Which factors are associated with COVID-19 infection incidence in care services for older people in Nordic countries? A cross-sectional survey

• Published in: Scandinavian journal of public health 2022-08, Vol.50 (6), p.787-794
• Main Authors: Rauhala, Auvo S., Fagerström, Lisbeth M., Lindholst, Andrej C., Sinervo, Timo S., Bertelsen, Tilde M., Bliksvær, Trond, Lunde, Bente V., Solli, Rolf, Wolmesjö, Maria G., Hansen, Morten B.
• Format: Article
• Language: English
• Subjects: COVID-19; COVID-19 testing; cross-sectional studies; Home Care Services; infection control; multilevel analysis; nursing homes; Original; pandemics; primary prevention; Scandinavian and Nordic countries
• ISSN: 1403-4948; 1651-1905; 1651-1905
• DOI: 10.1177/14034948221085398

Aims: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units’ and frontline managers’ background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. Methods: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. Results: The proportions of residential/home units with client COVID-19 cases, mid-March–April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden’s mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p ⩽ .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p ⩽ .05. Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.