As the COVID-19 pandemic gathers pace in the UK, the BGS has issued this statement for healthcare professionals on the particular issues that older people face in relation to the virus and the importance of maintaining high-quality patient care.
While older people do not appear to be at an increased risk of contracting COVID-19 compared to younger people, they are at much higher risk of developing serious complications if they contract the virus. This may be because many older people are living with frailty, which depletes their reserves and makes them less resilient. Many also have other long-term and complex health conditions. It is therefore critical that efforts are made to prevent older people from coming into contact with the virus in the first place. Strict hygiene measures need to be observed to reduce the risk of spreading the virus.
The UK Government has recently issued further advice with the aim of protecting vulnerable people from exposure. Older people have been asked, regardless of whether they have symptoms, to employ ‘social distancing’ measures such as staying at home as much as possible, and avoiding public places and contact with people who may be carrying the infection but unaware of this or asymptomatic. While asking people over a certain age does seem arbitrary and does not account for the heterogeneity of the older population, we appreciate the need for the Government to draw a line somewhere. Family members and friends of older people who are undertaking social distancing are encouraged to use phone, post and digital solutions to keep in touch with their loved ones to prevent them becoming lonely. The BGS understands the measures that care homes are taking to reduce the risk of infection by limiting visits, but we are concerned about older people’s feelings of being unsupported. We recognise that some older people living in care homes may need extra support if they are vulnerable or close to end of life and one size may not fit all.
During the period of this pandemic, older people living with frailty and long-term conditions will continue to experience episodes of ill-health, falls or other unforeseen events, and health professionals will need to continue to respond to provide high-quality, person-centred care. While COVID-19 will be the main concern for the health system as a whole, much of the care that BGS members provide during this time may be routine care. As far as possible, efforts will need to be made to provide such care at home or in community settings, keeping older people out of hospital unless strictly necessary. Acute care staff will be dealing with large numbers of people infected by COVID-19 and older people will be vulnerable to contracting the virus in such a setting, despite the best precautions to minimise the risk of contamination. It is well-established that prolonged hospital stays bring the risk of deconditioning for older people, and efforts need to be made to discharge older people safely for post-acute care and rehabilitation.
It is likely that some older people will die of this disease over the coming months, or will die with this disease but from underlying health conditions. It is important for all healthcare professionals to remember that death is a natural part of life and for them to be supported to have responsible and sensitive conversations with their patients and families. Conversely, it is important to remember that while older people are the most likely to be seriously affected by COVID-19, many older people who get the virus will recover from it. Treatment for the virus must be determined by clinical need and the best scientific evidence and not by age alone.
The BGS recognises the risks to health professionals as they care for people infected by the virus, and urges them to follow official advice on wearing protective equipment, hygiene and other precautions to minimise the risk to themselves. We know our members are incredibly committed to the care of older people, and will be working extremely hard for the benefit of their patients. We encourage them to look after their own health and safety. We are committed to supporting our members during this time of increased pressure and ask members to contact us if there are specific ways we can do this.
In addition to looking after their physical health, we urge our members to look after their own mental health and wellbeing. As well as being dedicated healthcare professionals, our members are parents, spouses, children, siblings and friends. We know that at this time they will be worrying not only about their patients but also about their own loved ones. We urge them to take time to care for themselves and their families and, again, to let us know how we can better support them.
At BGS, we have taken action to cancel all of our events in the coming months, in order to do our part to prevent the spread of the virus, particularly among our members who are on the frontline caring for the people most at risk of developing complications if they contract COVID-19. We are ensuring that they have access to the most reliable and up-to-date information about COVID-19 in older people, and using our website to signpost to relevant resources and advice. We are monitoring official advice from the NHS, Public Health England and other sources across the four nations, and are ready to support the dissemination of official information as quickly as we can. If there is an information gap, we will explore how we can work with our members to produce the information that they need.
President of the British Geriatrics Society, Professor Tahir Masud, commented:
This is an unprecedented situation, putting great demands on the NHS. I am particularly concerned for the welfare of older people, who are more vulnerable than others to the effects of the virus. We have an amazing workforce of multidisciplinary professionals committed to the care of older people, and they will need to use their skills, knowledge and energy over the coming months to care for older people who already live with frailty or other health conditions. I know that members of the BGS will do their utmost to ensure older people are well cared for, across acute, primary and community care, to minimise the damaging effects of this pandemic. I urge all those involved to continue to provide the high-quality, holistic, patient-centred care for older people that is even more important at this challenging time”.