A general deterioration in health should be treated as a sign of potential coronavirus infection in care home residents, according to a new UK study supported by nurses.
A rapid evaluation has been carried out of a testing strategy implemented across care homes in North Norfolk by a nurse-led team.
“These findings are really vital for protecting care home communities”
Out of 518 residents tested across 44 care homes between 7 April and 29 June 2020, Covid-19 was identified in 103 residents in 14 homes.
The evaluation found that more than half (54) of the residents who had Covid-19 were asymptomatic at the time of the test, although 12 went on to develop symptoms within 14 days.
Just 38 residents had typical symptoms such as a new cough or fever at the time of the test.
Meanwhile, a feeling of “general unwellness” was found to be common among those who had Covid-19, and was reported in 18 residents.
The research team concluded that being generally unwell “may indicate [Covid-19] infection in older people in the absence of more typical symptoms”.
They added: “Where a resident appears generally unwell [Covid-19] infection should be suspected.”
The evaluation was led by the University of East Anglia (UEA) and North Norfolk Primary Care, supported by UEA Health and Social Care Partners.
Due to the rapid-response nature of the work, it has not yet been peer reviewed.
“It may also be difficult for some patients to recognise or communicate that they are feeling unwell”
Among the authors of the paper were nurses Sharon Dunham and Emma Smith, both from NHS North Norfolk Primary Care.
Dr Paul Everden, from UEA’s Norwich Medical School and innovation lead for North Norfolk Primary Care, said the findings of the evaluation were “vital”.
“Older people in care homes have multiple co-morbidities including dementia, lung disease, a reduced sense of smell, and may have communication problems too,” he explained.
“Together, this means it is difficult for staff to identify typical listed Covid-19 symptoms – a temperature, cough and anosmia. It may also be difficult for some patients to recognise or communicate that they are feeling unwell.”
Dr Everden said at the start of the project there was no testing in care homes under the government’s strategy.
A decision was made in North Norfolk to implement an “intelligent” testing strategy to try and spot an outbreak at the earliest opportunity while protecting resources.
The service was rolled out by the nurse-led enhanced care home team (ECHT), which is made up of advanced nurse practitioners, nurses and healthcare assistants.
The ECHT works alongside general practices in North Norfolk to improve care for care home residents on their registers.
Under the programme, the trigger for testing a resident was “any general deterioration in health status”, with other residents and staff in the home subsequently tested following a positive result.
“It was through this process that we identified asymptomatic and presymptomatic people who could potentially infect other residents and staff,” said Dr Everden.
He added: “These findings are really vital for protecting care home communities and we hope they will help keep residents and staff safe – particularly if we are to face future waves of the pandemic in the UK where resources will again indeed be precious.”