Very early into the COVID-19 pandemic, we were told by national and international bodies alike that senior citizens were among the groups more vulnerable to the disease than the rest of the population. The mortality rates, compared to other age groups, have also been higher among those above 60.
Months into the pandemic though, doctors have had more experience in treating patients, including seniors. TNM asked two doctors from Chennai on what some of their takeaways are.
What emerged was interesting â€” the professionals highlighted that it was not just medical care, but also emotional support that particularly helped seniors pull through, compared to younger patients. They also discussed the systems they put in place to monitor patients and ensure that the morale of their staff was boosted.
How COVID-19 affects senior citizens
Dr Sameer Mehta, Vice Chairman, Dr Mehtaâ€™s Hospitals in Chennai, says that in retrospect, he would divide the senior patients of COVID-19 into three categories: those who had serious COVID-19 along with co-morbidities, and had low survival rate; those who had serious COVID-19 but not co-morbidities or other affiliated factors; and those who were asymptomatic or had light symptoms.
â€śIn the third category though, we noticed that if the disease worsens, the escalation happens very quickly,â€ť Dr Mehta says. He adds that in the early days of the pandemic especially, senior citizens with COVID-19 would prefer to be treated at home. â€śHowever, if the disease escalated in them, the lung involvement is very high. And so, if the medication is given even 3-4 days later, the disease could have catastrophic results.â€ť
In Dr Mehtaâ€™s experience, those who had pre-existing respiratory ailments, or those who had had a prior respiratory ailment were worse affected. In the latter situation, the lung capacity would have been affected or reduced, leading to more vulnerability.
However, Dr Rajendran Magesh, Consultant Geriatrician at Chennaiâ€™s Apollo Hospitals, says that the manifestation of COVID-19 would vary on a case-to-case basis. â€śWe have seen people with 4-5 comorbidities getting discharged after 7-10 days, and also those who have just one condition like hypertension or diabetes but struggled a lot.â€ť He added that the risk of severe COVID-19 may be higher for senior citizens with poorly controlled or uncontrolled diabetes.
â€śIf we separate the senior patients into 60 to 75-year-olds and those above 75, the mortality was not very different,â€ť Dr Rajendran adds.
Dr Rajendran says that they also followed an interdisciplinary approach â€“ consulting a pulmonologist, infectious diseases specialist, and intensive care staff, and other departments that helped ensure that all bases were covered with senior citizens. â€śThe number of medical reviews that happened also helped. We reviewed each patient every day at least 4-5 times. We understood that the disease can change course unexpectedly, so frequent follow-ups helped,â€ť he explains.
At Dr Mehtaâ€™s, the staff set up a system of staggered alarms to monitor the patients. This meant that multiple staff members monitoring a patient could set an alarm for a particular threshold in their health vitals. This removed the responsibility of monitoring from a single health worker, and different people could be alerted at different times. Further, staffers were also provided technology that allowed them to monitor the patient remotely, even from their own homes.
The hospital also constituted a team of clinicians and nurses to look through developing research and material on COVID-19 online. â€śThis team read and filtered the data that was useful and passed it on to the doctors and those treating the patients, who may otherwise have not had the time to read through the sheer volume of information coming in,â€ť Dr Sameer says.
Support beyond medical treatment
Both Dr Sameer and Dr Rajendran emphasised that for senior citizens, emotional support and helping them stay in touch with their loved ones played a key role in recovery and keeping their morale up.
â€śWhen you have COVID-19, unlike other illnesses, you cannot see loved ones because you have to be in isolation. That is really scary, especially for senior citizens. So we made sure that our patients, particularly those above 60, had access to Facetime, WhatsApp video calls and Skype to speak to their loved ones,â€ť Dr Sameer says.
At Apollo too, Dr Rajendran says that the staff was trained to help the senior citizens do the same, because many of them are not comfortable with smartphones and are not tech-savvy. â€śThe staff would also sit with them, help them eat and talk to them. These things really mattered.â€ť
Dr Sameer adds that one of the biggest takeaways from this pandemic is that if the hospital staff is assured that they and their loves ones will be taken care of if they contract the virus â€“ regardless of government assurances or policies to that effect â€“ it increases their confidence in looking after patients by 3x-5x. â€śWe told the staff that we had kept aside some of the drugs and some ICU beds for them or their family members. Once they were assured that they would be taken care of, their morale was up.â€ť
The Vellapanchavadi campus of Dr Mehtaâ€™s Hospitals has a recovery and discharge percentage of 98.69% in senior citizens when it comes to COVID-19. Dr Rajendran says that in Chennai, Apollo Hospitals has a recovery and discharge rate of over 80%.