Authors (including presenting author) :
PC Ho (1), SM Li (2), TC Sim (1)
Affiliation :
(1)Department of Medicine and Geriatrics, (2)Community Nursing Services Division, United Christian Hospital
Introduction :
Elderly people living in the Residential Care Home for Elderly (RCHE) have a higher risk of developing severe complications and mortality after COVID-19 infection as they are older and frailer with multiple comorbidities. As of early August 2021, six months after the initiation of the COVID-19 vaccination program in Hong Kong, only 7.2% of elders aged 80 or above have completed first dose of COVID-19 vaccine. An extremely low vaccination rate, only one out of the 160 residents received COVID-19 vaccine, was observed in a RCHE covered by CGAT in Kowloon East District in September 2021.
Objectives :
Aim of the study is to improve the vaccination rate in a RCHE by CGAT, identify barriers for low vaccination rate, and suggest ways to improve vaccination in RCHEs.
Methodology :
In addition to providing regular outreach medical consultations to elders in the RCHE, the CGAT doctor also assessed their physical fitness to receive COVID-19 vaccines. Consent for vaccination was obtained from family by phone. If immediate decision for consent could not be made, the team would contact the family later to reconfirm their decisions. The CGAT also assisted the RCHE to send letters to family of all elderly residents to promote vaccination and liaised with the government mobile vaccination service to RCHE.
Result & Outcome :
From 9 September to 25 November 2021, of the 78 patients assessed, 23 patients with mean age 84.8 years, female sex 60% successfully received the vaccines. The vaccination rate increased significantly from 0.6% to 15% (p<0.0001). Most of the patients were moderately frail with Clinical Frailty Scale 5.91 and mentally incapacitated (70%) due to underlying dementia or psychiatric illness. No admission or mortality occurred within 14 days after vaccination. Significant barriers to successful vaccination included concerns of vaccine safety by the family and patients, difficulty for family to transport patients to community vaccination centers. Three patients who were considered as unfit for vaccination due to acute medical illness on initial assessment could receive vaccination after reassessment later by the CGAT.
In conclusion, the COVID-19 vaccination rate in a nursing home improved significantly with proactive participation by the CGAT. CGAT can collaborate with the government mobile vaccination team and RCHE in promotion, education and reassessment patients’ fitness for vaccination.
