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Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective

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Abstract
Purpose Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. Methods Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. Results Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. Conclusion This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.
Keywords
Automotive Engineering, Resuscitation order, Advance care planning, Palliative care, Collaboration, Older patients, Covid-19

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Citation

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MLA
van Bruchem-Visser, Rozemarijn Lidewij, et al. “Scope of Treatment and Clinical-Decision Making in the Older Patient with COVID-19 Infection, a European Perspective.” EUROPEAN GERIATRIC MEDICINE, vol. 14, Springer Science and Business Media LLC, 2023, pp. 43–50, doi:10.1007/s41999-022-00721-6.
APA
van Bruchem-Visser, R. L., Vankova, H., Rexach, L., Ahmed, M. V., Burns, E., Pautex, S., & Piers, R. (2023). Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective. EUROPEAN GERIATRIC MEDICINE, 14, 43–50. https://doi.org/10.1007/s41999-022-00721-6
Chicago author-date
Bruchem-Visser, Rozemarijn Lidewij van, Hana Vankova, Lourdes Rexach, Marc Vali Ahmed, Eileen Burns, Sophie Pautex, and Ruth Piers. 2023. “Scope of Treatment and Clinical-Decision Making in the Older Patient with COVID-19 Infection, a European Perspective.” EUROPEAN GERIATRIC MEDICINE 14: 43–50. https://doi.org/10.1007/s41999-022-00721-6.
Chicago author-date (all authors)
van Bruchem-Visser, Rozemarijn Lidewij, Hana Vankova, Lourdes Rexach, Marc Vali Ahmed, Eileen Burns, Sophie Pautex, and Ruth Piers. 2023. “Scope of Treatment and Clinical-Decision Making in the Older Patient with COVID-19 Infection, a European Perspective.” EUROPEAN GERIATRIC MEDICINE 14: 43–50. doi:10.1007/s41999-022-00721-6.
Vancouver
1.
van Bruchem-Visser RL, Vankova H, Rexach L, Ahmed MV, Burns E, Pautex S, et al. Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective. EUROPEAN GERIATRIC MEDICINE. 2023;14:43–50.
IEEE
[1]
R. L. van Bruchem-Visser et al., “Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective,” EUROPEAN GERIATRIC MEDICINE, vol. 14, pp. 43–50, 2023.
@article{01H3VCTQH5VKCDFCVA0XRGHEZQ,
  abstract     = {{Purpose Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. Methods Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. Results Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. Conclusion This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.}},
  author       = {{van Bruchem-Visser, Rozemarijn Lidewij and Vankova, Hana and Rexach, Lourdes and Ahmed, Marc Vali and Burns, Eileen and Pautex, Sophie and Piers, Ruth}},
  issn         = {{1878-7649}},
  journal      = {{EUROPEAN GERIATRIC MEDICINE}},
  keywords     = {{Automotive Engineering,Resuscitation order,Advance care planning,Palliative care,Collaboration,Older patients,Covid-19}},
  language     = {{eng}},
  pages        = {{43--50}},
  publisher    = {{Springer Science and Business Media LLC}},
  title        = {{Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective}},
  url          = {{http://doi.org/10.1007/s41999-022-00721-6}},
  volume       = {{14}},
  year         = {{2023}},
}

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