COVID-19, frailty and long-term care: Implications for policy and practice

Melissa K. Andrew, Samuel D. Searle, Janet E. McElhaney, Shelly A. McNeil, Barry Clarke, Kenneth Rockwood, David J. Kelvin

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

45 Citas (Scopus)

Resumen

Older adults have been disproportionately affected by the COVID-19 pandemic, with many outbreaks occurring in Long Term Care Facilities (LTCFs). We discuss this vulnerability among LTCF residents using an ecological framework, on levels spanning from the individual to families and caregivers, institutions, health services and systems, communities, and contextual government policies. Challenges abound for fully understanding the burden of COVID-19 in LTCF, including differences in nomenclature, data collection systems, cultural differences, varied social welfare models, and (often) under-resourcing of the LTC sector. Registration of cases and deaths may be limited by testing capacity and policy, record-keeping and reporting procedures. Hospitalization and death rates may be inaccurate depending on atypical presentations and whether or not residents’ goals of care include escalation of care and transfer to hospital. Given the important contribution of frailty, use of the Clinical Frailty Scale (CFS) is discussed as a readily implementable measure, as are lessons learned from the study of frailty in relation to influenza. Biomarkers hold emerging promise in helping to predict disease severity and address the puzzle of why some frail LTCF residents are resilient to COVID-19, either remaining test-negative despite exposure or having asymptomatic infection, while others experience the full range of illness severity including critical illness and death. Strong and coordinated surveillance and research focused on LTCFs and their frail residents is required. These efforts should include widespread assessment of frailty using feasible and readily implementable tools such as the CFS, and rigorous reporting of morbidity and mortality in LTCFs.

Idioma originalEnglish
Páginas (desde-hasta)428-432
Número de páginas5
PublicaciónJournal of Infection in Developing Countries
Volumen14
N.º5
DOI
EstadoPublished - may. 31 2020

Nota bibliográfica

Funding Information:
This work was supported by the Li-Ka Shing Foundation, Shantou University Medical College; a Rapid Response award for COVID-19, Canadian Institutes of Health Research; Dalhousie Medical Research Foundation; and a Rapid Response Award from Research Nova Scotia. DJK holds the Canada Research Chair in Translational Vaccinology and Inflammation at Dalhousie University.

Publisher Copyright:
Copyright © 2020 Andrew et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ASJC Scopus Subject Areas

  • Parasitology
  • Microbiology
  • Infectious Diseases
  • Virology

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