Resources relevant to Clinical Care in Geriatrics during the COVID-19 Pandemic

The following information is specific to geriatrics clinical care that is relevant to COVID-19 and our patient population.

1) MoCA by Telephone and Video – A post from the authors of the Montreal Cognitive Assessment (MoCA) about the use of the MOCA by telephone and videoconference. https://mailchi.mp/mocatest/remote-moca-testing?e=bbeb81559c. This may be helpful for your virtual visits.

2) WHO guidance on the acute clinical management of COVID-19 patients.  Several Toronto experts contributed to this helpful document, including the team at Li Ka Shing led by Dr. Sharon Straus. For the older patient, they note that symptoms may be atypical.  There is a section at the end of the document on the older patient with recommendations that emphasize being person-centred, including caregivers in management planning, reviewing for polypharmacy and multidisciplinary team approach. A reminder that geriatric care principles are still important in this pandemic situation. WHO clinical-management-of-novel-cov (1)

3) BGS Statement on delirium in COVID patients- it is a general statement and mostly reinforces the usual approaches to delirium https://www.bgs.org.uk/resources/coronavirus-managing-delirium-in-confirmed-and-suspected-cases

4) The Geriatric Emergency Department Collaborative has published “COVID-19 in Older Adults: Key Points for Emergency Department ProvidersJGEM-COVID-19-in-Older-Adults. In addition to some of the advice you have likely already seen, they highlight:

  • Fever may be blunted in older adults
  • Separate older adults with respiratory symptoms from those that don’t in the emergency department
  • Communicate slowly and clearly when wearing a mask
  • Ensure messages are clear and directions are easy to understand (e.g. voicemail)
  • Caregivers for older adults should have a back-up plan in case they become ill
  • Increased risk of delirium and dehydration for older adults – continue to be vigilant on these issues
  • Warm handoffs/checklists to support transitions in care
  • Getting enough sleep is important for everyone

5) Virtual Care to Long Term Care Homes (LTCHs)– A provincial effort is underway to increase the availability of physician consultation from general internal medicine, geriatric medicine, geriatric psychiatry, and care of the elderly, through virtual means. These services would be coordinated with existing teams serving LTCHs, including psychogeriatric resource consultants, Nurse-led outreach teams, Behavioural Supports Ontario (BSO) services, geriatric psychiatry outreach teams, among others.