The impact of COVID-19 is being felt most acutely by older patients whose health risks are compounded by multi-morbidity as well as compromised immune systems, decreased physiological reserve, frailty and sarcopenia. Data from the World Health Organization shows that more than 95% of COVID-19 deaths around the world have been among people over the age of 60, with more than half of all deaths being people aged 80 and older (April 2020).
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As this global pandemic exerts its toll most severely on elderly patients, Cleveland Clinic’s Center for Geriatric Medicine (CGM) has been finding novel ways to reach the elderly population in the Northeast Ohio community.
“We are focusing on social determinants of health [SDH] screening in our efforts to care for the older population of our communities,” says Ardeshir Hashmi, MD, Cleveland Clinic Endowed Chair for Geriatric Innovation and Director, Center for Geriatric Medicine. “This means taking into account the economic and social conditions that influence health status.”
Partnering with the community
The CGM offers a support program in alliance with Benjamin Rose Institute on Aging (BRI), a respected Cleveland-based nonprofit that supports older adults in their homes. Through a bidirectional partnership, CGM and BRI refer financially disadvantaged people in the community to each other as necessary. When BRI staff are reaching out to the community for care coordination, delivering food and groceries and providing financial guidance, they will refer patients in need of medical attention to the CGM for virtual visits.
“With this elderly demographic in the community, these virtual visits are typically done via the phone,” says Dr. Hashmi. “Our physicians set up half hour appointments to talk to older people about their medical conditions to determine what treatment is necessary and if they need to come in for in-person medical care.” He notes that because of COVID-19, these virtual medical visits are now being covered by Medicare, thus allowing the CGM to provide no/zero cost healthcare to many more people in the community.
Reciprocally, the CGM team now connects Cleveland Clinic patients with positive SDH screens to the BRI Care Consultants and Volunteer Team, so they can help with medication and food home delivery as well mental health counseling and care coordination. From a BRI grant, this is cost neutral to socioeconomically disadvantaged patients.
Advancing tele-health efforts
Dr. Hashmi notes that the pandemic has led to greater social isolation of many elderly patients, which can exacerbate depression, symptoms of dementia, frailty/physical deconditioning and any number of health conditions. And with nursing home populations at the highest risk of being affected by COVID-19, according to the U.S. Centers for Disease Control and Prevention, CGM is also working to set up virtual visits for patients in continuing care retirement communities (CCRCs), including independent and assisted living and memory care facilities where patients are often in lock down because of COVID-19.
“Our CGM virtualist geriatricians will connect with residents of three large state-of-the-art Northeast Ohio facilities to meet the geriatric healthcare needs as they stay safely quarantined,” says Dr. Hashmi. “This will decrease avoidable ED visits and hospitalizations during this pandemic.” The virtual visits will include new patient visits as well as urgent care visits. CGM will be able to offer virtual cognitive assessments, geriatric pharmacy, virtual pharmacogenomics and goals of care conversations, when appropriate.
CGM is also working to set up tele-health inpatient consults with all Cleveland Clinic regional hospitals to create a regional cross continuum of geriatric consultations. This will include consulting with physicians in emergency departments, inpatient and medical intensive care units in the care of COVID 19 positive geriatric patients.
“Technology-based population health has been a paradigm shift for our CGM at this time of adversity,” says Dr. Hashmi. “The numerous benefits of this approach to care will be universal and far reaching, extending beyond the pandemic, for all times to come.”
Additionally, the CGM team responded to the COVID-19 pandemic by compiling a wide-ranging support guide for its patients, family caregivers and fellow healthcare colleagues. The 30-page guide features 16 content areas written by members of the geriatrics interdisciplinary team, with critical information for helping patients to age well and stay healthy while being sequestered. CGM has also partnered with Cleveland Clinic’s Office of Caregiver Experience to do weekly educational Q&A segments for Cleveland Clinic caregivers about caring for elderly family and friends.
“Innovation forged in the crucible of challenges is at the heart of everything we do,” says Dr. Hashmi, who also serves as the Cleveland Clinic Endowed Chair for Geriatric Innovation. “We have harnessed the unique skills, compassion and spirit of continuous improvement of the CGM team to rapidly operationalize several innovation programs to serve our most vulnerable and special patient population.”