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.
METHODS: Retrospective cohort study.
METHODS: 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: 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.
METHODS: Retrospective cohort study.
METHODS: 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: 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.
摘要：
目的：养老院（NH）居民的流浪行为会增加感染风险。这项研究的目的是评估退伍军人事务（VA）社区生活中心（CLC）居民中流浪行为与SARS-CoV-2感染的关系。
方法：回顾性队列研究。
方法：居住在133个VACLC中的退伍军人。
方法：我们从VA电子病历中纳入了从2020年3月1日至2020年12月31日进行SARS-CoV-2测试的居民。我们确定了在最低数据集3.0评估中徘徊的CLC居民，并将其与未徘徊的居民进行了比较。结果是SARS-CoV-2感染，作为监测测试的测试，在那些有和没有徘徊。使用具有针对相关协变量调整的泊松链接的广义线性模型。
结果：居民（n=9995）包括在分析队列平均值中，（SD）年龄73.4（10.7）；388（3.9％）女性。总体队列中日常生活活动评分的平均值(SD)为13.6(8.25)。在该队列的379名（3.8％）（n=379）中发现了流浪。暴露组在以前的痴呆中有所不同(92.6%vs62.1%，标准化平均差[SMD]=0.8)和精神病(41.4%vs28.1%，SMD=0.3)。总的来说,12.5％（n=1248）的SARS-CoV-2检测呈阳性，与未游走的人群相比，游走组中更多的居民为SARS-CoV-2阳性（19％[n=72]vs12.2％[n=1176]，SMD=0.19）。调整协变量，流浪居民感染SARS-CoV-2的相对风险高34%(调整RR，1.34；95%CI，1.04-1.69）。
结论：流浪的CLC居民感染SARS-CoV-2的风险更高。这可能会为实施感染控制和隔离政策提供信息，因为NHs试图平衡居民自治的道德概念，相称性,股本，和功利主义。
方法：回顾性队列研究。
方法：居住在133个VACLC中的退伍军人。
方法：我们从VA电子病历中纳入了从2020年3月1日至2020年12月31日进行SARS-CoV-2测试的居民。我们确定了在最低数据集3.0评估中徘徊的CLC居民，并将其与未徘徊的居民进行了比较。结果是SARS-CoV-2感染，作为监测测试的测试，在那些有和没有徘徊。使用具有针对相关协变量调整的泊松链接的广义线性模型。
结果：居民（n=9995）包括在分析队列平均值中，（SD）年龄73.4（10.7）；388（3.9％）女性。总体队列中日常生活活动评分的平均值(SD)为13.6(8.25)。在该队列的379名（3.8％）（n=379）中发现了流浪。暴露组在以前的痴呆中有所不同(92.6%vs62.1%，标准化平均差[SMD]=0.8)和精神病(41.4%vs28.1%，SMD=0.3)。总的来说,12.5％（n=1248）的SARS-CoV-2检测呈阳性，与未游走的人群相比，游走组中更多的居民为SARS-CoV-2阳性（19％[n=72]vs12.2％[n=1176]，SMD=0.19）。调整协变量，流浪居民感染SARS-CoV-2的相对风险高34%(调整RR，1.34；95%CI，1.04-1.69）。
结论：流浪的CLC居民感染SARS-CoV-2的风险更高。这可能会为实施感染控制和隔离政策提供信息，因为NHs试图平衡居民自治的道德概念，相称性,股本，和功利主义。
