stefania Del Signore, Gianluca Zia, Raffaele Antonelli Incalzi, and on behalf of the GeroCovid LTCFs Working Group

Subjects
COVID-19, long term care facilities, gerocovid observational study, symptoms cluster, Medicine (General), R5-920, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Background: Long-term care facility (LTCF) residents often present asymptomatic or paucisymptomatic features of SARS-CoV-2 infection. We aimed at investigating signs/symptoms, including their clustering on SARS-CoV-2 infection and mortality rates associated with SARS-CoV-2 infection in LTCF residents. Methods: This is a cohort study of 586 aged ≥ 60 year-old residents at risk of or affected with COVID-19 enrolled in the GeroCovid LTCF network. COVID-19 signs/symptom clusters were identified using cluster analysis. Cluster analyses associated with SARS-CoV-2 infection and mortality were evaluated using logistic regression and Cox proportional hazard models. Results: Cluster 1 symptoms (delirium, fever, low-grade fever, diarrhea, anorexia, cough, increased respiratory rate, sudden deterioration in health conditions, dyspnea, oxygen saturation, and weakness) affected 39.6% of residents and were associated with PCR swab positivity (OR = 7.21, 95%CI 4.78–10.80; p < 0.001). Cluster 1 symptoms were present in deceased COVID-19 residents. Cluster 2 (increased blood pressure, sphincter incontinence) and cluster 3 (new-onset cognitive impairment) affected 20% and 19.8% of residents, respectively. Cluster 3 symptoms were associated with increased mortality (HR = 5.41, 95%CI 1.56–18.8; p = 0.008), while those of Cluster 2 were not associated with mortality (HR = 0.82, 95%CI 0.26–2.56; p = 730). Conclusions: Our study highlights that delirium, fever, and low-grade fever, alone or in clusters should be considered in identifying and predicting the prognosis of SARS-CoV-2 infection in older LTCF patients.

Published
2022
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3. Monitoring COVID-19 vaccine use in Italian long term care centers: The GeroCovid VAX study

Author

Angela Marie Abbatecola, Raffaele Antonelli Incalzi, Alba Malara, Annapina Palmieri, Anna Di Lonardo, Giorgio Fedele, Paola Stefanelli, Gilda Borselli, Marcello Russo, Marianna Noale, Stefano Fumagalli, Pietro Gareri, Enrico Mossello, Caterina Trevisan, Stefano Volpato, Fabio Monzani, Alessandra Coin, Giuseppe Bellelli, Chukwuma Okoye, Susanna Del Signore, Gianluca Zia, Elisa Bottoni, Carmine Cafariello, Graziano Onder, Abbatecola, A, Incalzi, R, Malara, A, Palmieri, A, Di Lonardo, A, Fedeli, G, Stefanelli, P, Borselli, G, Russo, M, Noale, M, Fumagalli, S, Gareri, P, Mossello, E, Trevisan, C, Volpato, S, Monzani, F, Coin, A, Bellelli, G, Okoye, C, Del Signore, S, Zia, G, Bottoni, E, Cafariello, C, and Onder, G

Subjects
Aged, 80 and over, COVID-19 Vaccines, Frailty, General Veterinary, General Immunology and Microbiology, SARS-CoV-2, Public Health, Environmental and Occupational Health, COVID-19, COVID-19 vaccine, Elderly, Frailty syndrome, GeroCovid Vax, Long term care (LTC), Nursing homes (NH), Safety, Aged, Humans, Long-Term Care, Infectious Diseases, 80 and over, Molecular Medicine
Abstract

The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample.

Published
2022
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4. Diabetes Affects Antibody Response to SARS-CoV-2 Vaccination in Older Residents of Long-Term Care Facilities: Data From the GeroCovid Vax Study

Author

Enrico, Virgilio, Caterina, Trevisan, Angela, Abbatecola, Alba, Malara, Annapina, Palmieri, Giorgio, Fedele, Paola, Stefanelli, Pasqualina, Leone, Ilaria, Schiavoni, Stefania, Maggi, Stefano, Volpato, Raffaele Antonelli Incalzi, Graziano, Onder, the GeroCovid Vax Working Group, Angela Marie Abbatecola, Domenico, Andrieri, Francesca, Arenare, Viviana, Bagalà, Baldovin, Tatjana, Riccardo, Bernardi, Alessandra, Bianchi, Paola, Bianchi, Raffaella, Bisceglia, Ivan, Bissoli, Fabio, Bontempi, Gilda, Borselli, Luigi, Bottaro, Elisa, Bottoni, Silvia, Brandi, Claudio, Bravin, Maria Adele Buizza, Carmine, Cafariello, Alessia Maria Calabrese, Valeria, Calsolaro, Marta, Canepa, Carla, Capasso, Mariagrazia, Capuano, Sebastiano, Capurso, Gabriele, Carbone, Marialudovica, Carducci, Silvia, Carino, Nicoletta, Cattaneo, Francesco, Ceravolo, Maria Angelica Dorotea Chiesara, Danila, Clerici, Pierpaolo, Clerici, Coin, Alessandra, Vieri, Collacchioni, Mauro, Colombo, Michela, Compiano, Giuseppina, Costanza, Giovanna, Crupi, Roberta, Cucunato, Manuela Marina D'Abramo, Emilia, D'Agostino, Ferdinando, D'Amico, Antonio De Simone, Stefania Del Vecchio, Maria, Deleo, Annalaura, Dell'Armi, Tommasina Di Brango, Anna Di Lonardo, Maria Raffaella Di Nanno, Babette, Dijk, Luisa, Elmo, Marisa, Ferraro, Christian, Ferro, Claudia, Fiorucci, Francesca, Fortunato, Pasquale, Froncillo, Domenico, Galasso, Nicola, Galdiero, Caterina, Galdiero, Stefania, Gallo, Pier Paolo Gasbarri, Maria Grazia Gennai, Giuliana Ghiselli Ricci, Elisa, Giribaldi, Carmen, Godeanu, Samuele, Gommaraschi, Roberta, Granata, Giada Ida Greco, Angela, Greco, Antonio, Grillo, Gianbattista, Guerrini, Mauro, Guglielmo, Labjona, Haxhiaj, Claudio Giuseppe Iacovella, Marina, Indino, Valerio Alex Ippolito, David, Kanah, Liudmila, Kountsevich, Jovan, Leci, Limongi, Federica, Agata, Lipari, Vincenzo, Longo, Leonarda, Maltese, Maria, Marotta, Giuseppe, Mazzarella, Hior, Melnik, Pasquale, Minchella, Paolo, Moneti, Fabio, Monzani, Walter, Morandotti, Francesco, Morelli, Maria Grazia Mortola, Marianna, Noale, Chukwuma, Okoye, Patrizia, Orlanducci, Barbara, Paganelli, Michele, Pagano, Nicola, Pagano, Raffaele, Palladino, Magda, Palumeri, Simone, Paolini, Raimondo, Paternò, Angela, Pavan, Loris, Pelucchi, Agostino, Perri, Francesco, Perticone, Rosanna, Pesce, Pigozzo, Sabrina, Francesco, Pili, Rosa, Prato, Rosanna, Pullia, Ahmad Amedeo Qasem, Francesco Raffaele Addamo, Cecilia, Raffaelli, Vincenzo, Restivo, Michela Fernanda Rigon, Franco, Romagnoni, Carmine, Romaniello, Valentina, Romano, Maria Cristina Ruberto, Marcello, Russo, Bruno, Sala, Sara, Sambo, Maria Concetta Sciurti, Antonietta, Scriva, Luca, Secchi, Vincenzo, Settembrini, Federica, Sirianni, Deborah, Spaccaferro, Fausto, Spadea, Manuela, Stefanelli, Brunella, Stelitano, Stefania, Stringhini, Andrea, Tarsitano, Camilla, Terziotti, Rita, Ursino, Giovanni, Veneziano, Maria Teresa Vigliotta, Marco, Vignati, Eva, Vignola, Maria, Visconti, Susanna, Vozzi, and Sabrina, Zaccone

Subjects
Type 2 diabetes, antibody response, SARS-CoV-2 vaccination, long-term care facilities (LTCFs), older adults, Advanced and Specialized Nursing, SARS-CoV-2 vaccination, Endocrinology, Diabetes and Metabolism, Internal Medicine, Type 2 diabetes, long-term care facilities (LTCFs), antibody response, older adults
Abstract

OBJECTIVE Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTCFs) and tested for differences according to antidiabetic treatment. RESEARCH DESIGN AND METHODS For this analysis, 555 older residents of LTCFs participating in the GeroCovid Vax study were included. SARS-CoV-2 trimeric S immunoglobulin G (anti-S IgG) concentrations using chemiluminescent assays were tested before the first dose and after 2 and 6 months. The impact of diabetes on anti-S IgG levels was evaluated using linear mixed models, which included the interaction between time and presence of diabetes. A second model also considered diabetes treatment: no insulin therapy (including dietary only or use of oral antidiabetic agents) and insulin therapy (alone or in combination with oral antidiabetic agents). RESULTS The mean age of the sample was 82.1 years, 68.1% were women, and 25.2% had diabetes. In linear mixed models, presence of diabetes was associated with lower anti-S IgG levels at 2 (β = −0.20; 95% CI −0.34, −0.06) and 6 months (β = −0.22; 95% CI −0.37, −0.07) after the first vaccine dose. Compared with those without diabetes, residents with diabetes not using insulin had lower IgG levels at 2- and 6-month assessments (β = −0.24; 95% CI −0.43, −0.05 and β = −0.30; 95% CI −0.50, −0.10, respectively), whereas no differences were observed for those using insulin. CONCLUSIONS Older residents of LTCFs with diabetes tended to have weaker antibody response to COVID-19 vaccination. Insulin treatment might buffer this effect and establish humoral immunity similar to that in individuals without diabetes.

Published
2022

5. Promoting and Building Long-Term Care Health Research Networks: GeroCovid Observational and Gerocovid Vax Initiatives

Author

Angela Marie Abbatecola, Raffaele Antonelli Incalzi, Giuseppe Bellelli, Gilda Borselli, Carmine Cafariello, Alessandra Coin, Stefania Del Signore, Susanna Del Signore, Stefano Fumagalli, Pietro Gareri, Alba Malara, Enrico Mossello, Fabio Monzani, Marianna Noale, Chukwuma Okoye, Graziano Onder, Caterina Trevisan, Stefano Volpato, and Gianluca Zia

Subjects
Health Policy, General Medicine, Geriatrics and Gerontology, General Nursing
Published
2023
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6. Disentangling the impact of COVID-19 infection on clinical outcomes and preventive strategies in older persons: An Italian perspective

Author

Elisa Bottoni, Raffaele Antonelli Incalzi, Annapina Palmieri, Marianna Noale, Gianluca Zia, Alessandra Coin, GeroCovid Observational, Alba Malara, Gilda Borselli, Enrico Mossello, Pietro Gareri, Stefano Volpato, Stefano Fumagalli, Fabio Monzani, Caterina Trevisan, Anna Di Lonardo, Angela Marie Abbatecola, Chukwuma Okoye, Marcello Russo, Giuseppe Bellelli, Susanna Del Signore, Graziano Onder, Carmine Cafariello, Abbatecola, A, Antonelli Incalzi, R, Malara, A, Palmieri, A, Di Lonardo, A, Borselli, G, Russo, M, Noale, M, Fumagalli, S, Gareri, P, Mossello, E, Trevisan, C, Volpato, S, Monzani, F, Coin, A, Bellelli, G, Okoye, C, Del Signore, S, Zia, G, Bottoni, E, Cafariello, C, and Onder, G

Subjects
Gerontology, Aging, Elderly, Coronavirus disease 2019 (COVID-19), Italy, Depression, Perspective (graphical), COVID-19, Geriatrics and Gerontology, Psychology, Vaccines in long term care
Abstract

Italy was one of the first western countries to embrace the first wave of COVID-19 and undergo detrimental outcomes in older adults in different clinical settings, especially in those with comorbidity and frailty. In addition, older nursing home (NH) residents had significantly higher mortality rates most likely due to the increased susceptibility of infection due to combined physical vulnerability and risks linked to the NH living environment itself. Different reports throughout Italy have rapidly highlighted selected outcomes related to COVID-19 in older patients being treated in acute and long-term care (LTC) settings. However, the majority of these studies are single center studies. Thus, it remains fundamental to collect large data from prospective based-population studies in order to identify preventive and therapeutic COVID-19 risk/protective factors correlated with COVID-19 health status outcomes. In this commentary paper, we will discuss different Italian reports according to clinical settings and highlight the importance of GeroCovid Observational and GeroCovid Vax, two large population based prospective studies in Italy.

Published
2022

7. Clinical Features of SARS-CoV-2 Infection in Italian Long-Term Care Facilities: GeroCovid LTCFs Observational Study

Author

Alba Malara, Marianna Noale, Angela Marie Abbatecola, Gilda Borselli, Carmine Cafariello, Stefano Fumagalli, Pietro Gareri, Enrico Mossello, Caterina Trevisan, Stefano Volpato, Fabio Monzani, Alessandra Coin, Giuseppe Bellelli, Chukwuma Okoye, Susanna Del Signore, Gianluca Zia, Raffaele Antonelli Incalzi, Francesco Raffaele Addamo, Domenico Andrieri, Rachele Antognoli, Paola Bianchi, Valeria Calsolaro, Francesco Antonio Campagna, Sebastiano Capurso, Silvia Carino, Manuela Castelli, Arcangelo Ceretti, Mauro Colombo, Antonella Crispino, Roberta Cucunato, Ferdinando D'Amico, Annalaura Dell'Armi, Christian Ferro, Serafina Fiorillo, Pier Paolo Gasbarri, Roberta Granata, Nadia Grillo, Antonio Guaita, Marilena Iarrera, Valerio Alex Ippolito, Irene Mancuso, Eleonora Marelli, Paolo Moneti, Sara Osso, Agostino Perri, Maria Perticone, Carmine Romaniello, Marcello Russo, Giovanni Sgrò, Federica Sirianni, Deborah Spaccaferro, Fausto Spadea, Rita Ursino, Malara, A, Noale, M, Abbatecola, A, Borselli, G, Cafariello, C, Fumagalli, S, Gareri, P, Mossello, E, Trevisan, C, Volpato, S, Monzani, F, Coin, A, Bellelli, G, Okoye, C, Del Signore, S, Zia, G, and Antonelli Incalzi, R

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Socio-culturale, Long Term Care Facilities, Covid-19 clinical presentation, medicine, Humans, General Nursing, Skilled Nursing Facilities, business.industry, SARS-CoV-2, Health Policy, COVID-19, General Medicine, COVID-19, GeroCOVID, older, long-term care, mortality, Long-Term Care, Research Letters, Long-term care, Italy, Emergency medicine, Observational study, Geriatrics and Gerontology, business
Published
2021

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