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1.
Med Arch ; 75(1): 4-10, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1236906

ABSTRACT

BACKGROUND: The key considerations for healthy aging are diversity and inequity. Diversity means that there is no typical older person. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. OBJECTIVE: The aim of this article is to describe negative influence of Corona pandemic (COVID-19) for realization of the WHO project about Healthy Aging global strategy proposed in the targets "Health for all". METHODS: Authors used descriptive model for this cross-sectional study based on facts in analyzed scientific literature deposited in on-line databases about healthy aging concept of the prevention and treatment of the people who will come or already came to the "third trimester of the life". RESULTS AND DISCUSSION: Some 80-year-olds have levels of physical and mental capacity that compare favorably with 30-year-olds. Others of the same age may require extensive care and support for basic activities like dressing and eating. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. Inequity reflects a large proportion (approximately 75%) of the diversity in capacity and circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across people's lives. Importantly, the relationships we have with our environments are shaped by factors such as the family we were born into, our sex, ethnicity, level of education and financial resources. CONCLUSION: COVID-19 pandemic "celebrated" one year of existing in almost all countries in the world with very difficult consequences for whole population. But in the first risk group are old people who have in average 6 to 7 co-morbidities. WHO recommended some measures to improve prevention and treatment this category of population, but COVID-19 pandemic stopped full realization of Decade of Healthy Aging project.


Subject(s)
Health Promotion/organization & administration , Health Status , Healthy Aging , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Geriatric Assessment/statistics & numerical data , Geriatrics/standards , Humans , Male , Mental Health/statistics & numerical data , World Health Organization
2.
J Am Geriatr Soc ; 69(6): 1422-1428, 2021 06.
Article in English | MEDLINE | ID: covidwho-1211533

ABSTRACT

Geriatricians have long debated the parameters, positioning, and prospects of their specialty. The year 2020 started full of promise as many organizations anticipated assessing themselves using perfect, or 2020, vision. While challenging on several levels, the momentous combination of events in 2020-the COVID-19 pandemic, Racial Justice Movement, and the November elections-provided Geriatric Medicine several opportunities to firmly secure a position in the mainstream. As we reflect on the new perspectives, programs, and partnerships initiated in 2020, five broader lessons emerge that can help safeguard the future of Geriatrics: the field could employ more intentional "direct to consumer" marketing strategies, expand the scope of what it means to be a patient advocate, pursue new strategic partnerships, take the opportunity to address racial injustice, and leverage existing skillsets to expand scope of care for patients. Given the interdisciplinary nature of Geriatrics, it is fitting that many of these lessons build upon this collaborative philosophy and are derived from domains outside of health care. So in an unexpected way, the events of 2020 may actually help Geriatrics see, with 2020 vision, how to remain mainstream. With this new clarity, Geriatrics holds renewed promise to truly become specialists in whole-person care and it is our hope that, with insight from the lessons shared here, the specialty brings this vision to fruition in the current decade and beyond.


Subject(s)
COVID-19 , Geriatrics , Health Services Needs and Demand , Aged , Geriatrics/standards , Geriatrics/trends , Health Services Needs and Demand/standards , Health Services Needs and Demand/trends , Humans , SARS-CoV-2
3.
Age Ageing ; 50(2): 279-283, 2021 02 26.
Article in English | MEDLINE | ID: covidwho-960469

ABSTRACT

Several vaccines against coronavirus disease 2019 (COVID-19) are on the cusp of regulatory approval. Their safety and efficacy in older people is critical to their success. Even though care home residents and older people are likely to be amongst the first to be vaccinated, these patient groups are usually excluded from clinical trials. Data from several Phase II trials have given cause for optimism, with strong antibody responses and reassuring safety profiles but, with the exception of AstraZeneca's vaccine, recruited few older people. Overall, the sparse data from Phase II trials suggest a reduction in both antibody responses and mild to moderate adverse events in well older people compared to younger participants. Many of the Phase III trials have made a conscious effort to recruit older people, and interim analyses of the Pfizer and Moderna vaccine have led to press releases announcing high degrees of efficacy. However, older people with co-morbidities and frailty have once again been largely excluded and there are no published data on safety and efficacy in this group. Although the speed and impact of the pandemic on older people with frailty justify an approach where they are offered vaccination first, patients and their carers and supervising health care professionals alike will need to make a decision on accepting vaccination based on limited evidence. Here we review the main candidate vaccines that may become available, with a focus on the evidence of safety and efficacy in older people.


Subject(s)
COVID-19 Vaccines , COVID-19 , Frail Elderly , Geriatrics , Immunization Programs , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/classification , COVID-19 Vaccines/therapeutic use , Geriatrics/methods , Geriatrics/standards , Humans , Immunization Programs/methods , Immunization Programs/organization & administration , Patient Safety , Patient Selection , SARS-CoV-2 , Treatment Outcome
4.
Geriatr Gerontol Int ; 20(12): 1112-1119, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-901048

ABSTRACT

Since the end of 2019, a life-threatening infectious disease (coronavirus disease 2019: COVID-19) has spread globally, and numerous victims have been reported. In particular, older persons tend to suffer more severely when infected with a novel coronavirus (SARS-CoV-2) and have higher case mortality rates; additionally, outbreaks frequently occur in hospitals and long-term care facilities where most of the residents are older persons. Unfortunately, it has been stated that the COVID-19 pandemic has caused a medical collapse in some countries, resulting in the depletion of medical resources, such as ventilators, and triage based on chronological age. Furthermore, as some COVID-19 cases show a rapid deterioration of clinical symptoms and accordingly, the medical and long-term care staff cannot always confirm the patient's values and wishes in time, we are very concerned as to whether older patients are receiving the medical and long-term care services that they wish for. It was once again recognized that it is vital to implement advance care planning as early as possible before suffering from COVID-19. To this end, in August 2020, the Japan Geriatrics Society announced ethical recommendations for medical and long-term care for older persons and emphasized the importance of conducting advance care planning at earlier stages. Geriatr Gerontol Int 2020; 20: 1112-1119.


Subject(s)
Advance Care Planning , COVID-19/therapy , Long-Term Care/ethics , Advance Care Planning/ethics , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/mortality , COVID-19/prevention & control , Consensus , Decision Making/ethics , Geriatrics/standards , Health Resources/economics , Humans , Japan , Pandemics/ethics , Triage/ethics
6.
J Geriatr Oncol ; 11(8): 1190-1198, 2020 11.
Article in English | MEDLINE | ID: covidwho-650323

ABSTRACT

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.


Subject(s)
COVID-19/complications , Geriatric Assessment , Neoplasms/complications , Neoplasms/therapy , Aged , COVID-19/epidemiology , Consensus , Geriatrics/standards , Humans , Medical Oncology/standards , Neoplasms/radiotherapy , Neoplasms/surgery , Palliative Care/methods , Pandemics , Risk Assessment , Societies, Medical
7.
J Am Geriatr Soc ; 68(7): 1370-1375, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-232600

ABSTRACT

Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID-19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long-term care institutions, a triage instrument, and palliative care. Patient autonomy was emphasized, with a strong recommendation for people of all ages to update their advance directives or, if they did not have any, to quickly draw them up. Considering the value of distributive justice, with respect to triage, a "soft utilitarian" approach was advocated with the main criteria being function and comorbidity. Although chronological age was rejected as a sole criterion, in the case of an overwhelming crisis, "biological age" would enter into the triage considerations, but only in the case of distinguishing between people with equal non-age-related deficits. The guideline emphasized that no matter what, in the spirit of beneficence, anyone who fell ill must receive active palliative care throughout the course of a COVD-19 infection but especially at the end of life. Furthermore, in the spirit of nonmaleficence, the frail, very old, and severely demented would be actively protected from dying on ventilation. J Am Geriatr Soc 68:1370-1375, 2020.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Geriatrics/standards , Health Services for the Aged/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Israel , Long-Term Care/methods , Long-Term Care/standards , Male , Palliative Care/methods , Palliative Care/standards , SARS-CoV-2 , Triage/methods , Triage/standards
8.
J Am Geriatr Soc ; 68(6): 1136-1142, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-186723

ABSTRACT

Coronavirus disease 2019 (COVID-19) continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, inappropriately disfavoring older adults. This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and deemphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short-term (not long-term) outcomes; (4) avoiding ancillary criteria such as "life-years saved" and "long-term predicted life expectancy" that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID-19, aligning with AGS positions. The statement also includes recommendations for post-pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions. J Am Geriatr Soc 68:1136-1142, 2020.


Subject(s)
Betacoronavirus , Coronavirus Infections , Geriatrics/standards , Health Care Rationing/standards , Health Planning Guidelines , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , SARS-CoV-2 , United States/epidemiology
9.
J Am Geriatr Soc ; 68(6): 1131-1135, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-133540

ABSTRACT

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID-19) pandemic. It focuses on the need for personal protective equipment, access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer-reviewed articles, as well as ongoing and updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID-19 in nursing homes (DOI: 10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID-19. J Am Geriatr Soc 68:1131-1135, 2020.


Subject(s)
Assisted Living Facilities/standards , Coronavirus Infections/prevention & control , Geriatrics/standards , Health Planning Guidelines , Homes for the Aged/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Female , Humans , Infection Control/standards , Male , Pneumonia, Viral/virology , SARS-CoV-2 , Societies, Medical , United States/epidemiology
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