Advance care planning and use of health resources among COVID-19 nursing home patients in an integrated health care program for frail elders

• Published in: Revista española de geriatría y gerontología Vol. 58; no. 1; p. 31
• Main Authors: Gallo Acosta, Cristian Matías, Cunha Ferré, María Florencia, Elizondo, Cristina María, Muedra, Benjamín, Schapira, Marcelo Carlos, Martínez, Bernardo, Garfi, Leonardo Guillermo, Perman, Gaston, Saimovici, Javier Matías
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-01-2023
• Subjects: Advance Care Planning; Aged; Aged, 80 and over; COVID-19 - epidemiology; Delivery of Health Care; Female; Frail Elderly; Health Resources; Humans; Male; Nursing Homes; Palliative Care; Prospective Studies; COVID-19; Frail elders; Recursos hospitalarios; Cuidados integrados; Adultos mayores frágiles; Health resources; Integrated health care; Planificación anticipada del cuidado; Advance care planning
• ISSN: 1578-1747
• DOI: 10.1016/j.regg.2022.10.009

To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19.
Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed.
We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001).
Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies.