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Working With Older Patients at Risk for the Coronavirus

Although there is still much to learn about SARS-CoV-2, the virus that causes COVID-19, research indicates that older individuals who become infected are at higher risk for complications, including hospitalization, ventilation and death. Whether you are a nurse working in a long-term care facility or an adult gerontology acute care nurse practitioner (AG ACNP) in a hospital emergency department, there is an added responsibility to protect this vulnerable demographic.

Why Are Older Patients More Vulnerable to COVID-19?

Older patients are more vulnerable to the effects of the novel coronavirus largely due to their compromised immune systems, which tend to weaken with age and when strained by existing comorbidities.

According to the National Council on Aging (NCOA), approximately 80% of older adults have at least one chronic disease or condition, such as heart disease, cancer, stroke or diabetes, while as many as 77% have two or more. A less robust immune response coupled with underlying health conditions makes it difficult to effectively fight the virus or tolerate complications like pneumonia, which can be linked to age-related reductions in cardiopulmonary function.

If these individuals contract COVID-19, they are at higher risk of morbidity and mortality. Provisional data from the National Center for Health Statistics (NCHS) indicates that in the early months of the pandemic, from February 1 to June 10, 2020, roughly 80% of all deaths occurred in individuals aged 65 and older. Individuals aged 85 and older accounted for one-third of all COVID-related deaths during that same timeframe.

Populated by vulnerable elderly patients, long-term care facilities have been particularly impacted by coronavirus outbreaks. The New York Times reported that one-third of all COVID-related deaths have occurred among residents or employees of these facilities. The communal living arrangements are also conducive to rapid spread of the virus.

How Can Nurses and NPs Protect Older Patients?

Nurses and nurse practitioners who work with older patients have an opportunity to help reduce risk factors through care management, education and communication.

Improved management of underlying conditions. With so many older patients living with chronic disease, ensuring underlying conditions are well-controlled is imperative. Nurses and healthcare providers can offer patients resources and tools to maximize their current health status. This may take the form of a referral to a nutritionist to better manage diet or a handout of at-home exercises to enhance mobility.

Practice proper infection control. Strict measures should be taken when working with older patients. You should wear all recommended personal protective equipment (PPE), including gloves and N95 masks, during these encounters. You may also need to rapidly identify the potentially COVID-positive, then triage and quarantine them. This allows patients to receive critical care much faster and protects others from acquiring the virus. Advise patients of infection control methods to use at home, in the workplace and in public, such as regular handwashing, avoiding large crowds and wearing a mask when close contact is unavoidable.

Keep communication flowing. As more becomes known about COVID-19 and its effects, guidelines and recommendations will likely change. Healthcare employees are instrumental in disseminating this information, ensuring patient understanding and ability to comply. Due to ongoing visitor restrictions, nurses and NPs — especially those working in hospital and nursing home settings — will be the main lines of communication with family members and should be prepared to serve in this capacity.  

Early data indicates that older patients are at higher risk for COVID-19 as well as any resulting complications, including death. While this is discouraging news, healthcare workers are able to mitigate some of these risk factors by supporting treatment of existing conditions, being mindful of infection control procedures and providing timely information to patients and their families.

Learn more about UTA's MSN in Adult Gerontology Acute Care Nurse Practitioner online program.


Sources:

Centers for Disease Control and Prevention, National Center for Health Statistics: Provisional COVID-19 Death Counts by Sex, Age and State

Institute for Healthcare Improvement: COVID-19 Resources – Care of Older Adults

Minority Nurse: Protecting Older Adults During the COVID-19 Outbreak

National Council on Aging: Healthy Aging Facts

New York Times: One-Third of All U.S. Coronavirus Deaths Are Nursing Home Residents or Workers


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