|Year : 2020 | Volume
| Issue : 3 | Page : 89-90
Care of Older Adults in the Post-COVID Era
Ex-Principal and Controller, Professor of Medicine, Dr S. N. Medical College, A-79, Shastri Nagar, Jodhpur - 342 003, Rajasthan, India
|Date of Web Publication||24-Feb-2021|
Ex-Principal and Controller, Professor of Medicine, Dr S. N. Medical College, A-79, Shastri Nagar, Jodhpur - 342 003, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathur A. Care of Older Adults in the Post-COVID Era. J Indian Acad Geriatr 2020;16:89-90
The COVID-19 pandemic has placed significant strains on health care systems worldwide, especially on routine geriatric care. Covid 19 has a substantial impact on older people, both directly and indirectly. Multi-morbidity and increased vulnerability to severe disease in older people leads to higher mortality. Covid 19 presents with atypical symptoms like fatigue, malaise, weakness, functional decline, delirium, dizziness and fall, which delays the diagnosis. Physical health suffers on account of respiratory, cardiac, and multi-organ involvement due to the disease. Mental health is affected due to fear and the anxiety of illness compounded by depression caused by social isolation. Due to the pressing priority of healthcare system to address the pandemic, treatment of the pre-existing conditions has suffered. Lockdown and quarantine have also compromised access to health care for older people. Social distancing has highlighted essential gaps in care. Ageism visible in the health care response to Covid 19 adds to the hardship of older people. Listening to a physician stating “Luckily, in our hospital, no one younger than 60 years has died” provides an unmistakable taste of the well-known ageism of our society. Besides difficulties of access to healthcare, caregivers, supplies of food, drugs and care supplies have also affected older adults. The understanding and compliance of public health responses and preventative measures are different in older adults. Older people have less accessibility to accurate, updated information and technology. COVID 19 pandemic has a significant economic impact on older adults also.
Geriatric Care is a complex speciality. The Covid-19 pandemic has added additional complexity, necessitating reform of the health care services with the increased delivery of healthcare closer to home for geriatric patients. Like basic laboratory tests, imaging evaluations, and home care services, many aspects of aged care are being shifted to the community. In geriatric practice, virtual care is being accepted by both clinicians, patients and families as it is flexible, convenient, and economical; ensuring independence, security and socialization of older adults. Technology enables the communication between primary health care providers and specialist doctors, thereby improving the quality of multidisciplinary patient-centred care.
Remote care delivery with telemedicine, including videoconferencing for remote consultations is feasible and effective. Telemedicine can be used to deliver home-based interventions also, such as activity-based training for survivors of stroke. Sensors could be used to monitor remotely specific symptoms, such as tremor, gait, falls, and paroxysmal events (e.g., seizures). Telemedicine offers better access to care, greater convenience, enhanced patient comfort, better confidentiality and avoidance of contagion.
Following the global trend, the use of telemedicine has accelerated in India. “The telemedicine market in India is expected to grow at a compound annual growth rate (CAGR) of 31 per cent for the period 2020–25 and reach USD 5.5 billion”, the EY-Indian Pharmaceutical Alliance (IPA) study predicts.
In India, recognizing the need for telemedicine due to COVID 19, Board of Governors (In supersession of the Medical Council of India) issued “Telemedicine Practice Guidelines” on 25th March 2020. It addressed the critical legal issues and standards of care, enabling Registered Medical Practitioners to provide healthcare using telemedicine. Ministry of Health & Family Welfare, Government of India, launched telemedicine service platforms, i.e., 'eSanjeevani' and 'eSanjeevaniOPD'. In November 2019 a doctor to doctor telemedicine system, eSanjeevani, was started under the Ayushman Bharat Health and Wellness Centre (AB-HWCs) programme. Amid the Covid-19 pandemic, to enable patient-to-doctor teleconsultation eSanjeevaniOPD was launched on 13th April 2020. With the government's vision of 'Digital India' and the necessity of Covid-19 pandemic, these platforms will continue to provide easy access to medical specialists for older people in the future.,
Technology can monitor both physical and mental health. For mental health also the use of telemedicine is becoming increasingly popular. It assists with the home management of People with Dementia (PwD) by offering services to the carers that may enhance their ability to care for their relative. Robot therapy is a new method of mental healthcare for older people. The Socially Assistive Robots (SAR) are used as a complementary therapy in dementia with a potentially beneficial relationship. Telemedicine helps in counselling and behavioural care also. Even after the pandemic, a blended approach is likely to emerge with eMental health solutions forming a greater part of routine clinical services.
Though telemedicine is a remarkable tool for many healthcare services, it has some limitations for geriatric patients. Older adults have communication difficulties with sensory deficits, e.g., visual, hearing which is further compounded by cognitive impairment. Many older adults are not comfortable in using technology. There is a need to address the “digital literacy” of the old. Telemedicine has significant security concern about privacy for which ethical, regulatory, and legal considerations need to be addressed. Inability to perform thorough clinical examination is another limitation of telemedicine.
In post-Covid 19 times, the fair use of assistive technology devices by older people with functional decline has to be ensured. Advances in assistive technology devices for seniors and ageing-in-place technology have changed how we deliver care and health services to ageing societies. The use of assistive technologies focuses on daily activities, safety monitoring, memory aids, preventing social isolation, improving the ease of living, maintaining functional independence, and promoting ageing at the site. The assistive technologies could help both the patient and the caregivers. They are useful for carrying out in-home diagnoses and treatment to improve quality of life and enhance adherence to medications and specialists' access. Development of novel patient monitoring and smart home technologies, artificially intelligent monitoring system, telecare, and robotic technologies have improved the functional independence and health care outcomes of older people.
The m-health helps manage older people with chronic conditions, remembering medical appointments, improving support for people with dementia, and screening for cognitive decline. It is also useful for primary prevention in the promotion of healthy habits regarding food and physical activity in the general population and as a tool to reduce costs, increase accessibility and improve the results of interventions. Social media and behavioural science interaction are likely to be used extensively for health promotion, education, and mass communications.
Development of ePharmacy with home delivery of drugs prescribed for a longer duration has been useful during the pandemic.
Virtual care may not be an option for many older adults who would still need care at home. In-home care needs to provide routine care and case management, post-discharge, home-based care, focusing on urgent care and behavioural care. Home visits offer new insights into a patient's natural environment. In post covid era, home-based and community-based care will have to be strengthened with augmentation of the community-level healthcare workforce.
Covid-19 is the third coronavirus (CoV) outbreak of international concern in 20 years, after the severe acute respiratory syndrome (SARS-CoV) and the Middle-East respiratory syndrome (MERS-CoV), in addition to other viral outbreaks such as Zika virus and Ebola virus over the last decade. In future also, new emerging infectious diseases are likely to be among the most critical health hazards. Infection Prevention and Control practices will have to be adapted to all sites of care.
Covid 19 has exposed limitations of the health care system for older people. In the post-Covid era, a new model of geriatric healthcare delivery will develop with emphasis on preventive care, remote care and substantial technological dependence. Community-Based Assessment to detect functional decline with person-centred care planning will form the basis of primary care with the continuum of care across all levels - home, community, long term care facilities, subacute care and acute care hospitals.
Post-Covid healthcare transformation would prepare for any global emergency, prevent similar future crisis and improve the whole spectrum of health. Change needs to be at the individual, societal and government level with the active participation of healthcare providers and patients. Community-based care delivery and virtual care with telemedicine and remote home monitoring will transform the geriatric care into a much more accessible, collaborative, efficient, and patient-centred care in the post-Covid era.
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