Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic #covid19rftlks

Rowland, B. & Kunadian, V. |2020| Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic |

 

A review published in the BMJ Journal Heart sought to evaluate the challenges and the management strategies in the care of older patients presenting with acute coronary syndromes (ACS) in the context of the COVID-19 pandemic. It finds that edence is sparse on the optimal care of older patients with ACS with lack of robust RCTs.

Abstract

Ischaemic heart disease (IHD), in particular acute coronary syndrome (ACS), comprising ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina, is the leading cause of death worldwide. Age is a major predictor of adverse outcome following ACS. COVID-19 infection seems to escalate the risk in older patients with heart disease. Increasing odds of in-hospital death is associated with older age following COVID-19 infection. Importantly, it seems older patients with comorbidities such as cardiovascular disease (CVD), in particular IHD, diabetes and hypertension, are at the highest risk of mortality following COVID-19 infection. The evidence is sparse on the optimal care of older patients with ACS with lack of robust randomised controlled trials. In this setting, with the serious threat imposed by the COVID-19 pandemic in the context of rapidly evolving knowledge with much unknown, it is important to weigh the risks and benefits of treatment strategies offered to older patients. In cases where risks outweigh the benefits, it might not be an unreasonable option to treat such patients with a conservative or a palliative approach. Further evidence to elucidate whether invasive management is beneficial in older patients with ACS is required out-with the COVID-19 pandemic. Though it is hoped that the actual acute phase of COVID-19 infection will be short lived, it is vital that important clinical research is continued, given the long-term benefits of ongoing clinical research for patients with long-term conditions, including CVD. This review aimed to evaluate the challenges and the management strategies in the care of older patients presenting with ACS in the context of the COVID-19 pandemic.

Full article from Heart

Supporting older people and people living with Dementia during self-isolation

Supporting older people and people living with Dementia during self-isolation | British Psychological Society | Division of Clinical Psychology

Older people and those with dementia are likely to be some of the hardest hit by the current crisis, being most at risk of severe disease if they contract the virus and in many cases advised to stringently self-isolate for the foreseeable future.

This guidance for older people includes advice on remaining connected and staying active during the pandemic, and a section on the needs of people living with dementia and memory problems — particularly on how to help them understand and follow Covid-19 advice.

Full document available at British Psychological Society

 

Housing conditions in England

The Centre for Ageing Better and Care & Repair England’s new report reveals that over two million over-55s are living in a home that endangers their health or wellbeing.

The aim of this report is to provide an overview of housing conditions in England, particularly in the context of population ageing, to inform the policy and practice that relates to ageing well at home.

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Image source: https://www.ageing-better.org.uk/

The report, written with Care & Repair England, reveals that over two million over-55s are living in a home that endangers their health or wellbeing. The report into non-decent housing in England found that over 4.3 million homes in England don’t meet basic standards of decency, most commonly because of the presence of a serious hazard to their occupants’ health or safety.

Age proud: exploring positive ageing

Greater Manchester Old People’s Network | December 2019 | Age proud: exploring positive ageing

The Greater Manchester Older People’s Network (GMOPN) is a group that aims to ensure that older people have an influence in key decision-making and that their voices are
championed in the areas that most affect their lives. 

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Image source: manchestercommunitycentral.org

This report unites the thoughts and ideas of participants attending GMOPN’s Age Proud Event on 2 October 2019, held as part of the national #AgeProud campaign.

Their findings suggest that the current narratives on ageing are overwhelmingly negative; but it also finds that older people value opportunities to share their knowledge
and experience as well as to continue to have an impact and express their views.

The report makes a number of recommendations including:

  1. Strengths based narrative Negative ideas about ageing are ingrained in our society and media narratives often reinforce these attitudes. A commitment is needed across organisations that work with older people to create a
    strengths-based narrative, that represents older people in a positive and realistic way and acknowledges their contributions. This needs to include a stock of positive words and phrases, that can be reinforced through repetition.
  2. Focus on words and imagery We need to focus equally on words and images and ensure that visual representations of older people are positive and realistic.

    Full details from GMOPN 

Age proud: exploring positive ageing 

 

Estimating Need In Older People

Estimating Need In Older People: Findings For England. An analysis by Age UK

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This report by Age UK outlines how ill health, poverty, unmet needs for care and support, poor housing, loneliness and social isolation are profound challenges for many older people. It estimates the numbers and percentages of people aged 65 and over in England with these disadvantages, and collates insights from older people’s own voices about the experience of living with them.

Full report at Age UK

Place-Age Place-Making with Older Adults: Towards Age-Friendly Cities and Communities

Heriot- Watt | October 2019| Place-Age Place-Making with Older Adults: Towards Age-Friendly Cities and Communities

New PLACE-AGE guidelines have been directly informed by the experiences of older adults living across three cities: Edinburgh, Glasgow and Manchester. They present key findings for each of the cities that participated in the research, structured according to the main themes identified in each city, as well as neighbourhood-specific findings and recommendations.

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The report is structured around themes, some of which are:

  • Housing, home and place
  • Navigating outdoor spaces
  • Civic engagement and social participation

    The recommendations are wide reaching and cross-cutting addressing housing and home, transport and mobility, respect and feeling valued, intergenerational supports and social participation.

Place-Age Place-Making with Older Adults: Towards Age-Friendly Cities and Communities (opens new window)

WHO: Integrated care for older people

World Health Organization | October 2019 | Integrated care for older people

The WHO Integrated Care for Older People (ICOPE) offers evidence-based tools and guidance for every level of care o understand, design, and implement a person-centred and coordinated model of care. ICOPE helps health systems support Healthy Ageing and maximise older people’s intrinsic capacity and functional ability (Source: WHO).

Integrated Care for Older People  

Related:

What is Healthy Ageing?

Population ageing in the UK

New report argues that the UK’s unprecedented population ageing poses a set of daunting, yet not insurmountable, challenges for policymakers, institutions and healthcare providers to design better solutions fit for an ageing society | International Longevity Centre UK

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The UK’s population is ageing more rapidly than ever before with the share of people aged 65+ projected to reach 1 in 4 within the next two decades. With today’s 65-year-olds expected to live, on average, 20 years beyond state pension age, the UK’s ageing population is placing considerable strain on government pension and social security systems. Moreover, as retirees come to outnumber new entrants to the workforce, labour shortages could lead to economic growth slowdowns. Finally, already over-stretched and underfunded health and social care systems will need to adapt to growing demand as they prepare to cater for an ever-growing share of the population.

This report argues that the UK’s unprecedented population ageing poses a set of daunting, yet not insurmountable, challenges for policymakers, institutions and health care providers to design better solutions fit for an ageing society. It calls for health policy reforms that focus on preventing, rather than curing disease to enable people to stay active and healthy for longer.

Full report: Navigating the uncharted waters: population ageing in the UK | International Longevity Centre – UK