Death and Other Losses in the COVID-19 Pandemic in Long-Term Care Facilities for Older Adults in the Perception of Occupational Therapists: A Qualitative Study

Abstract

Long-term care facilities for older adults (LTCFs) were directly affected by the COVID-19 pandemic. This study aimed to discuss the perceptions of occupational therapists about deaths and other losses in LTCFs during the pandemic. This qualitative study is anchored in social phenomenology, and conducted in-depth interviews with eight occupational therapists who worked in LTCFs. Thus, two themes were generated after the Thematic Analyses: “The proximity of death” and “Losses associated with living and dying in a LTCF.” In the first theme, the interviewees addressed the feeling of imminent death in the daily life of the LTCF, and feelings related to their own death, that of their family members and other older adults. In the second, the professionals highlighted three groups of losses: social, functional, and psychological/cognitive. These results highlighted the challenges faced by occupational therapists and can contribute to improve behavior and care for institutionalized older adults during the pandemic.

Keywords

COVID-19 death long-term care facility for older adults occupational therapist qualitative study

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References

American Occupational Therapy Association (2016). Role of occupational therapy in end-of-life care. American Journal of Occupational Therapy, 70(Supplement_2), 7012410075p1. https://doi.org/10.5014/ajot.2016.706S17

Aredes

J. de S.

Giacomin

K. C.

Firmo

J. O. A.

(2018). The physician in the face of death in the emergency room. Revista de Saude Publica, 52, 1-9. https://doi.org/10.11606/S1518-8787.2018052000296.

Ataide

C. E. R.

Junior

A. G. M.

Araújo

L. D. H.

Farias

L. F.

Filho

C. R. M. de V.

Zanona

A. de F.

(2021). Occupational therapy productions in times of pandemic: a systematic review of occupational therapeutic actions against the new coronavirus (COVID-19) epidemic. F1000Research, 75(10), 1-17. https://doi.org/10.12688/f1000research.28020.1

Blanco-Donoso

L. M.

Moreno-Jiménez

Amutio

Gallego-Alberto

Moreno-Jiménez

Garrosa

(2021). Stressors, job resources, fear of contagion, and secondary traumatic stress among nursing home workers in face of the COVID-19: The case of Spain. Journal of Applied Gerontology, 40(3), 244-256. https://doi.org/10.1177/0733464820964153

Borgstrom

(2017). Social death. QJM An Internacional Journal of Medicine, 110(1), 5-7. https://doi.org/10.1093/qjmed/hcw183

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Brown

(2021). The response to COVID-19: Occupational resilience and the resilience of daily occupations in action. Australian Occupational Therapy Journal, 68(2), 103-105. https://doi.org/10.1111/1440-1630.12721

Bye

R. A.

(1998). When clients are dying: Occupational therapists’ perspectives. Occupational Therapy Journal of Research, 18(1), 3-24. https://doi.org/10.1177/153944929801800101

Canadian Institute for Health Information (2021). The impact of COVID-19 on long-term care in Canada: Focus on the first 6 months. http://www.scie-socialcareonline.org.uk/the-impact-of-covid-19-on-long-term-care-in-canada-focus-on-the-first-6-months/r/a116f00000UuXxWAAV.

10.

Chen

M. K.

Chevalier

J. A.

Long

E. F.

(2020). Nursing home staff networks and COVID-19. Proceedings of the National Academy of Sciences of the United States of America, 118(1), 1-7. https://doi.org/10.1073/pnas.2015455118

11.

Chu

C. H.

Donato-Woodger

Dainton

C. J.

(2020). Competing crises: COVID-19 countermeasures and social isolation among older adults in long-term care. Journal of Advanced Nursing, 7617(104), 245665-245977. https://doi.org/10.1080/J148v17n04

12.

Comas-Herrera

Zalakain

(2020). Mortality associated with COVID-19 outbreaks in care homes: Early international evidence. International Long-Term Care Policy Network. https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/.

13.

Diolaiuti

Marazziti

Beatino

M. F.

Mucci

Pozza

(2021). Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Research, 300(January), 113916. https://doi.org/10.1016/j.psychres.2021.113916

14.

Duncan

J. M.

Killian

T. S.

Lucier-Greer

(2017). Leisure, relatedness, and ill-being among older adults in long-term care. Activities, Adaptation and Aging, 41(4), 273-290. https://doi.org/10.1080/01924788.2017.1326764

15.

Edelman

L. S.

McConnell

E. S.

Kennerly

S. M.

Alderden

Horn

S. D.

Yap

T. L.

(2020). Mitigating the effects of a pandemic: facilitating improved nursing home care delivery through technology. JMIR Aging, 3(1), 1-7. https://doi.org/10.2196/20110.

16.

Eghtesadi

(2020). Breaking social isolation amidst COVID-19: A viewpoint on improving access to technology in long-term care facilities. Journal of the American Geriatrics Society, 68(5), 949-950. https://doi.org/10.1111/jgs.16478.

17.

Eisma

M. C.

Tamminga

Smid

G. E.

Boelen

P. A.

(2021). Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. Journal of Affective Disorders, 278, 54-56. https://doi.org/10.1016/j.jad.2020.09.049.

18.

Figueiredo

C. de S.

Ferreira

E. F.

Assis

M. G.

(2021). Death and dying in long-term care facilities: The perception of occupational therapists. Omega - Journal of Death and Dying, 1-17. Online ahead of print. https://doi.org/10.1177/00302228211019206

19.

Galea

Merchant

R. M.

Lurie

(2020). The mental health consequences of COVID-19 and physical distancing. JAMA Internal Medicine, 180(6), 817-818. https://doi.org/10.1001/jamainternmed.2020.1562

20.

Ghane

Shahsavari

Zare

Ahmadnia

Siavashi

(2021). Social death in patients: Concept analysis with an evolutionary approach. SSM - Population Health, 14(100795), 1-8. https://doi.org/10.1016/j.ssmph.2021.100795.

21.

Giorgi

Lecca

L. I.

Alessio

Finstad

G. L.

Bondanini

Lulli

L. G.

Arcangeli

Mucci

(2020). COVID-19-related mental health effects in the workplace: A narrative review. International Journal of Environmental Research and Public Health, 17(21), 1-22. https://doi.org/10.3390/ijerph17217857

22.

Grabowski

D. C.

Mor

(2020). Nursing home care in crisis in the wake of COVID-19. JAMA, 324(1), 21-25. https://doi.org/10.1001/jama.2020.8524

23.

Graneheim

U. H.

Lundman

(2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112. https://doi.org/10.1016/j.nedt.2003.10.001

24.

Hammill

Bye

Cook

(2019). Occupational engagement of people living with a life-limiting illness: Occupational therapists’ perceptions. Australian Occupational Therapy Journal, 66(2), 145-153. https://doi.org/10.1111/1440-1630.12557

25.

Hoel

Zweck

C. von

Ledgerd

(2021) The impact of Covid-19 for occupational therapy: Findings and recommendations of a global survey (pp. 1-8). World Federation of Occupational Therapists Bulletin. https://doi.org/10.1080/14473828.2020.1855044

26.

Indacochea-Cáceda

Torres-Malca

J. R.

Vera-Ponce

V. J.

Pérez

M. A.

Cruz-Vargas

J. A.

(2021). Fear and death anxiety among Latin American doctors during the Covid-19 pandemic. Medrxiv, 1-14. https://doi.org/10.1101/2021.02.12.21251445

27.

Králová

(2015). What is social death? Contemporary Social Science, 10(3), 235-248. https://doi.org/10.1080/21582041.2015.1114407.

28.

Krefting

(1991). Rigor in qualitative research: The assessment of Trustworthiness. The American Journal of Occupational Therapy, 45(3), 214-222. https://doi.org/10.5014/ajot.45.3.214

29.

Kumar

Katto

M. S.

Siddiqui

A. A.

Sahito

Ahmed

Jamil

Ali

(2020). Predictive factors associated with fear faced by healthcare workers during COVID-19 pandemic: A questionnaire-based study. Cureus, 12(8), 10-15. https://doi.org/10.7759/cureus.9741

30.

Lynn

(2020). Playing the cards we are dealt: COVID-19 and nursing homes. Journal of the American Geriatrics Society, 68(8), 1629-1630. https://doi.org/10.1111/jgs.16658

31.

Marcella

Kelley

M. Lou.

(2015). Death is part of the job” in long-term care homes: Supporting direct care staff with their grief and bereavement. SAGE Open, 5(1), 1-15. https://doi.org/10.1177/2158244015573912

32.

McMichael

T. M.

Currie

D. W.

Clark

Pogosjans

Kay

Schwartz

N. G.

Lewis

Baer

Kawakami

Lukoff

M. D.

Ferro

Brostrom-Smith

Rea

T. D.

Sayre

M. R.

Riedo

F. X.

Russell

Hiatt

Montgomery

Rao

A. K.

Duchin

J. S.

(2020). Epidemiology of Covid-19 in a long-term care facility in King County, Washington. New England Journal of Medicine, 382(21), 2005-2011. https://doi.org/10.1056/nejmoa2005412

33.

Menzies

R. E.

Menzies

R. G.

(2020). Death anxiety in the time of COVID-19: Theoretical explanations and clinical implications. Cognitive Behaviour Therapist, 13(19), 1-11. https://doi.org/10.1017/S1754470X20000215

34.

Ouslander

J. G.

Grabowski

D. C.

(2020). COVID-19 in nursing homes: Calming the perfect storm. Journal of the American Geriatrics Society, 68(10), 2153-2162. https://doi.org/10.1111/jgs.16784

35.

Pizarro-Pennarolli

Sánchez-Rojas

Torres-Castro

Vera-Uribe

Sanchez-Ramirez

D. C.

Vasconcello-Castillo

Solís-Navarro

Rivera-Lillo

(2021). Assessment of activities of daily living in patients post COVID-19: A systematic review. PeerJ, 9(e11026), 1-17. https://doi.org/10.7717/peerj.11026.

36.

Rose

Johnson

C. W.

(2020). Contextualizing reliability and validity in qualitative research: toward more rigorous and trustworthy qualitative social science in leisure research. Journal of Leisure Research, 51(4), 432-451. https://doi.org/10.1080/00222216.2020.1722042

37.

Schutz

(1972).. In Natanson

(Ed.), The Problem of Social Reality: Collected Papers I H. Kluwer Boston, Inc.

38.

Sepulveda

E. R.

Stall

N. M.

Sinha

S. K.

(2020). A comparison of COVID-19 mortality rates among long-term care residents in 12 OECD countries. Journal of the American Medical Directors Association, 21(11), 1572-1574. https://doi.org/10.1016/j.jamda.2020.08.039

39.

Shenton

A. K.

(2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22, 63-75. https://pdfs.semanticscholar.org/cbe6/70d35e449ceed731466c316cd273032b28ca.pdf.

40.

Simard

Volicer

(2020). Loneliness and isolation in long-term care and the COVID-19 pandemic. Journal of the American Medical Directors Association, 21(7), 966-967. https://doi.org/10.1016/j.jamda.2020.05.006

41.

Thompson

D. C.

Barbu

M. G.

Beiu

Popa

L. G.

Mihai

M. M.

Berteanu

Popescu

M. N.

(2020). The impact of COVID-19 pandemic on long-term care facilities worldwide: An overview on international issues. BioMed Research International, 2020, 1-7. https://doi.org/10.1155/2020/8870249

42.

Treggalles

Lowrie

(2018). An exploration of the lived experience of professional grief among occupational therapists working in palliative care settings. Australian Occupational Therapy Journal, 65(4), 329-337. https://doi.org/10.1111/1440-1630.12477

43.

UNI Global Union (2021). The impact of COVID-19 on long-term care workers in the US, UK, Canada, Ireland, and Australia. UNI Global Union. https://www.uniglobalunion.org/sites/default/files/imce/the_impact_of_covid-19_fin.pdf.