Introduction

Some text in this chapter and Appendix 1 has been reproduced from a review paper published by the authors in 2022.³¹ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.

This chapter describes the first phase of the study: the rapid review of evidence on measures used to prevent or control the transmission of COVID-19 and other infectious diseases in CHs for older people. Recommendations from papers exploring COVID-19 interventions and from papers exploring other infectious disease interventions are presented. The method for the review is presented in Chapter 2, with full details of the search strategy, screening and selection, flow chart of the review process, summary table of 103 records and findings presented in Appendix 1.

Included papers

A total of 103 records were included in this review.^{9,22,24,25,32–130} Of the 103 records included in the review, 10 were empirical research studies, 7 were literature/rapid reviews and 86 were policy documents/grey literature. Of the 10 empirical studies, 8 explored COVID-19 and 2 explored other infectious diseases. Three studies were conducted in the UK; four were conducted in Europe, two in Asia and one in North America. Two empirical studies mentioned social distancing measures, nine mentioned isolation interventions, eight mentioned restrictions and two mentioned zoning or cohorting. The quality of these studies varied greatly (e.g. one was pre-print and not peer-reviewed) and methodologies included a randomised control trial, a pilot survey study and a retrospective cohort study. However, the risk of bias of each study was assessed by two researchers, using an appropriate quality assessment tool^131–134 and there was an agreement to include all 10 studies in the review. Also included in this review were 85 policy documents/grey literature, which came from around the world and included policy documents highlighting different countries’ responses to the pandemic, guidelines/guidance for CHs, briefing documents, discussions and commentaries. The seven literature/rapid reviews were also of varying quality (again, some were pre-printed and not peer-reviewed) and five were related to COVID-19 and two related to other infectious diseases.

Recommendations from papers exploring COVID-19 interventions

A wide range of recommendations was made by papers exploring strategies used by CHs to prevent and control the transmission of COVID-19. These recommendations included the following:

• Governments (internationally but also specifically those in the UK, New Zealand and Finland) must work collaboratively with acute and community sectors to develop guidance for the safe discharge of people with COVID-19 from hospitals to CHs^82,112 and provide more extensive and detailed guidance on how CHs should operate in future pandemics.⁶⁹ They must acknowledge that a ‘blanket approach’ to guidance is inadequate and ensure that the individual needs of older people are at the heart of policy-making.^91,94,112 Particular attention should be paid to the clarity and feasibility of guidelines to ensure that CH providers can implement them successfully within their facilities.⁶⁹
• Long-standing problems in social care systems, including inadequate funding and staffing, lack of integration between health and social care, lack of recognition and regard for care staff and other workforce pressures, must be addressed by governments.^{22,56,66,77,85,116}
• A balance should be sought between the implementation of IPC measures and the need to ensure residents’ quality of life, dignity and well-being^33,52,80,113 to ‘explore creative ways of providing care during COVID-19 that makes life worth living’⁸⁴ (p28).
• There is a requirement for consistent records to be maintained by CHs worldwide to enhance research into COVID-19 in these settings.^24,37,56 This includes the need for openly accessible and comprehensive records on COVID-19 cases and fatalities identified within CHs³⁷ and a minimum dementia data set to enhance understanding of people living with dementia in CHs.²⁴
• All CH residents should be provided with recovery and rehabilitation opportunities to address the periods of reduced activity and social isolation they have experienced.^94,112 Trauma and grief counselling services may also need to be provided for family members and CH staff.^84,94
• Care homes must review their visiting policies for future outbreaks, including exploring how family members, including children, may be enabled to visit safely.^{48,56,82,91,113} Blanket visitor bans should not be used to prevent future outbreaks.^91,113 Care homes should also receive additional government funding and support to enable them to implement safe visiting practices.⁹¹
• Clear, proactive communication between CHs and family members must be maintained during periods of restriction, making use of technology where possible.^95,110
• Staff members should consider, where possible, confining themselves to CHs to protect the facility from an outbreak of COVID-19.³⁹
• More research is required in a variety of areas, including the exploration of new models of planning and design to develop CH structures and layouts that better address IPC measures;^{33,91,112,119} an evaluation of which measures of IPC have proved successful in COVID-19;³⁸ an investigation of the long-term effects of the COVID-19 lockdown;⁸⁴ and an exploration of innovative ways of mitigating loneliness for CH residents, especially those with cognitive impairment.^24,25,103

Recommendations from papers exploring other infectious disease interventions

A limited number of recommendations were made by papers exploring strategies used by CHs to prevent and control the transmission of non-COVID-19-related infectious diseases. These recommendations were the following:

• Develop sound, evidence-based guidelines for isolation in CHs during infectious disease outbreaks.⁷²
• Further research is required on a range of topics, including how to maintain quality of life within CHs during outbreaks of infectious diseases;⁸⁸ and around the concerns, experiences and perceptions of CH staff around delivering IPC interventions.⁶⁵

Concluding remarks

The material presented here is the first-ever review of strategies previously and currently used by CHs worldwide to prevent and control the transmission of COVID-19 and other infectious and contagious diseases. We learnt that there is a lack of empirical evidence and only limited policy documentation around social distancing and isolation measures in CHs. Evaluative research on these interventions is needed urgently. In the following chapters, we present findings from the empirical phase of the study. We explore the real-life experiences, challenges, facilitators and impacts of implementing social distancing and isolation interventions within the CH setting, informing best practice guidance and resources, thus adding to, but also complicating, the picture presented by the review.