RE: COVID-19 Response and Chronic Disease Management

  • George A Heckman, MD (Geriatrician), Schlegel-University of Waterloo Research Institute for Aging
  • Other Contributors:
    • Margaret Saari, RN, PhD, Post-doctoral fellow, SE Health
    • Caitlin McArthur, MScPT, PhD, Post doctoral fellow, GERAS Centre for Aging Research, St. Peter’s Hospital, Ontario, Canada
    • Nathalie IH Wellens, SLP, PhD, Program Manager coRAI, Centre Qualité et Systèmes, Department of Public Health Services and Social Affairs, Canton Vaud, Switzerland
    • John P Hirdes, Health services researcher, University of Waterloo
23 March 2020

We thank Dr. Laupacis for his solemn yet hopeful editorial on COVID-19.[1] While the focus on acute care and public health services is justified, we posit that chronic disease management must continue during this pandemic.[2]

Social distancing decelerates viral transmission, but could have substantial adverse impacts on older Canadians living with frailty and multimorbidity.[3] Many healthcare providers prioritise “urgent” conditions, downsizing access to “non-urgent” frail older persons. Social distancing is likely to affect both formal and informal care, lead to loneliness, depression, anxiety, accelerated functional and cognitive decline, and falls and fractures.[4] A distressed caregiver can quickly become overburdened if supports are reduced, with respite being sought in the emergency department. Those with chronic cardiac or lung disease may see mild symptoms worsen to the point of requiring hospitalization.[4] Vulnerable older adults who are discharged from home and community services may fall victim to exacerbation of conditions that had previously been stable with appropriate community supports. If hospitalized, these persons will be further isolated and face a greater risk for delirium and functional decline, leading to increased length of stay and need for home care, rehabilitation, or institutionalization upon discharge.[5]

Thus, outbreak measures may in fact lead to greater burden on hospitals.

Geriatric assessment can prevent acute care usage and be reliably delivered virtually, ensuring that social distancing is maintained.[6] Clinical decision support with interRAI assessments, deployed in virtually all Canadian home and long-term care sectors, can successfully guide “telegeriatrics”. Effective chronic disease management must be part of our pandemic response.

1. Laupacis A. Working together to contain and manage COVID-19. CMAJ. 2020 Mar 17. pii: cmaj.200428. doi: 10.1503/cmaj.200428.
2. Scott IA. Chronic disease management: a primer for physicians. Intern Med J. 2008;38(6):427-37. doi: 10.1111/j.1445-5994.2007.01524.x.
3. Vetrano DL, Palmer K, Marengoni A, et al. Frailty and Multimorbidity: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2019;74(5):659-666. doi:10.1093/gerona/gly110.
4. Wodchis WP, Austin PC, Henry DA. A 3-year study of high-cost users of health care. CMAJ. 2016;188(3):182-188. doi: 10.1503/cmaj.150064.
5. Surkan MJ, Gibson W. Interventions to Mobilize Elderly Patients and Reduce Length of Hospital Stay. Can J Cardiol. 2018 Jul;34(7):881-888. doi:10.1016/j.cjca.2018.04.033. Epub 2018 May 9. Review. PubMed PMID: 29960617.
6. Martin-Khan MG, Edwards H, Wootton R, et al. Reliability of an Online Geriatric Assessment Procedure Using the interRAI Acute Care Assessment System. J Am Geriatr Soc. 2017;65(9):2029-2036. doi: 10.1111/jgs.14895.
7. Heckman G, Gray LC, Hirdes J. Addressing health care needs for frail seniors in Canada: the role of interRAI instruments. CGS Journal of CME 2013;3(1):8-16.

Competing Interests: All authors are members of interRAI, a not-for-profit international scientific organization. They are writing on behalf of interRAI.
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