COVID-19 infections in older inpatients in mental health trusts wards [COVID-19]
Research type
Research Study
Full title
COVID-19 infections in older inpatients in mental health trusts wards in five London mental health trust
IRAS ID
284782
Contact name
Gill Livingston
Contact email
Sponsor organisation
NoCLoR
Duration of Study in the UK
0 years, 6 months, 29 days
Research summary
Research Summary
The new coronavirus was first identified in Hubei province, China and since then has become a global pandemic. The death rate of the resulting illness COVID-19 worsen with increasing age and in those who are already vulnerable with underlying illnesses, possibly including dementia.Although there are large studies of the inpatient population, to our knowledge this has been limited to those in acute hospitals and care homes. The particular high risk population (most of whom have dementia) in a psychiatric hospital has not been described. This is a cross sectional, multi-site, observational study using routinely collected data from five NHS trusts describing all older psychiatric inpatients and people with young onset dementia in beds from 1st March to 30th April 2020.
Any patients who are inpatient either in old age psychiatric wards or on designated COVID psychiatric wards and are age ≥65 or have young onset dementia. Patients of either sex Patients diagnosed as having had a COVID-19 infection between March 1st and April 30th 2020. We will also collect the number of people admitted to these wards who fit criteria 1 but not criteria 3 to enable us to calculate the period prevalence. Some people included will be patients in other wards than those specified.
Patients admitted to the wards under study who are aged <65 years and without dementia. We will gather sociodemographic and illness related data of older psychiatric inpatients with COVID-19 during the study period and information about numbers of inpatients with COVID-19. We will include everyone who fulfils criteria and estimate this to be around 100 people. We will analyse the data using descriptive and inferential statistics. Our primary objective is to describe the period prevalence (the percentage patients affected) of COVID-19 in these patients. The secondary objectives are to describe the demographics, symptoms of, treatment given and outcomes for COVID-19. We wish to do this to learn lessons from treating patients during first wave of COVID-19; and to make recommendations about future management.
Summary of Results
Our study in five London NHS mental health trusts was the first to give details of older patients and those with dementia in psychiatric wards during the height of the first COVID-19 pandemic wave between March-April 2020. We subsequently repeated data collection during the second wave between December 2020-February 2021 to examine whether any changes in clinical guidance and practice were associated with improved COVID-19 prevalence and outcomes.During the first pandemic wave, we found that no patients had known severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when admitted, but nearly 40% subsequently received a diagnosis of COVID-19. On average, sites received their first COVID-19 testing kits 4.5 days after the first clinical COVID-19 presentation. In two Trusts, PPE became available 2–7 days after the first suspected case of COVID-19 and many were likely to have already developed undetected COVID-19 before isolation. 15% of those clinically diagnosed as having COVID-19 died, which is a much higher mortality rate than in the community. The patients in our study had severe mental health problems and most of them were in hospital compulsorily using legislative framework for mental illness or an absence of decisional capacity.
Psychiatric wards were able achieve isolation of people who might be infectious and some gave oxygen treatment on the ward, administered anticoagulation, and had much closer liaison with physicians. We made a number of recommendations to optimise the prevention and management of COVID-19 in psychiatric inpatient settings.
During the second pandemic wave, we found evidence of improved infection control measures in older adult psychiatric wards, including routine testing of patients and staff, isolation of patients on admission and availability of PPE, which was likely to be related to the significant reduction in COVID-19 infections (25% were diagnosed with COVID-19) and correspondingly fewer deaths observed in patients (15%). The infection rate remained higher compared to community levels, and 29% presented without any symptoms. The first dose vaccination uptake rate (85%) was slightly lower compared to the London vaccination uptake rate in eligible care home residents (93%). Although vaccination is likely to reduce serious illness from COVID-19, cautious management of vulnerable patient groups remains appropriate to reduce the impact of future COVID-19 waves.
REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
20/WM/0165
Date of REC Opinion
28 May 2020
REC opinion
Favourable Opinion