Wandering Behavior and SARS-CoV-2 Infection in Veterans Affairs Community Living Center Residents

Authors

Mriganka Singh, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Frank DeVone, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Thomas Bayer, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Yasin Abul, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Alexander Garbin, VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
Ciera Leeder, Rochester Regional HealthFollow
Chris Halladay, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Kevin W. McConeghy, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
Stefan Gravenstein, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
James L. Rudolph, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.

Department

Medicine

Document Type

Article

Publication Title

Journal of the American Medical Directors Association

Abstract

OBJECTIVE: Wandering behavior in nursing home (NH) residents could increase risk of infection. The objective of this study was to assess the association of wandering behavior with SARS-CoV-2 infection in Veterans Affairs (VA) Community Living Center (CLC) residents.

DESIGN: Retrospective cohort study.

SETTING & PARTICIPANTS: Veterans residing in 133 VA CLCs.

METHODS: We included residents with SARS-CoV-2 test from March 1, 2020 to December 31, 2020 from VA electronic medical records. We identified CLC residents with wandering on Minimum Data Set 3.0 assessments and compared them with residents without wandering. The outcome was SARS-CoV-2 infection, as tested for surveillance testing, in those with and without wandering. Generalized linear model with Poisson link adjusted for relevant covariates was used.

RESULTS: Residents (n = 9995) were included in the analytic cohort mean, (SD) age 73.4 (10.7); 388 (3.9%) women. The mean (SD) activities of daily living score in the overall cohort was 13.6 (8.25). Wandering was noted in 379 (3.8%) (n = 379) of the cohort. The exposure groups differed in prior dementia (92.6% vs 62.1%, standardized mean difference [SMD] = 0.8) and psychoses (41.4% vs 28.1%, SMD = 0.3). Overall, 12.5% (n = 1248) tested positive for SARS-CoV-2 and more residents among the wandering group were SARS-CoV-2 positive as compared with those in the group without wandering (19% [n = 72] vs 12.2% [n = 1176], SMD = 0.19). Adjusting for covariates, residents with wandering had 34% higher relative risk for SARS-CoV-2 infection (adjusted relative risk, 1.34; 95% CI, 1.04-1.69).

CONCLUSIONS AND IMPLICATIONS: CLC residents with wandering had a higher risk of SARS-CoV-2 infection. This may inform implementation of infection control and isolation policies as NHs attempt to balance ethical concepts of resident autonomy, proportionality, equity, and utilitarianism.

First Page

105101

DOI

10.1016/j.jamda.2024.105101

Volume

25

Issue

8

Publication Date

8-1-2024

Medical Subject Headings

Humans; COVID-19 (epidemiology); Female; Male; Aged; Retrospective Studies; Wandering Behavior; United States (epidemiology); Veterans (statistics & numerical data); SARS-CoV-2; Aged, 80 and over; Nursing Homes; United States Department of Veterans Affairs; Activities of Daily Living

PubMed ID

38906176

Recommended Citation

Singh, M., DeVone, F., Bayer, T., Abul, Y., Garbin, A., Leeder, C., Halladay, C., McConeghy, K. W., Gravenstein, S., & Rudolph, J. L. (2024). Wandering Behavior and SARS-CoV-2 Infection in Veterans Affairs Community Living Center Residents. Journal of the American Medical Directors Association, 25 (8), 105101. https://doi.org/10.1016/j.jamda.2024.105101