“Amidst this pandemic, every single person in a nursing home, assisted living and independent living community needs help. While some need help rehabilitating from a COVID-19 infection, countless others require a prescriptive approach to recover from the negative effects of isolation.” - James A. Avery, MD, Visiting Assistant Professor of Medicine at the University of Virginia School of Medicine.
Those recovering from a COVID-19 infection – especially older adults – are experiencing significant, persistent deficits. To optimize physical, psychological and functional recovery, the authors of a recent study in Journal of Rehabilitation Medicine recommend post-acute and long-term rehabilitation interventions. Multidisciplinary teams – inclusive of physical therapists, occupational therapists, psychologists, speech and language therapists, and dietitians – are ideal and best-suited to address the complex syndrome of symptoms commonly associated with seniors recovering from COVID-19.
The Profile of a Senior (s/p) COVID-19
A clear clinical picture of the short and long term impact of COVID-19 on older adults is emerging as researchers and the medical community continue to assimilate the relevant data. Experts have identified, for example, that pulmonary symptoms – including persistent cough, difficulty breathing and dependency on supplemental oxygen – are common and ongoing for seniors recovering from COVID-19. Also, researchers have found that frailty – a clinical condition signified by a loss of reserves, energy and well-being that leaves patients vulnerable to sudden changes in health, at higher risk for hospitalization, and the need for long- term care – has been associated with poor mortality outcomes. Likewise, patients who required intubation may experience difficulty swallowing and with speaking (resulting from bruising or inflammation s/p intubation). And those who spent days or weeks in a hospital acute care unit or Intensive Care Unit (ICU) may suffer from Post-intensive Care Syndrome and/or present with muscle atrophy, major muscle weakness, cognitive dysfunction and mental health problems. And finally, Dr. Avery advises: “We must not discount the deleterious effects of isolation: loneliness, pain, deconditioning, falls, weight loss, pressure ulcers, insomnia, fatigue, anxiety, depression, and fear.”
Rx For Seniors: Rehab During and After COVID-19
The medical community strongly supports the need for skilled therapy interventions to accelerate recovery and help facilitate the best quality of life for those impacted by COVID-19. According to Dr. Avery, “Every patient who has been hospitalized or been seriously ill with a COVID-19 infection would benefit from receiving therapy.” Specifically, studies strongly support the need for physical therapy treatments to assess lung capacity, improve cough effectiveness, monitor breath sounds and provide highly specific treatments to improve breathing techniques, lung capacity and trunk/rib cage muscle strength; deconditioning, balance, and pain issues need specialized attention and care intervention as well. Speech therapists assure successful recovery by providing critically necessary treatment intervention for voice/speech/language, intonation and safe swallowing strategies (especially for patients s/p intubation.) Finally, the occupational therapist’s role is essential in facilitating a patient’s ability to return sooner to usual activities of daily living.
In fact, all therapy disciplines serve to decrease risk and improve the quality of life for those impacted by COVID-19. Therapists utilize techniques to re-educate seniors on ADLs and memory issues and help restore function to the muscles, bones, tissues and nervous system to improve strength, balance, and endurance. Ultimately, therapy plays a very important role in assessing/reducing fall risk and frailty (as defined above) in conjunction with ample health literacy for patients and caregivers.
“We’ve been primarily focused on prevention and treatment, but now is the time for medical teams to emphasize the need for recovery and rehabilitation,” states Dr. Avery. “It’s important to acknowledge that there’s often a limited window of opportunity for improvement for the elderly, because once muscle strength, function and flexibility are lost, it can be very challenging or nearly impossible to restore.” As such, post-acute care and senior living communities must rely on therapy teams for early, innovative and comprehensive specialized rehab interventions to address care delivery challenges associated with seniors and COVID-19.
For example, HealthPRO Heritage’s Safe Transition Program provides an evidence-based framework for therapists to proactively assess risk, comorbid conditions, physical function, medications, and psychological status. Patients recovering from COVID-19 benefit from customized treatments that progress seniors safely and proactively to an optimal level of care that ultimately supports their physical, cognitive and psychosocial wellbeing.
Seniors in Isolation: Solutions for the New World of COVID-19
Seniors who managed to escape a COVID-19 infection are still suffering the effects of this pandemic; isolation has taken its toll on both the physical and mental health of our nation’s seniors. According to Dr. Avery, we are already seeing an increase in falls, pressure ulcers, depression, anxiety and behavioral issues – even in facilities and homes that never had a single COVID-19 infection. As such, skilled rehab facilities and senior living communities should ensure their therapy team is well-prepared to proactively address these issues, because the necessary isolation restrictions have caused an overall trend in deconditioning that may ultimately precipitate a spike in the number of falls once the isolation restrictions are lifted and seniors return to normal ambulating.
Learn more about clinical solutions such as:
- Defying Gravity Program is a rehab-led IDT approach that assesses fall risk and focuses on proactive fall prevention strategies -- like gait training and balance -- to improve deficits and ultimately progress patients safely to the next level of care.
- Get Up & Get Connected, a virtual exercise/wellness resource that seniors can use to stay healthy and engaged during quarantine.
The Future: Rehab Redesigned
Amidst the uncertainty during the onset of COVID-19, some PAC providers expressed concerns about the risk for cross contamination by therapists. But with 7+ months of COVID-19 research and clear guidance from the medical community: Therapists’ role in caring for the growing number of patients impacted by COVID-19 is essential!
But this awesome responsibility requires that therapy departments (whether in-house or outsourced to a therapy company) make significant changes. For example, recent research from British Medical Journal emphasizes the need for frontline therapists to be adequately prepared and trained in the appropriate use of PPE. (According to the study: when PPE was used appropriately, 420 healthcare workers who performed aerosolized procedures on COVID-19 positive patients did not contract COVID-19 themselves.) Innovative treatment strategies (e.g.: offering virtual visits, unique scheduling options, redesigned gym/treatment spaces) must be considered in order to best meet the needs of patients and residents impacted by COVID-19. Also, therapists must be specialty-trained to provide treatment for patients with active COVID-19 diagnosis and/or on COVID-19 recovery units. (To illustrate, HealthPRO Heritage staff were required to complete mandatory training and competencies in PPE use and infection control best practices, as well as implement the ideas listed herein that enabled staff to proudly serve continuously on the front lines throughout the COVID-19 crisis.)
Conclusion
Recovering from COVID -19 may be especially challenging for our nation’s seniors. Physical, occupational and speech therapy have always been a part of clinically indicated post-acute care, and the medical community remains confident in the need for therapists to continue essential, specialized therapeutic interventions to facilitate a quicker and more complete recovery for seniors with COVID-19.
References:
- Society of Critical Care Medicine Post Intensive Care syndrome. Publication 2013
Page Created By: Judy E. Davidson, RN, CNS, DNP, FCCM; Ramona O. Hopkins, PhD; Deborah Louis, RN, MSN; Theodore J. Iwashyna, MD, PhD - Functional Disability 5 years After Acute Respiratory Distress Syndrome. New England journal Medicine Margaret S. Herridge, April 2011 M.D., M.P.H. et al,
- Jonathan Hewitt et al. The effect of frailty on survivalin patients with COVID-19 (COPE): a multicentre, European, observational cohort study, The Lancet Public Health (2020). DOI: 10.1016/S2468-2667(20)30146-8University of Aberdeen
- Falls in Older Adults: Risk assessment, Management and PreventionMoylan KC, Binder EF.Am J Med. 2007 Jun;120(6):493.e1-6. doi: 10.1016/j.amjmed.2006.07.022.
- Journal of Rehabilitation Medicine 2020: Long term clinical outcomes in Survivors of Severe Acute Respiratory Syndrome ( SARS) and Middle east Respiratory Syndrome( MERS) after Outbreaks of Hospitalization and ICU Admission: A systematic review and Meta analysis
- Hassaan Ahmed, Kajal Patel, Darren C. Greenwood, Stephen Halpin, Penny Lewthwaite, Abayomi Salawu, Lorna Eyre, Andrew Breen, Rory O’Connor, Anthony Jones, Manoj Sivan School of Medical Sciences, University of Manchester, UK
- Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study BMJ2020; 369 doi: https://doi.org/10.1136/bmj.m2195 (Published 10 June 2020)Cite this as: BMJ 2020;369:m2195