How do we help older people with COVID-19 recover?

Adam Gordon is Professor of Care of Older People at the University of Nottingham. Miriam Haaksma is a Senior Researcher at the department of Public Health and Primary Care at Leiden University Medical Centre, and Stefan Grund is Senior Consultant and Postdoctoral Fellow at the Geriatric Centre of the University of Heidelberg.  Here they describe a Pan-European Project which aims to develop understanding of the role of specialist rehabilitation for older people in recovery from COVID-19. Watch the related EuGMS E-CONGRESS 2020 presentation here.

COVID-19 has proven to be particularly harmful to older people, who are more likely to experience severe symptoms, and be hospitalised as a consequence. COVID-19 affects multiple organ systems, has been shown to affect physical function, and is associated with prevalent delirium. There is emerging evidence that older people affected with COVID-19 may experience significant disability after the acute phase of their illness has passed.

There has been recognition in many countries of the need to provide structured rehabilitation for older people with frailty who have become unwell with COVID-19.  In England, this has taken the form of a pledge of specific funding for reablement for up to 6 weeks post-discharge¹. In the Netherlands, COVID rehabilitation care to vulnerable older people is provided in geriatric rehabilitation centres based in nursing homes.  In Germany, COVID-19 survivors with multimorbidity receive structured rehabilitation in either specialist pulmonary rehabilitation clinics, geriatric medicine departments of acute hospitals, or in special post-acute geriatric rehabilitation clinics, which are similar to nursing home-led facilities in the Netherlands.

In many countries, special rehabilitation services for older people with COVID-19 related needs will be provided by staff and services already set up to provide geriatric rehabilitation. Geriatric rehabilitation is an evidence-based approach to assessing and managing older people with frailty as they recover from acute illness or adjust to changes in physical functioning associated with ageing and long-term conditions. The core principles of what works well in geriatric rehabilitation have been agreed across Europe². Nevertheless the design and structures of geriatric rehabilitation services differ between the countries³.

It is not currently clear how older people recovering from COVID-19 will respond to geriatric rehabilitation interventions. It is also not clear how these interventions will have to be adapted or modified to take into account the patterns of disability, and the trajectory of recovery following COVID-19 as our knowledge continues to evolve.

We have written a protocol to collect data from geriatric rehabilitation services across Europe as they respond to the pandemic. You can access the protocol here. We will use this study to understand how older people have been affected by COVID-19, the rehabilitation services and approaches they were offered in each country and how these services have helped them to recover.

In all countries involved, we will use anonymised routinely collected service data. In most countries, including the UK, the project will be administered under service evaluation guidance and protocols. In Germany and The Netherlands, ethical approval has been obtained because of the way research is structured in those countries.

We are looking now for rehabilitation services to volunteer to support this work. By taking part you can help us to understand how older people recover from COVID-19, and the services that make a difference. It is possible that the data collected will help us better understand long-term questions about the best configuration of rehabilitation for older people. This could help us harmonise approaches across Europe in an evidence-based way.

It is possible that COVID-19 will remain with us; even if vaccination is mostly successful, we still need to understand how to support older people to recover.

If you are interested in helping out, and are based in the UK, please visit COVID-19: COGER Study. If you’re interested in participating from Germany, please contact stefan [dot] grund [at] bethanien-heidelberg [dot] de (Stefan Grund) and for all other European countries, please contact EU-COGER [at] lumc [dot] nl (Miriam Haaksma).

1. NHS Guidance: Care after illness or hospital discharge (reablement) https://www.nhs.uk/conditions/social-care-and-support-guide/care-after-a-hospital-stay/care-after-illness-or-hospital-discharge-reablement/
2. European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement https://doi.org/10.1007/s41999-019-00274-1
3. EuGMS survey on structures of geriatric rehabilitation across Europe https://doi.org/10.1007/s41999-019-00273-2