The global new challenge COVID-19 has had many effects of older adults’ life. The pandemic restrictions, which older adults tend to be more diligent in following, has limited older adult’s ability to move and engage with their community outside the home. Outdoor activity is an essential part of maintaining the functional capacity of older people, it goes without saying that functional capacity begins to decline as the time spent indoors at home increases.
Older age combined with the functional decline is a risk factor for increasing mortality in those affected by COVID-19 (Laosa et al. 2020). Older adults also have a greater burden of chronic diseases such as diabetes, cardiovascular, cancer and chronic lung disease than younger populations. (Dorjee et al. 2020) Older adults who have these chronic diseases have a higher risk for frailty (Chinnadurai et al. 2020). All these factors alone and together increase the risk of mortality with the COVID-19.
The need of rehabilitation has increased globally in recent years prior to the COVID-19 pandemic. According to the Cieza (2020) and colleagues’ study, it is estimated that “at least one in every there people in the world need rehabilitation at some point in the course of their illness or injury.” Importantly, the number of older adults is increasing globally too and most of the rehabilitation users are older adults. Furthermore, they are the majority of health care and long-term care users. Especially in long-term care, an importantly challenge is the access to rehabilitation services (World Health Organization 2020). In addition to these many factors, the COVID-19 pandemic has further increased the need for rehabilitation services for older adults across residence settings.
COVID-19 patient’s rehabilitation and education
COVID-19 is presents challenges to the education of physiotherapy students, both from ensuring appropriate health care practices to prevent COVID-19 within the context of teaching clinical skills in person and the delivery of education with up to date practices for rehabilitation of people with COVID-19.
From the teaching point, it is important to teach the physiotherapy students about the basics of COVID-19 disease with regards to infection control and prevention (i.e., proper hand washing, donning and doffing face masks). Students also need to understand how to deliver rehabilitation care for people who have had the disease, specifically having an understanding of the effects this disease has on the different body systems, functional capacity and ability to do exercises (Barker-Davies et al. 2020).
According to the WHO (2020) guidelines “in hospitalized patients, during the acute phase of illness, rehabilitation professionals may provide interventions that relieve respiratory distress, prevent complications and support communication.” Students need to know how they should screen the needs of rehabilitation and how they can support recovery and/or rehabilitation process for the person with COVID-19. It is important to include the following practice points in working in the acute care setting:
- breathing exercises
- early mobilization
- education and support for the self-management
- screen for physical, cognitive and mental impairments
- optimal use of written and/or digital information for the instruction of patients
COVID-19 is a multisystem disease, in many cases it will require a full multidisciplinary rehabilitation team to enable recovery (Barker-Davies et al. 2020). One important topic to teach is how to work as a member of the multidisciplinary team. While COVID-19 does not change the essential role of physiotherapy in a multidisciplinary rehabilitation team there will be new considerations due to the health status. Importantly, delivery of care for people with COVID-19 will be in specialized units to limit spread and rehabilitation sessions will likely be within the person’s room.
Patients who have been discharged from the hospital or who managed at home without hospital admission there are a few additional considerations:
- If people experience persistent symptoms and/or limitations in functioning, then screen for physical, cognitive and mental impairments, and manage accordingly
- Provide individualized rehabilitation programmes which are guided by any persistent symptoms and function limitations
The Canadian Geriatrics Society website has an excellent listing of resources for management of COVID-19 (https://canadiangeriatrics.ca/covid-19-resources/). If your country has specific national, regional or local information please use those resources. Some specific resources for best practices for rehabilitation include:
- World Physiotherapy COVID-19 information hub (https://world.physio/resources/covid-19-information-hub);
- Presentation and management of COVID-19 in older adults in acute care (https://canadiangeriatrics.ca/wp-content/uploads/2020/06/sg_presentations_and_management_of-covid-19_in_older_people.pdf)
- Critical care in adults (https://www.nice.org.uk/guidance/ng159)
- Maximizing mobility in older adults when isolated with COVID-19 (https://www.cebm.net/covid-19/maximising-mobility-in-the-older-people-when-isolated-with-covid-19/)
- Rehabilitation for post-acute care patients diagnosed with COVID-19 (https://canadiangeriatrics.ca/wp-content/uploads/2020/05/Summary-of-rehabilitation-of-post-acute-care-of-COVID-19-patients-4May20.pdf)
- Thomas P, Baldwin C, Bissett B et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. Journal of Physiotherapy. 2020;66:73-82.
- How older adults can stay active indoors during the COVID-19 pandemic (https://www.rgptoronto.ca/wp-content/uploads/2020/04/SLoT-Intervention-COVID19-2020-04-13.pdf )
- Fysioterapiasuositus COVID-19 (https://www.suomenfysioterapeutit.fi/edunvalvonta/koronavirus-ohjeita-fysioterapeuteille/fysioterapiasuositus-covid-19/ )
To the future
In the future, general and national recommendations and/or consensus statements for the rehabilitation of people post COVID will be developed and will be informed by experiences to date. National recommendations that are address the unique features of each country’s health care delivery models are needed to support physiotherapists in the delivery of rehabilitation across care settings. In education, it is important that the newest knowledge and evidence-based methods are taught and educators need to have resources to inform the content that is taught. This will open new possibilities to do research and teaching collaboration between universities.
Our ultimate goal is to address and optimize health of older adults, by prevention of mobility decline in older adults who are isolating to prevent getting COVID-19, and then working with older adults who have COVID-19 across care setting to recover function.
Marja Äijö, PT PhD, Principal lecture of gerontology and rehabilitation, Savonia University Applied Sciences, Kuopio Finland
Susan Hunter, PT PhD, Associate Professor, School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada
Barker-Davies RM, O’Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, et al. 2020. The Stanford Hall consensus statement for post COVID-19 rehabilitation. Br J Sports Med, 54(16) 949-959.
Chinnadurai R, Ogedengbe O, Agarwal P, Money-Coomes S, Abdurrahman AZ, Mohammed S, et al. 2020. Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting – a cohort study. BMC Geriatrics, 20(1):409.
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S & Vos T. 2020. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 19;396(10267):2006-2017. doi: 10.1016/S0140-6736(20)32340-0.
Dorjee K, Kim H, Bonomo E & Dolma R. 2020. Prevalence and predictors of death and severe disease inpatients hospitalized due toCOVID-19: A comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients. PLoSONE 15(12):e024319. https://doi.org/10.1371/journal.pone.0243191
Laosa O, Pedraza L, Alvarez-Bustos A, Carnicero JA, Rodriguez-Artalejo F, Rodriguez-Mañas L. 2020. Rapid assessment at hospital admission of mortality risk from COVID-19: the role of functional status. J Am Med Dir Assoc, 21(12):1798-1802.
World Health Organization (WHO) 2020. Preventing and managing COVID-19 across long-term care services: policy brief, 24 July 2020. World Health Organization. https://apps.who.int/iris/handle/10665/333074. License: CC BY-NC-SA 3.0 IGO