Long-term care homes must balance risks and benefits to mental health during lockdowns

Monday, February 1, 2021
Nurse with iPad speaking with older adult.

Long-term care residents, isolated because of the COVID-19 pandemic, are at increased risk for negative mental health outcomes, but new research from the University of Waterloo shows those outcomes can not only be measured, but mitigated, with thoughtful interventions informed by data.

In a study of seven long-term care facilities in New Brunswick, clinical information systems that tracked changes in residents’ status through the lockdowns were found to be crucial in helping homes make decisions over resource deployment.

The homes in New Brunswick successfully used these systems to help keep residents engaged, said John Hirdes, the principal investigator of the study and a professor in the School of Public Health and Health Systems at the University of Waterloo. “They brought in new staff and programs and showed that you can do a good job in terms of mental health during lockdown.”

The strategies used by the homes included window visits and video chats, which were supported by the New Brunswick government through the distribution of iPads. One home hired students to facilitate virtual calls and engage in virtual one-on-one visits with residents. Students were also hired to increase recreation activities within the homes during lockdowns.

Now, as governments continue to weigh restrictions at long-term care facilities, Hirdes said policy makers can use the associated clinical information systems’ outputs to guide resource deployment, and health-service researchers can examine the data to identify better management strategies for when a pandemic strikes again.

“A balance needs to be struck between quality of life and the risk to physical health,” Hirdes said. “When you have large numbers of visitors from the general community, just one asymptomatic person can wreak havoc. These are hard decisions, and this is where clinical information systems are helpful.”

The researchers studied data from seven francophone long-term care homes in the province using a standardized assessment called the interRAI long-term care facility (LTCF) assessment, used by more than 30 countries to inform clinical care and evaluate the effect of strategies geared at improving mental health outcomes. The team reviewed 4,209 assessments from 765 residents between January 2017 and June 2020 and modeled the changes in depression, delirium and behavioural problems over time.

“However, the facilities were not experiencing deaths and COVID-19 cases like in Ontario and Quebec, which would complicate how mitigating strategies are deployed,” Hirdes said.

In the seven homes that were studied In New Brunswick, mental health conditions such as depression, delirium and disruptive behaviour stayed the same, and in some cases, those behaviours even decreased.

“Even though in-person visits with family decreased from 73 per cent to 18 per cent during lockdown, the percentage of residents who experienced depression, delirium and behavioural problems did not increase,” Hirdes said.

In the case of residents with dementia, delirium rates experienced a decrease, possibly because there was less noise and movement in the facility. However, those without dementia had slightly higher rates.

“This study shows that thoughtful use of mitigating strategies and clinical information systems like the interRAI LTCF can help stabilize or improve mental health in long-term care homes, even during a lockdown,” Hirdes said. 

The study, “Evaluating the Effect of COVID-19 Pandemic Lockdown on Long-Term Care Residents’ Mental Health: A Data-Driven Approach in New Brunswick,” was published in JAMDA and authored by Caitlin McArthur, Margaret Saari, George Heckman, Nathalie Wellens, Julie Weir, Paul Hebert, Luke Turcotte, Jalila Jbilou and John Hirdes.