Background: COVID-19 disproportionately affects older adults, placing residents of closed-community settings, such as long-term care facilities (LTCFs), at increased risk for severe illness and death. Objective: To describe the epidemiology and healthcare resource utilization associated with acute COVID-19 in LTCFs in the United States during Omicron variant predominance. Data Sources: MEDLINE and Embase databases were searched on January 15, 2025 for full-text citations published on or after January 1, 2022. Conference abstracts from long-term care conferences in 2023 and 2024 were hand-searched. Records were included if they described acute COVID-19 in LTCFs (nursing homes, assisted living facilities, or Veterans Affairs Community Living Centers). Records were excluded if they were conducted outside the United States, published in languages other than English, focused on long COVID, did not include data from the Omicron predominance period (beginning November 1, 2021), or were clinical trials, case reports/case series, narrative reviews, editorials, or commentaries. Data Synthesis: Forty-three articles met the inclusion criteria, most of which reported COVID-19 cases (20 studies), mortality (18 studies), and/or healthcare resource utilization (11 studies). Although all studies included COVID-19 data during the Omicron period, most also included earlier periods during which other COVID-19 variants were predominant. In the United States, weekly incidence rates for COVID-19 infections and hospitalizations among nursing home residents ranged from 614 to 1338 and from 38 to 71 per 1,000 residents, respectively. Approximately 1 in 6 COVID-19 hospitalizations occurred among LTCF residents. Compared with community-dwelling individuals, mortality was 4.6-fold higher among LTCF residents. Conclusion: COVID-19 in LTCFs was associated with high rates of hospitalization and mortality among residents, including vaccinated individuals, during the study period.
Background: Sickle cell disease (SCD) is a hematologic disorder that affects approximately 100,000 Black individuals in the United States. Although extensive literature describes fall risk factors in adults 65 years and older, evidence regarding fall risk in older adults with SCD remains limited and largely anecdotal. Risk factors for falls in adults aged 50 years and older with SCD overlap with those observed in the general geriatric population aged 65 years and older. Objective: The objective of this study was to describe factors associated with increased fall risk in older patients with SCD. Data Sources: A literature search of PubMed and MEDLINE was performed using the following search terms: "sickle cell disease", "falls", "risk factors", "older adults", "management," and "prevention," as well as combinations of these terms. Data Synthesis: Fifteen studies were identified. Reduced physical functioning, dizziness/imbalance, cognitive impairment, visual deficits, vitamin D deficiency, osteoporosis, polypharmacy, and silent cerebral ischemia (SCI) were identified as risk factors for SCD-related falls. Discussion: Fall risk factors, prevention, and management strategies in patients are understudied and complex. Fall-prevention strategies used for older adults are also important for patients with SCD. Conclusion: Falls in older adults with SCD appear to reflect a convergence of neuromusculoskeletal complications, sensory deficits, cognitive vulnerability, and medication-related effects; however, the evidence base remains limited, and SCD-specific guidance is lacking. Clinicians should evaluate older adults with SCD for the aforementioned fall risk factors.
Purpose: Bloodstream infections (BSIs) require prompt, targeted antimicrobial therapy, but traditional blood culture methods may delay optimal treatment. The BIOFIRE® Blood Culture Identification 2 (BCID2) panel provides rapid pathogen identification and mayreduce time to targeted therapy. This study evaluated the impact of BCID2 implementation at a community teaching hospital. Methods: A retrospective, quasi-experimental pre/post study was conducted at a for-profit community teaching hospital in adults aged ≥18 years with BSIs. Eligible patients had bacteremia, blood cultures collected, and empiric antibiotic therapy initiated during the study periods. Exclusion criteria included pregnancy, detection of multiple pathogens in a single culture, availability of susceptibility results before the designated timeline, and discharge, transfer, or leaving against medical advice before completion of testing. The pre-implementation group included 64 patients (October-December 2023), and the postimplementation group included 60 patients (October 2024-February 2025). The primary outcome was time from blood culture collection to initiation of targeted antibiotic therapy based on final susceptibility results. Secondary outcomes included pathogen identification, empiric and total antibiotic use, and length of stay. Results: The study included 124 patients (mean age, 70.5 ± 17.3 years; 67% ≥65 years; 50% male). Blood cultures were ordered for suspected sepsis/septic shock in 58% of patients and suspected secondary bacteremia in 42%. Pathogen distribution was similar between groups, with Escherichia coli, Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus identified most frequently. BCID2 implementation significantly reduced time to optimal therapy (3.73 ± 2.01 vs. 2.02 ± 1.48 days, p<0.001) and empiric antibiotic duration (3.73 ± 2.01 vs. 2.04 ± 1.48 days, p < 0.001). Total antibiotic duration and length of stay did not differ significantly between groups. Conclusion: BCID2 implementation at a community hospital significantly shortened time to optimal therapy and reduced empiric antibiotic use among older hospitalized adults.
