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Friday Sep 18, 2020

Treating Older Patients in the Pandemic Age

Older adults have always been a vulnerable and complex population when it comes to health care. During the pandemic, their health risks have grown exponentially, and providing needed care has become much more complicated and challenging. Not only are older patients most at risk of dying from COVID-19, but fear of the virus has deterred many older adults from seeking medical attention for treatment of chronic and acute conditions that also threaten their health. Additionally, the pandemic has exacerbated the feelings of isolation so common in this population and has created obstacles to vital social services.

[physician wearing mask speaking with two older patients]

I am a practicing family physician in Houston and the chief medical officer of a network of medical centers that provide senior-focused primary care. Given the immense needs of our patients, we have made every effort to continue to provide comprehensive care while keeping the safety of both our patients and staff our No. 1 priority. Although we quickly ramped up our technical capabilities to offer virtual visits -- both telephonic and online -- there has been considerable resistance to virtual platform adoption among our patients. Not only do many of them struggle with the use of technology, they also crave the human contact of face-to-face visits.

Knowing the limitations of virtual services for this population, a heroic effort by our staff made it possible to expeditiously develop and implement safety protocols following CDC guidance(www.cdc.gov) to keep our centers open throughout the pandemic. A notably large number of our patients have continued with in-person visits, but we have also worked to accommodate patients who are unable or unwilling to come to our offices so we can meet them where they need us to be.

An example of this flexibility is a recent experience I had with an 84-year-old patient. She had been completely isolated from friends and family for several weeks and was feeling extremely anxious and frightened. She had made regular visits to our clinic before the pandemic, but she had not been into the center in three months. Although she still wasn't comfortable coming inside, she drove herself to the center and my staff and I met her at the curb. We gave her a basic medical exam but, even more importantly, we also spent time just talking and providing that human contact she had been deprived of for too long.

Loneliness and depression are common in older adults, but the pandemic has magnified and multiplied the mental health issues our patients face. We have long believed it's important to have behavioral specialists on our care teams, and they've proven to be especially critical now for providing needed counseling and support.

The other crucial link for our patients during the pandemic is the social workers on our care team who have been helping secure basic needs and services. Many of our patients suffer from food insecurity, a problem that has only grown worse because of COVID-19. As a result, we are partnering with food pantries and farmers markets to ensure patients have access to nutritious food.

Transportation is another barrier to care, especially with patients who are uncomfortable using public transportation during the pandemic. Many times, we have helped arrange for alternative transportation so patients can make it to their medical visits and other necessary appointments.

Our holistic model, using a care team approach for older patients, has been a huge advantage in taking on the challenges of this pandemic. One obstacle for which we were not well prepared, however, is caring for patients while wearing masks.

Personally, I sometimes have trouble understanding people who are wearing masks, so just think what it's like for many of our patients who are hard of hearing and rely on lip reading and facial expressions to understand the information being relayed. Masks are the best safety measures we have for protecting our patients and ourselves, but they often muffle our voices and cover much of our face. To improve communications, I instituted special sensitivity training sessions to help staff better understand what our older patients are experiencing in this new mask-wearing world. Wearing clear masks is one way we've approached the problem, but even more effective is relying on the simple lesson I learned in my youth while making the rounds with my mother, a family physician treating patients in long-term care facilities: Speak slowly, clearly and loudly. Even this simple advice takes awareness and practice.

Not only do our patients need special care and attention at this time, but our staff do, as well. Keeping our 46 centers open has been an amazing accomplishment and a credit to every single employee, although we have not been immune to the pandemic. Some of our staff members have contracted COVID-19 but, thankfully, we have experienced only mild and moderate cases. We make sure that those who are quarantining and want to work have the opportunity to take on tasks from home, and we continue to include them virtually in our daily morning huddle when the entire staff meets to discuss our patients' medical and social service needs. During this exceptionally stressful time, we need to make sure that as care practitioners, we're giving and getting the emotional support we need so we can continue to be there for our patients.

Although the pandemic has presented huge challenges, it has also confirmed my deeply held belief that when treating older adults, we must do much more than apply our medical skills. We must offer an open mind, a sympathetic ear and a helping hand.

Tina Shenouda, M.D., M.B.A., is the chief medical officer for Partners in Primary Care,(partnersinprimarycare.com) a senior-focused primary care practice delivering care to older adults in seven states.

Posted at 04:30PM Sep 18, 2020 by Tina Shenouda, M.D., M.B.A.

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