The world is headed toward a silver tsunami. Globally, people aged 60-plus represent 15–30% of each country’s population. That percentage is expected to double by 2050 (WHO 2022).
In addition, two-thirds of the world’s population who will turn 60 by the year 2050 will live in low- and middle-income countries that are essentially healthcare deserts. Because these countries are starved for supplies, staff, and safe spaces, one in ten people globally are expected to die from a healthcare-associated infection, or HAI (WHO).
Even in western, modernized countries like the U.S., one in 31 hospitalized patients gets an HAI in their lifetime, causing thousands to die every year from these infections (CDC 2022). Humans aged 60-plus are especially vulnerable due not only to weakened immune systems, but also a higher risk of exposure from frequent visits to healthcare facilities for treatment or screenings.
The High Risk of Disease at Congregate Settings
Elderly populations living in congregate settings like long-term care facilities are at high risk for contracting communicable diseases like influenza. The last two decades of HAI data from the Centers for Disease Control and Prevention (CDC) have shown outbreaks of gastroenteritis, influenza, a variety of respiratory infections, skin infections that become necrotic, soft-tissue infections that often entail MRSA, and urinary tract infections that require hospitalization (Bayer 2018).
Even before the COVID-19 pandemic, nursing homes had difficulty with infection control as influenza outbreaks in these facilities accounted for 74 percent of global influenza morbidity and mortality (Lansbury 2017). During the global pandemic, nursing homes became the deadliest place to live for the 60-plus population (Alonzo- Zaldivar 2021).
In Italy 2020, the death rate in long-term care facilities for the elderly was close to 15 percent. In the U.S., from April to August 2020, 45 percent of COVID-19 deaths were in long-term care facilities, despite those residents representing less than one-half of one percent of the U.S. population (Chidambaram 2020).
The World’s Population Is Aging. Society Must Prepare.
The data is clear. Society lacks the resources to house or care for our aging population individually. At the same time, congregate-care facilities have the greatest risk of acquiring an infectious disease. Governments must engage with communities now to create alternative models for supporting our aging population, including:
Affordable at-home services allowing for longer durations of independent living
Alternative assisted living models
Low-cost support services for working families who care for aging parents while raising their own children at the same time
Globally, adherence to infection prevention and control protocols can reduce HAI deaths by 70% (Holden 2021). These protocols involve:
- Hand hygiene
- Access to clean water
- Clean air filtration
- Cohorting patients appropriately within a facility
Training staff on how to use personal protective equipment (PPE) safely - Establishing patient and staff traffic controls that minimize cross-contamination
- Creating specific patient staffing assignments
- Having ample stock of PPE, cleaning supplies, medical supplies, and pharmaceuticals
These protocols can literally be the difference between life and death (Hung 2021). Unfortunately, many elder adults have frequent visits to hospitals and clinical care settings to treat chronic conditions, creating a higher risk of exposure to infectious diseases.
Reducing Risk in Healthcare Settings
From a socio-ecological model, the 60-plus patient in a healthcare setting has the least amount of control in whether or not they contract an HAI. Other than wearing a mask and washing their hands, they cannot control if a catheter, IV, medication, food, water, or any other treatment device has been handled in a sterile manner.
In addition, the patient may share a room with multiple patients or have multiple staff enter the room. Each individual entering the room could have very different hand hygiene practices or living situations at home that increase the risk of bringing a disease into the facility.
Beyond the social aspect and routine activities in the resident’s or patient’s room, there is the larger community of the healthcare facility to consider. Facilities in communities with low vaccination rates have a higher risk of disease in their population. Also, there’s a higher risk for facilities that provide geriatric care in lower income areas that may have fewer resources including enough trained staff.
Engaging Communities and Leveraging the Power of Data
The global community is comprised of many local communities that need to adapt in the coming years to protect the 60-plus population. Some may need to create more congregate settings with ample infection protocols because they lack the infrastructure, staffing, and transportation for at-home models of care. Other communities will likely create more options for home-based care services because of the cost and danger of congregate settings.
What works for one global community may not work for the next. Community engagement is key to creating a successful model for each individual community and their culture, including partnering with facilities across the healthcare continuum. To ensure sufficient staffing for the care of the aging population, countries are already brainstorming new certification and training programs for existing caregivers, as well as developing career pipelines through their education systems for the next generation of their healthcare workforce.
In some US states, leaders have harnessed data and analytics to determine where and when to send infection prevention and control resources based on risk factors—and they’ve seen a huge drop in case fatality ratios. Successfully engaging with communities through strategic planning, identifying areas with the greatest need, and acting with early interventions can not only save lives, but livelihoods for the local community.
The silver tsunami is coming. Let’s take steps now to prepare for the storm and ensure elderly loved ones live as many peaceful, joyful years as possible. Contact the HHS team at Resultant to discuss the challenges facing your community and how our HHS solutions can help.
Resources
- AHRQ’s Healthcare-Associated Infections Program | Agency for Healthcare Research & Quality
- Alonzo- Zaldivar, Ricardo: “Watchdog: Nursing home deaths up 32% in 2020 amid pandemic” Washington AP, September 2021.
- Baker, Meghan: “The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare- Associated Infections” Clinical Infectious Diseases, 2021.
- Bayer, Antony: “Mortality in nursing home residents: A longitudinal study over three years” National Library of Medicine, September 2018.
- Bonner, Alice: “Changing the dynamic: What can we learn from infectious disease management In long- term care settings?” Geriatric Nursing, December 2021.
- Chidambaram, Priya: “Key Questions About the Impact of Coronavirus on Long-Term Care Facilities Over Time” Kaiser Family Foundation, September 2020.
- CDC Nursing Homes Data Dashboard | NHSN | CDC 2022.
- Davidson, Patricia: “Nursing homes and COVID‐19: We can and should do better” Nursing Outlook, August 2020.
- Dyer, Adam: “Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update” Journal of the American Medical Director’s Association, July 2022.
- Epson, Erin: “Resident racial and ethnic composition, neighborhood‐level socioeconomic status, and COVID‐19 infections in California SNFs” Journal of the American Geriatrics Society, October 2022.
- Gupta, Debrasree: “Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time” Journal Pone, February 2021.
- Holden, Diana: “The Resurgence of Candida auris in California during the Novel Coronavirus (COVID-19) Pandemic, May 2020–May 2021” Open Forum Infectious Diseases, December 2021.
- Hung, Kevin: “Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations” International Journal for Environmental and Public Health Research, March 2021.
- Lansbury, Louise: “Influenza in long‐term care facilities” Journal of Influenza and Other Respiratory Viruses, July 2017.
- National Academies of Sciences, Engineering, and Medicine: “The National Imperative toImprove Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.” The National Academies Press, April 2022.
- Rantz, Marilyn: “Systematic Review of Studies of Staffing and Quality in Nursing Homes” Journal of the American Medical Director’s Association, July 2006.
- Rodriquez, Vicente: “The Impact of COVID-19 on Nursing Homes: Study Design and Population Description” Journal of Environmental Research and Public Health, November 2022.
- Shen, Karen: “Relationship between nursing home COVID-19 outbreaks and staff neighborhood characteristics” Journal Pone April 2022.
- Skully, Jenna: “Enhancing respiratory protection in skilled nursing facilities during the COVID-19 pandemic: A public health fit-test training program” Cambridge University Press May 2022.
- Stall, Nathan: “A Hospital Partnership with a Nursing Home Experiencing a COVID-19 Outbreak: Description of a Multiphase Emergency Response in Toronto, Canada” Journal of the American Geriatrics Society, May 2020.
- The COVID Tracker: https://covidtracking.com/nursing-homes-long-term-care-facilities The Atlantic 2022 US Government Accountability Office: “Nursing Home Quality: Continued Improvements Needed in CMS’s Data and Oversight” September 2018.
- Wasserman, Michael: “Beyond Compliance: A More Integrated Public Health Approach to Outbreaks In Nursing Homes And Other Disasters.” Health Affairs June 2022.
- World Health Organization “Global Report on Infection Prevention and Control,” May 2022
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About the Author
Heidi Steinecker
Director, Business Development Health and Human Services @ Resultant
With a focus on public and behavioral health, Heidi leads the strategy in implementing data and analytics solutions for health and human services (HHS) agencies that enable data-driven decisions and...
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