True, True, and Unrelated
COVID-19 has taken a disproportionate toll on older adults and the understandable tendency has been to report age alone as the greatest risk factor for contracting and dying from this infection. This all too simplistic explanation has led to more expressions of ageism in healthcare than is usually present. True, as the general population ages, they are generally at higher risk of bad things happening. True, there has been a disproportionate amount of COVID-19 impact in the higher age groups. Using age alone to drive health care decisions is one example of ageism but does not accommodate for the heterogeneous process of aging. One can be fit at 70 or frail at 40 and if stalked by COVID-19 may or may not succumb to the infection.
To challenge ageist views allow risk to be defined by frailty:
- Frailty is the best indicator of risk agnostic of age and diagnosis
- Results from conditions that lead to functional and cognitive impairment
- Frailty impacts young and old alike under these circumstances
- Measured and applied helps to challenge ageism
- Frailty identifies residents in need of focused, best practice care
We must change the way we think about aging and realize that it isn’t just the age, but the ones with the greatest cognitive and functional dependence (frailest) that are most susceptible.
Words from experts in Aprahamian I, Cesari M. Geriatric Syndromes and SARS-COV-2: More than just being old. The Journal of Frailty & Aging. Vol. 9, No. 3, 2020, 127-129.
“We are at war. The enemy is microscopic, extremely contagious, clinically unpredictable (kills the fit as well as the frail, the young as the old), and poses a huge threat to modern way of life and health systems.”
Stories from The Field
CMDs Can Lead the Way in Challenging Ageism
Certified Medical Directors, with their experience and expertise in geriatric medicine, have a unique opportunity to implement best practices in care even while having to adhere to COVID-19 guidance from their state and federal governments. Caring for the nursing home population, where most residents are old, renders age, to a certain extent, as irrelevant, and during the pandemic, everyone in the nursing home is thought to be at risk of infection. No matter the resident’s age, the risks for infection are essentially the same, based on the presence of multiple deficits and increased dependence on basic functions. What we will likely discover is that it isn’t the chronic condition diagnosis that creates the risk, it’s the impact the diagnoses have on the individual. Whereby, no two individuals are alike and CMD trained medical directors to know that all too well.
Care, directed by a CMD, has evolved into different models, grounded in best practices but implemented based on the staffing, layout of the environment, usual infection control practices, and availability of PPE and testing. One significant example of best practices overriding ageist isolation procedures has to do with the approach to social isolation, cohorting, masks and social distancing. While the science is clear that these practices are necessary to mitigate and control the spread of the virus, geriatric medicine is also clear that prolonged social isolation may have deleterious consequences in nursing home residents, such as anxiety, depressions, and decompensation of chronic illnesses. Models of care to accommodate infection control and psychosocial well-being have been developed and in a recent JAMDA article, practical suggestions were offered, many of which can be implemented immediately:
Simard J, Volicer L. Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic. J Am Med Dir Assoc. 2020;21(7):966-967. doi:10.1016/j.jamda.2020.05.006