Older Adults and COVID Hospitalization

By Eric Bush, MD, RPh, MBA, Chief Medical Officer

Hospice of the Chesapeake and Chesapeake Supportive Care

. https://www.hospicechesapeake.org

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Older Adults and COVID Hospitalization

The COVID-19 pandemic has brought intense scrutiny of our hospital systems, especially what happens when adults older than age 80 or living with complex acute illness are facing hospitalization. The decisions a relatively healthy person might make without blinking require careful consideration when it’s an older adult living with life-limiting illnesses like congestive heart failure or COPD. 

Here are a couple of things to consider.

1. Be upfront with medical providers right from the start of the admission process. They will look at what we call ADLs, or activities of daily living: Are they able to get around independently, prepare their own meals, bathe and dress themselves or do they need a lot of assistance? Someone in their 80s who functions as if they are in their 70s will have a different conversation about treatment options than one who is bed bound, and does not have a similar degree of functionality. 

A serious conversation is needed about whether intubation or mechanical ventilation is a wise decision from a quality-of-life perspective. Ask this question: If they are intubated, how likely will they get off the vent? Then consider if that’s something that grandma or dad would have wanted in the first place.

2. The straight talk you have from the beginning is part of what helps providers determine what they call “goals of care.” This is defining the focus of the patient’s care. The first step is understanding the patient’s medical issues through conversations with the patient, family and other medical providers. 

The second step is what procedures and treatments you would or would not want done, especially factoring in the patient’s condition prior to hospitalization. The goals of care for a urinary tract infection is different depending on each patient. For a 40-year-old man in average health, you have a choice of a half dozen antibiotics. For an octogenarian with several complex medical conditions who has had prior infections and hospitalizations, you’re limited to perhaps one IV antibiotic, and even that has a lot of side effects including things like seizures and renal failure. Same diagnosis, two very different goals of care.

Perhaps the greatest takeaway from this is how important it is to make critical healthcare decisions now and to document and share them with your family. It is an act of love to let them know in advance what you would decide if facing hospitalization.