HJNO Sep/Oct 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2020 51 Jere` Hales Chief Operating Officer Lambeth House ON MARCH 13, 2020, the United States declared a national emergency in the fight against COVID-19, and it was during the early weeks of the pandemic that a con- cerning pattern emerged. Within the first couple of months, hospitals and hospi- tal systems reported declines of nearly 35 percent in outpatient volume, and almost 20 percent in inpatient volume. Cardiolo- gists took notice of the decreased number of STEMI patients that were being seen in emergency rooms, and neurologists won- dered where all the stroke patients had gone. The Centers for Disease Control reported that as the number of hospitalizations for COVID-19 rose, the number of Americans seeking emergency care for other medical reasons sharply declined. To quantify the extent of the decline, the CDC compared the number of emergency department vis- its during the early weeks of the pandemic (March 29–April 25, 2020) to those during the same period in 2019 (March 31–April 27, 2019). The results of that study revealed a 42 percent decline in emergency department visits compared to the prior year. It was clear that Americans were deferring care during the early pandemic period. Speculation re- lated to the cause of the staggering lower volumes in healthcare seemed to center around fear of exposure to COVID-19, par- ticularly in emergency department settings. This was especially true for seniors who re- ported feeling most vulnerable to the virus. Even now, months later, with infection control protocols strictly in place, many older adults pause prior to seeking inpa- tient or emergency department care. Ex- perts in the field of aging services (among others) are concerned about the extent to which these trends may impact the number of non-COVID-19 deaths in seniors (those who die for reasons related to the pandemic, but not from the virus itself).These concerns demand a call to action—a strategy to as- sist seniors in the second leg of this national pandemic. STRATEGIES FOR SENIOR CARE Alleviate contagion-related fears. Pro- viders should understand that seniors are prone to partaking in a sort of COVID-19 related calculus prior to accessing care, calculating the risk of seeking medical care with the risk of contracting the virus. These contagion related fears should be addressed head-on. Remind seniors that safety precau- tions are in place at hospitals and emergency departments, and that life-threatening emer- gencies must be addressed immediately in order to ensure the best outcomes. Seniors should be reminded that deferred care, in many cases, could be to their detriment, and that the risk of postponing care for a true healthcare emergency may outweigh potential exposure to COVID-19. Educate seniors on what a true health- care emergency looks like. Offer older adults consistent messaging regarding how a medical emergencymay present.TheAmeri- can College of Cardiology encourages pro- viders to educate patients on the signs of life-threatening conditions that need timely attention. Chest pain, acute abdominal pain, or signs and symptoms of stroke should always trigger concern and immediate re- sponse. If the condition is not life-threat- ening, a phone call or virtual visit may be appropriate to determine the safest access to care, but for true healthcare emergencies, early intervention can be critical. Use technology, but consider its limita- tions in caring for some older adults. The introduction of the COVID-19 pandemic has propelled telemedicine far beyond its pre-COVID-19 utilization in senior care, and providers have done an outstanding job of using telehealth to decrease unnecessary exposure during the COVID-19 pandemic. Virtual visits have now become a welcome norm in healthcare management of chronic illnesses that can be managed remotely. Dr. Josh Lowentritt, medical director of Lam- beth House, recommends that all seniors, at the very least, have a blood pressure cuff and digital scale, and that all diabetic seniors possess testing supplies to provide needed information during the virtual or phone visit. Followup consultations, labs, and additional diagnostic testing may require an in-per- son visit, but telehealth certainly reduces undue exposure. However, it is important to note the possible challenges that seniors may have with a remote visit. According to Pew Research, 27 percent of seniors do not use the internet. Additionally, cognitive is- sues may present challenges for some older adults, making telehealth unsuitable in some cases.According to the CDC, over 22 percent of older adults with coronary heart disease or stroke, or both, experience subjective cog- nitive decline, and have self-reported wors- ening or increased confusion and memory loss within the past year. A clear alternate plan must be created for the senior who struggles for any reason with technology. Seniors, for a multitude of reasons, are especially vulnerable to COVID-19, but im- plementation of these and other strategies may help in keeping them safe. n