Long COVID and older people

Long COVID is a poorly understood condition, with a wide spectrum of effects on multiple body systems and variable presentation in different individuals. Long COVID is of particular concern among older people (ie, aged 65 years or older), who are at greater risk than younger people of persisting symptoms associated with COVID-19. In addition, COVID-19 might trigger or exacerbate chronic conditions that occur commonly in older people, such as cardiovascular diseases, respiratory diseases, neurodegenerative conditions, and functional decline. In addition, the disruptive effects of COVID-19 for older people should not be underestimated;lockdowns and other restrictions might have reduced the social interactions of older people, and they are also likely to have lost a spouse or loved one during the pandemic, which can contribute to mental and physical decline. COVID-19 vaccination appears to reduce the effects of long COVID, and older people, especially those living in aged care facilities, should remain up-to-date with their COVID-19 vaccinations. Health-care staff should also consider long COVID in the differential diagnosis of relevant symptoms in older people, rather than assume increasing frailty, and should pursue early multidisciplinary assessment and management of persisting symptoms. Addressing physical, psychological, and functional sequelae will mitigate the effect of long COVID and improve the health and quality of life of older people.Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

An examination of peer recovery support specialist work roles and activities within the recovery ecosystems of Central Appalachia

BackgroundSubstance use/misuse is a leading public health concern in the United States. In the midst of the COVID-19 pandemic, drug-related deaths exceeded 100,000 in a 12-month period for the first time in history. There is currently an urgent need for empirical evidence to inform community leaders and policy makers on the benefits of recovery-informed approaches to SUD prevention and treatment. The peer recovery support specialist (PRSS) is a certified professional who self-identifies as being in recovery from a substance use disorder (SUD), mental illness, or co-occurring disorder and may play an important role in positively affecting outcomes for persons with SUD. However, the evidence for PRSS services is limited in part due to methods that are ill-fitted to measure the dynamic process of recovery across time and within a complex service continuum.MethodsThis sequential exploratory mixed-methods study queried PRSS in five Central Appalachian states regarding their work roles and activities within the context of regional service networks also known as 'recovery ecosystems.'Results565 Central Appalachian PRSS respondents indicate that they frequently provide emotional support in a broad array of regional service settings but have few professional advancement opportunities. PRSS also report that their role is frequently misunderstood.ConclusionsThis study expands the existing literature providing information about training, remuneration, job satisfaction, work roles and activities within the context of existing recovery ecosystems. Inclusion of peer recovery support specialist's perspectives improved measurement of peer service delivery and should be considered when working with this vital recovery-supporting workforce.

What is the role of primary care in COVID-19 programs focused on people experiencing homelessness?

Background: The pandemic has had a disproportionate impact on people who are living in socially disadvantaged situations. People experiencing homelessness are less able to isolate and follow public health messaging to reduce the risk of infection. In addition, due to the higher prevalence of chronic disease, they have a poorer prognosis with infection with higher rates of mortality and hospitalisation. In the early pandemic, many countries implemented programs that were exclusively focused on the care of people experiencing homelessness. Aim/Objectives: Our aim was to describe programs that have been implemented to reduce COVID-19 transmission and severity of illness in homeless populations and to understand the involvement of primary care. Method(s): We performed a rapid review of the international literature documenting COVID-19 related programs for people experiencing homelessness. We searched PubMed, Embase, and CINAHL plus Google using search term combinations of homeless persons and COVID-19. All articles were screened by two independent reviewers and one person extracted the items of interest. Finding(s): After screening 615 studies we included 42 studies and most were from the USA (n = 26). Programs commonly focused on isolation centres for people experiencing homelessness who tested positive for COVID-19 (n = 15). Sixteen studies included an evaluation of program effectiveness and two investigated the perspective of program participants. Universal screening was more effective than symptomatic screening in reducing COVID-19 transmission in homeless shelter settings. Comprehensive healthcare, including mental health and addiction support, was essential for people to be able to tolerate isolation, but care continuity post-isolation was problematic with limited primary care involvement. Implications: Few COVID-19 programs for people experiencing homelessness involve the primary care sector. As continuity of care post-program was a common problem, primary care may have a role in cross-sector collaboration.

General practitioner management of mental health during the COVID-19 pandemic

Background Psychological issues are common presentations in general practice. The COVID-19 pandemic has created a 'perfect storm' for the deterioration of mental health. General practitioners (GPs) are ideally placed to provide supports for people with mental health issues. Objective The objective of this article is to provide an overview of management approaches for mental health issues, paying attention to fostering resilience and lifestyle factors, particularly during the COVID-19 pandemic period. Discussion While feelings of fear and anxiety are expected in these uncertain times, some people may experience an exacerbation of a mental illness or develop a mental health issue for the first time during the COVID-19 pandemic. A list of resources available to GPs is provided, and case studies are used to demonstrate how these resources can be used to support assessment and management during the COVID-19 pandemic.