Articles of Interest regarding COVID-19
In an effort to support our members with the most updated information on COVID-19 we this informational page of articles reguarding COVID-19.
Also, GAPNA developed the COVID-19 Resources page to easily access current CDC information and other resources to assist you professionally and personally.
Crisis Intervention for Older Adults and Their Caregivers in the Age of Covid-19
By Amy M. Lewitz
Pragmatic intervention will be needed for the psychological crises arising from the COVID-19 pandemic. There is a dearth of providers with psychotherapeutic training. Advanced practice nurses are positioned to meet the needs of older adults and their families who are in crisis. Crisis intervention extends logically from brief psychotherapy. The minimum therapeutic goal of crisis intervention is psychological resolution of the immediate crisis and restoration to at least the level of functioning that existed prior to the crisis period. A maximum goal is improvement in functioning above the pre-crisis level.
COVID-19 will result in older adults and their caregivers needing secondary and tertiary levels of preventive intervention. In all likelihood, tertiary prevention will be needed to halt further disability while providing rehabilitation to achieve a maximal level of wellness and function. As individuals age there is a need for ego organization to withstand the increasing biopsychosocial threats to ego integrity. Aging is frequently accompanied by a diminished ability to cope with threats to psychological, physical, social, and structural integrity. Nursing is well positioned to foster and conserve growth/ego integrity in the face of senescence further stressed by the COVID-19 pandemic.
Pragmatic intervention designed to address provocative facts that can be easily evaluated will add to the knowledge base that underpins nursing. There is a need to focus on positive expectations about aging to limit self-fulfilling behaviors that could result from negative expectations about aging.
The following clinical points can be incorporated into community-based crisis management. The resultant outcomes will provide qualitative data that can help enhance research regarding care interventions for older adults and their caregivers:
- Practice person-centered communication and care during evaluation and management.
- Strive to develop and maintain a strong therapeutic relationship involving older adults and their caregivers while providing psychoeducation about conditions, care considerations, and resources. Capitalizing on residual strengths can facilitate this process.
- Provide counseling on ways to mitigate social isolation.
- Implement nonpharmacologic interventions and psychotropic medication for depression, anxiety, or psychosis.
- Promote general health, safety, and well-being for the older adult and caregiver(s) while supporting, not replacing, existing community resources.
Amy M. Lewitz, MS, RN, APRN-BC, PMHCNS
Aguilera, D.C., & Messick, J.M. (1974). Crisis intervention theory and methodology. The C.V. Mosby Company.
Atri, A., Goldfarb, D., Simon, S., & Shaughnessy, L. (2019). Current and emerging solutions to challenges in the management of Alzheimer's disease. Journal of Clinical Psychiatry, 80(6), 19-27.
Gonzalo, A. (2019). Myra Estrin Levine: The conservation model of nursing. https://nurseslabs.com/myra-estrin-levine-the-conservation-model-of-nurs...
Knight, B. (1986). Psychotherapy with older adults. Sage Publications.
The National Academies of Sciences Engineering Medicine. (2020). Care interventions for individuals with dementia and their caregivers-phase two meeting #1 and public workshop.
Sederer, L.I. (2020). Crisis counseling, not therapy, is what's needed in the wake of COVID-19. https://www.medscape.com/viewarticle/928306
Recommendations on Disaster Preparedness, Response, and Recovery for Older Adults
Experts Release an Evidence-Based Report Intended to Close the Disaster Prep Gap Among Older Adults
The American Academy of Nursing (Academy) and the American Red Cross collaborated on a white paper titled " Closing the Gaps: Disaster Preparedness, Response, and Recovery for Older Adults ." The report, based on review of the latest evidence and legislation on the topic, was produced by members of the American Red Cross Scientific Advisory Council and the Academy Policy Expert Round Table on Emergency/Disaster Preparedness for Older Adults.
The study found that while disaster preparedness is vital for people of all ages, older adults are more vulnerable and experience more casualties after a natural disaster or emergency due to several factors, including:
- Older adults have a greater prevalence of chronic conditions, multi-morbidity, cognitive impairment, and medication concerns during disasters.
- Older adults have a greater dependence on assistive devices (e.g., walkers, glasses), supplies, and support requirements (from caregivers and others) during disasters.
- Greater issues of social isolation make older persons more vulnerable.
- Mixed findings exist around the vulnerability for older adults to psychological distress compared to younger adults.
- Gaps exist in preparedness of caregivers of older persons, especially of those with dementia.
During both Hurricanes Katrina and Sandy, approximately half of all deaths related to the storms were seniors. "Disaster preparedness is especially important among this vulnerable population," said Academy President Eileen Sullivan-Marx, PhD, RN, FAAN. "We, as nurses, are on the front lines of responding to disasters and have to operate under volatile, uncertain, complex, and ambiguous (commonly known as VUCA) circumstances. Working with older adults to create their own preparedness plans will make it easier for health professionals to respond and mobilize during crisis."
These recommendations are also useful and pertinent when emergencies necessitate shelter-in-place policies, such as the directives a majority of states have enacted in response to the coronavirus (COVID-19) pandemic. Similar to a natural disaster, the pandemic is disproportionately impacting older adults. To help address preparedness gaps, the report includes 25 evidence-informed expert recommendations, such as:
- Older adults and their unpaid caregiver(s) should be provided with tailored, easy-to-access information related to emergency/disaster preparedness and guidance on how to develop customized emergency plans. Access to these programs should be increased.
- Older adults who are reliant on mobility aids should remove or minimize barriers affecting their ability to evacuate and should take steps to ensure their safety within their surroundings.
- Programs that provide essential community services and assistance with daily living activities for older people should develop plans and protocols related to responding adequately to the needs of their clients during emergencies and disasters.
- Local governments should leverage data sources, such as registries, that identify at-risk individuals to enable emergency responders to more easily prioritize their search and rescue efforts following a disaster or emergency.
- Healthcare professionals and emergency response personnel should receive training on providing geriatric care relevant to their discipline and how best to assist older adults and their unpaid caregivers during disasters.
Elder COVID-19 Resources
The Hospital Elder Life Program (HELP): COVID-19 Resource Hub and Delirium Prevention Toolkit
The Hospital Elder Life Program (HELP) has created a COVID-19 resource hub. A chief resource within the hub is a delirium prevention toolkit.
HELP is a comprehensive, evidence-based, patient care program that provides optimal care for older adults in the hospital. HELP prevents delirium and loss of functioning.
A highlight within the delirium prevention resource hub is the toolkit designed to support busy hospital staff. The toolkit consists of resources for a patient kit, including exercises, relaxation tools, sleep protocols, therapeutic activities, and instructions on how to assemble the kit. The toolkit resources and recommendations help hospitalized older adults maintain cognitive and physical functioning during COVID-19.
LTC Telehealth Toolkit
Long-Term Care Nursing Homes Telehealth and Telemedicine Toolkit
The Centers for Medicare & Medicaid Services (CMS) issued an electronic toolkit regarding telehealth and telemedicine for long-term care nursing home facilities. In responses to the need to limit the spread of community COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.
This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS in response to the National Health Emergency.
Most of the information is directed toward providers who may want to establish a permanent telemedicine program, but there is also information that will help in the temporary deployment of a telemedicine program.
There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools.
There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
Patient Safety Primer
New PSNet Primer Outlines Challenges of Protecting Nursing Home Residents From COVID-19
People living in nursing homes or residential care facilities use common dining and activity spaces and may share rooms, which increases the risk for transmission of COVID-19 infection, according to a new primer from the Agency for Healthcare Research and Quality's Patient Safety Network (PSNet).
The primer identifies federal guidelines and resources for healthcare provider teams related to COVID-19 prevention and mitigation in long-term care. Access the PSNet primer.