NYU Langone has just embarked on a small and targeted yet critically important pilot study. The study team now investigates new protocols to reduce the risk of SARS-CoV-2 infections in long-term care facilities (e.g., nursing homes, et al.) housing patients with Alzheimer’s disease and associated dementia. Hubs of illness and death during the COVID-19 pandemic, the nation hasn’t sufficiently ensured its elderly are safe and secure during this incredibly difficult period. The pandemic raises many bigger questions: Did the relevant health authorities at the federal, state, and local levels ensure that the appropriate strategies, processes, and systems were in place to deal with such epidemics or pandemics? And for that matter, what have we learned from this experience that can ensure the mitigation of risk to the nation’s vulnerable elderly population moving forward? These individuals residing in such facilities spent their lives working, caring for family, and contributing to society, including tax contribution. What about the social pact, the bond, to ensure a safe and comfortable end? In this important study funded by the National Institutes on Aging’s Impact Collaboratory, part of the National Institute of Health (NIH), the NYU Langone team investigates the impact of a pair of COVID-19 interventions, including 1) systematic antibody testing of residents and staff at facilities and 2) actual paring of persons with antibodies aside those who don’t have COVID-19 antibodies. Led by Dr. Josh Chodosh, director of the Freedman Center on Aging, Technology, and Cognitive Health, the study’s goal of demonstrating ways to minimize viral transmission of SARS-CoV-2 for this vulnerable population represents an important step toward a broader study to establish the evidence needed for changes to policy and practice.
The Study Premise
This study reacts to what’s been a horrific situation for the elderly in many long-term care facilities (e.g., nursing homes). This is especially the case for the elderly residing in such homes that may struggle with Alzheimer’s disease and related dementia. These residents face far greater risks of being unable to adhere to prevention protocol and therefore impact the entire facility and staff. For example, according to some reports, by May, 42% of all deaths in the U.S. were at nursing homes.
A further concern of the sponsor and investigator is the suggestion that asymptomatic spread may also rise in these care settings, challenging the ability to implement isolation practices without complete isolation of all residents: this would be unacceptable socially, particularly for those struggling with Alzheimer’s disease or related dementia. Crain’s New York recently reported the study, as did the NIA Impact Collaboratory.
With Several hundred thousand support from the NIH, the study will focus on a center with 300 residents and over 100 staff located in a pair of long-term care facilities in New York City. Starting in late October to early November, informed consent has been completed.
In the study led by Dr. Chodosh, the team will develop facility-specific staff-resident assignment protocols based on COVID-19 serology and PCR testing, which according to the study description, “are feasible, scientifically sound, safe and acceptable to stakeholder: administrators, clinical leaders, front-line staff, residents and families.”
The study team describes their methods, including “1) obtaining stakeholder feedback for testing and cohort protocol refinement; and 2) implementing Skilled nursing facility-unit staffing assignment strategies based on COVID-19 serology and PCR status to minimize viral transmission.”
Dr. Josh Chodosh, director of the Freedman Center on Aging, Technology and Cognitive Health, Professor, Departments of Medicine and Population Health
Joshua Chodosh, MD, MSHS, holds the inaugural endowed Michael L. Freedman Professor of Geriatric Research in the Division of Geriatric Medicine and Palliative Care in the Department of Medicine at NYU School of Medicine. He is a clinical geriatrician, seeing patients in the VA NY Harbor Healthcare System and is founding Director of the Freedman Center on Aging, Technology, and Cognitive Health (CATCH) and co-Director of the NYU Aging Incubator. Dr. Chodosh conducts multiple AD/ADRD NIH and VA pragmatic clinical trials and leads the Outreach and Recruitment Core of the NYU Alzheimer’s Disease Center. He has held several leadership roles focused on healthcare policy impacting the quality of care for patients with chronic disease, particularly those living with dementia. Dr. Chodosh served as chair of the State of California Alzheimer’s and Related Dementias Advisory Committee and co-chaired a statewide effort leading to the California State Plan for Alzheimer’s disease.
Call to Action: The hope here is that with positive outcomes achieved, this study will lead to a larger trial in a bid to create an evidence-based policy for nursing homes’ staff-resident assignments that minimize the risk of acquiring COVID-19.