Comprehensive care model applied to prevent deterioration in older adults suffering COVID-19

Offering comprehensive and multidisciplinary care to frail older patients admitted for COVID-19 makes it possible to reduce the impact hospitalisation and isolation have on their functional capacity. This has been demonstrated in a study by doctors and nurses at Hospital del Mar, which validates the usefulness of this comprehensive care model, ACE (Acute Care for Elders). The work has been published in the magazine Geriatric Nursing.

The study followed 51 patients admitted during the first wave of COVID-19 to the Dr. Emili Mira Centre, a facility at the Mar Health Park that specialises in the care of psychiatric diseases and geriatric patients. The functional deterioration that appears in older adults during a hospital stay for acute illness (30-80% of geriatric patients admitted to hospital suffer a reduction in their capacities as a result of a hospital stay), is even more important in the case of COVID-19 because of the restrictions applied to the isolation units. To avoid this situation, a comprehensive care model, ACE, was implemented. As Dr. María José Robles, head of the Orthogeriatric Unit at Hospital del Mar and the last author of the article, explains, "This involves the collaboration of a multidisciplinary team, comprising geriatric nurses, specialised nursing assistants, a social worker, physiotherapists, and a geriatrician specialising in infectious diseases."

"The multidisciplinary team developed a care plan based on the ACE model, with the aim of enabling the patient to return to their basic functional state, with weekly monitoring of their progress", clarifies Dr. Robles. At the time of admission, 9 out of 10 patients presented a high degree of dependency, which the conditions of hospitalisation could have worsened. However, at the time of discharge, 70% of these individuals had maintained the functional capacity they had had prior to being admitted to the COVID-19 Unit. At the same time, there was a lower mortality rate than observed in general for patients their age, and a very low number of transfers to more complex hospitals.

Validated model

Dr. Gabriel Vallecillo, the first author of the study, a consultant in the Institute of Neuropsychiatry and Addictions (INAD) at Hospital del Mar, and a researcher in the Addictions Research Group at the Hospital del Mar Medical Research Institute (IMIM), points out that "We have been able to observe that the ACE model is easily implemented in the daily clinical care of geriatric patients in the COVID-19 units, and that it is effective in preventing their functional and cognitive deterioration." At the same time, he highlighted "The fundamental role of the nursing staff, as they are responsible for preventing geriatric syndromes and implementing basic procedures that promote and maintain patient mobility and self-care."

According to Dr. Vallecillo, these results were obtained in a group of patients "With a high level of comorbidity and fragility, which are factors that predispose to functional deterioration during acute hospitalisation." During their hospital stay, two out of three patients also suffered a pathology other than COVID-19, with delirium being the most common. These findings have led the authors to recommend close monitoring of the symptoms of this disease in the isolation units, where the conditions can lead to disorientation and a lack of awareness, in order to limit its negative effects.

Reference article

Gabriel Vallecillo, Marta Anguera, Noemi Martin, Maria Jose Robles, Effectiveness of an Acute Care for Elders unit at a long-term care facility for frail older patients with COVID-19, Geriatric Nursing, 2020, ISSN 0197-4572, https://doi.org/10.1016/j.gerinurse.2020.10.004.