Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries

Oriol Miralles, Dolores Sanchez-Rodriguez, Esther Marco, Cédric Annweiler, Ainhoa Baztan, Évora Betancor, Alicia Cambra, Matteo Cesari, Benito J Fontecha, Jerzy Gąsowski, Sophie Gillain, Suzy Hope, Katie Phillips, Karolina Piotrowicz, Niccolò Piro, Guillaume Sacco, Edoardo Saporiti, Murielle Surquin, Estel Vall-Llosera, Oriol Miralles, Dolores Sanchez-Rodriguez, Esther Marco, Cédric Annweiler, Ainhoa Baztan, Évora Betancor, Alicia Cambra, Matteo Cesari, Benito J Fontecha, Jerzy Gąsowski, Sophie Gillain, Suzy Hope, Katie Phillips, Karolina Piotrowicz, Niccolò Piro, Guillaume Sacco, Edoardo Saporiti, Murielle Surquin, Estel Vall-Llosera

Abstract

Purpose: The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations.

Methods: Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond.

Results: In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings.

Conclusions: The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.

Keywords: Ageism; COVID-19; Geriatrics; Health policies; Older people; SARS-CoV-2.

Conflict of interest statement

The author declares that they have no cometing of interest.

Figures

Fig. 1
Fig. 1
WHO general recommendations to prevent infection and transmission of COVID-19
Fig. 2
Fig. 2
Comparison of selected measures specific to older adults implemented against COVID-19 as of May 2020 in Belgium, France, Italy, Poland*, Spain and UK (Scotland, England, Wales)

References

    1. World Health Organization . Coronavirus disease 2019 (COVID-19) situation report—101. Geneva: World Health Organization; 2020.
    1. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20:669–677. doi: 10.1016/S1473-3099(20)30243-7.
    1. Abbatecola AM, Antonelli-Incalzi R. Editorial: COVID-19 spiraling of frailty in older Italian patients. J Nutr Health Aging. 2020;24:453–455. doi: 10.1007/s12603-020-1357-9.
    1. The Impact of COVID-19 on older persons (2020). . Accessed 20 Aug 2020
    1. Statement of the EuGMS Executive Board on the COVID-19 epidemic - EuGMS. . Accessed 8 Oct 2020
    1. Scudellari M. How the pandemic might play out in 2021 and beyond. Nature. 2020;584:22–25. doi: 10.1038/d41586-020-02278-5.
    1. European Centre for Disease Prevention and Control (2020). An agency of the European Union. COVID-19 situation update for the EU/EEA and the UK, as of 24 June 2020 [Internet]. ECDC press room. . Accessed 24 Jun 2020
    1. Ecdc (2020) Surveillance of COVID-19 at long-term care facilities in the EU/EEA. . Accessed 20 Aug 2020
    1. Guide méthodologique Covid-19 (2020). . Accessed 25 May 2020
    1. Sanchez-Rodriguez D, Annweiler C, Gillain S, et al. Implementation of the integrated care of older people (ICOPE) app in primary care: new technologies in geriatric care during quarantine of COVID-19 and beyond. J Frailty Aging. 2020;2020:1–2. doi: 10.14283/JFA.2020.24.
    1. Azoulay E, Beloucif S, Vivien B, Guidet B, Pateron D, Le Dorze M (2020) Décision d’admission Des Patients En Unités de Réanimation et Unités de Soins Critiques Dans Un Contexte d’épidémie à Covid-19. Societé Française d’Anesthésie Réanimation. . Accessed 8 Oct 2020
    1. Âgisme et tensions intergénérationnelles en période de Covid-19. Académie nationale de médecine | Une institution dans son temps. (2020). . Accessed 26 May 2020
    1. Signorelli C, Scognamiglio T, Odone A. COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Acta Bio Medica Atenei Parm. 2020;91:175–179. doi: 10.23750/ABM.V91I3-S.9511.
    1. Riccardo F, Ajelli M, Andrianou X, et al. Epidemiological characteristics of COVID-19 cases in Italy and estimates of the reproductive numbers one month into the epidemic. medRxiv. 2020 doi: 10.1101/2020.04.08.20056861.
    1. Trabucchi M, De Leo D. Nursing homes or besieged castles: COVID-19 in northern Italy. Lancet Psychiatry. 2020;7:387–388. doi: 10.1016/S2215-0366(20)30149-8.
    1. Cesari M, Proietti M. COVID-19 in Italy: ageism and decision making in a pandemic. J Am Med Dir Assoc. 2020;21:576. doi: 10.1016/J.JAMDA.2020.03.025.
    1. Vergano M, Bertolini G, Giannini A, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care. 2020;24:165. doi: 10.1186/s13054-020-02891-w.
    1. Yourman LC, Lee SJ, Schonberg MA, et al. Prognostic indices for older adults: a systematic review. JAMA. 2012;307:182–192. doi: 10.1001/jama.2011.1966.
    1. Medycyna Praktyczna (2020) Geriatria. List otwarty Zarządu Głównego Polskiego Towarzystwa Gerontologicznego [Internet]. Liszki: Medycyna Praktyczna. . Accessed 17 Jun 2020
    1. Kolegium Lekarzy Rodzinnych w Polsce. #1. Apel KLR i KLSGeriatrii 24 03 2020 (1).pdf [Internet]. Warszawa: Kolegium Lekarzy Rodzinnych w Polsce (2020). . Accessed 17 Jun 2020
    1. Polskie Towarzystwo Psychiatryczne. Rekomendacje PTP: Epidemia SARS-COV-2 a populacja osób z otępieniem [Internet]. Warszawa: Polskie Towarzystwo Psychiatryczne; [updated 2020 April 9; cited 2020 June 17]. Available from:
    1. Instituto de Salud Carlos III (2020) Ministerio de Ciencia e Innovación. Gobierno de España. Informe situación COVID-19 en España a 11 de febrero. 2020. . Accessed 8 Oct 2020
    1. Rascado P, Ballesteros MA, Bodí MA et al (2020) Plan De Contingencia Frente a La Pandemia Covid-19. Soc Española Enferm Intensiva y Unidades coronarias. . Accessed 8 Oct 2020
    1. Manzano A, Labayen F, Bitor SC et al (2020) Recomendaciones éticas para la toma de decisiones en la situación excepcional de crisis por pandemia Covid-19 en las Unidades de Cuidados intensivos-Cuidados Críticos. Recomendaciones sobre Limitación. . Accessed 8 Oct 2020
    1. Deusdad B (2020) COVID-19 and Nursing Homes ’ crisis in Spain : Ageism and Scarcity of Resources . El COVID-19 y la Crisis de las Residencias de Mayores en España : Edadismo y Precariedad España : Edadismo y Precariedad
    1. Servei Català de la Salut (2020) Guia d’actuació enfront de casos d’infecció pel nou coronavirus SARS-CoV-2 a les residències. . Accessed 8 Oct 2020
    1. Tarazona-Santabalbina FJ, Martínez-Velilla N, María Teresa Vidán JAG-N. COVID-19, adulto mayor y edadismo: errores que nunca han de volver a ocurrir. Rev Esp Geriatr Gerontol. 2020 doi: 10.1016/j.regg.2020.04.001.
    1. Who’s at higher risk from coronavirus (COVID-19)—NHS. . Accessed 29 June 2020
    1. National Health System UK (2020) Information for GPs advising both shielding and non-shielding patients on support available during the COVID-19 pandemic. . Accessed 8 Oct 2020
    1. Pippa Allen-Kinross. What is ‘shielding’ and who needs to do it? - Full Fact. . Accessed 8 Oct 2020
    1. British Geriatrics Society. Coronavirus: advice to older people. . Accessed 29 June 2020
    1. National Institute of Health and Care Excellence. About Coronavirus (COVID-19). . Accessed 29 June 2020
    1. National Health System UK (2020). Advice on how to establish a remote ‘total triage’ model in general practice using online consultations. . Aaccessed 8 Oct 2020
    1. Robert Booth. Government rejected radical lockdown of England’s care homes | World news | The Guardian. . Accessed 29 June 2020
    1. Ian Trenholm. Sharing insight, asking questions, encouraging collaboration: CQC publishes first insight document on COVID-19 pressures | Care Quality Commission. . Accessed 29 June 2020
    1. Kretchy IA, Asiedu-Danso M, Kretchy J-P. Medication management and adherence during the COVID-19 pandemic: perspectives and experiences from low-and middle-income countries. Res Soc Adm Pharm. 2020 doi: 10.1016/j.sapharm.2020.04.007.
    1. Goodman-Casanova JM, Dura-Perez E, Guzman-Parra J, et al. Telehealth home support during COVID-19 confinement for community-dwelling older adults with mild cognitive impairment or mild dementia: survey study. J Med Internet Res. 2020;22:e19434. doi: 10.2196/19434.
    1. Sociedad Española de Medicina Familiar y Comunitaria (2020). Fase de transición de la pandemia por SARS-CoV-2 en Atención Primaria - semFYC. . Accessed 8 Oct 2020
    1. Li W, Fang Y, Liao J, et al. Clinical and CT features of the COVID-19 infection: comparison among four different age groups. Eur Geriatr Med. 2020;1:3. doi: 10.1007/s41999-020-00356-5.
    1. Tolson D, Rolland Y, Andrieu S, et al. International association of gerontology and geriatrics: a global agenda for clinical research and quality of care in nursing homes. J Am Med Dir Assoc. 2011;12:184–189. doi: 10.1016/j.jamda.2010.12.013.
    1. O’Neill D, Briggs R, Holmerová I, et al. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med. 2020;1:3. doi: 10.1007/s41999-020-00347-6.
    1. Szczerbińska K. Could we have done better with COVID-19 in nursing homes? Eur Geriatr Med. 2020;1:3. doi: 10.1007/s41999-020-00362-7.
    1. Ayalon L, Chasteen A, Diehl M, et al. Aging in times of the COVID-19 Pandemic: avoiding ageism and fostering intergenerational solidarity. Journals Gerontol Ser B. 2020 doi: 10.1093/geronb/gbaa051.
    1. Montero-Odasso M, Hogan DB, Lam R, et al. Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic. Can Geriatr J. 2020;23:152–154. doi: 10.5770/cgj.23.452.
    1. Lim W, Liang C, Assantachai P, et al. COVID -19 and older people in Asia: Asian Working Group for Sarcopenia calls to actions. Geriatr Gerontol Int. 2020;20:547–558. doi: 10.1111/ggi.13939.
    1. Brooke J, Jackson D. Older people and COVID-19: isolation, risk and ageism. J Clin Nurs. 2020;29:2044–2046. doi: 10.1111/jocn.15274.
    1. Beauchet O, Fantino B, Annweiler C. The ‘Action-Research’ philosophy: from bedside to bench, to bedside again. Int J Clin Pract. 2012;66:517–517. doi: 10.1111/j.1742-1241.2012.02909.x.
    1. Departament of Economic and Social Affairs (United Nations). Issue Brief on Older Persons and COVID-19: a Defining Moment for Informed, Inclusive and Targeted ResponseUnited Nations For Ageing | United Nations For Ageing. . Accessed 29 June 2020
    1. Archard D, Caplan A. Is it wrong to prioritise younger patients with covid-19? BMJ. 2020;369:m1509. doi: 10.1136/bmj.m1509.
    1. Previtali F, Allen LD, Varlamova M. Not only virus spread: the diffusion of ageism during the outbreak of COVID-19. J Aging Soc Policy. 2020;32:506–514. doi: 10.1080/08959420.2020.1772002.

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