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[初级保健、养老院与新型冠状病毒肺炎]

[Primary care, residential homes for the elderly, and COVID-19].

作者信息

Blanco-Tarrio E, Blanco Sánchez G

机构信息

Especialista en Medicina Familiar y Comunitaria, Centro de Salud de Periurbana Norte, Salamanca, España.

Especialista en Farmacia Hospitalaria, Adjunto, Hospital del Henares, Coslada, Madrid, España.

出版信息

Semergen. 2020 Aug;46 Suppl 1:26-34. doi: 10.1016/j.semerg.2020.06.003. Epub 2020 Jun 6.

Abstract

Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services.

摘要

由于当前的新冠疫情,养老院在危机期间受到了特别严重的冲击。在撰写本文时,已有超过17500名住在养老院的老年人死于新冠病毒,占死亡人数的66%以上。机构化人群中的感染率和死亡率很高。这是由于高龄、免疫系统缺陷、存在合并症,以及因为他们身体虚弱,与其他居民和护理人员生活在一个封闭的机构中,而且在一种高传染性和高致病性病毒的环境下传播很容易。老年人往往病情更为严重。非典型表现在老年人中更为常见,可能会延迟诊断。用于检测SARS-CoV-2病毒RNA的聚合酶链反应(PCR)检测在最初7天内被视为参考检测(“金标准”)。从养老院转诊到医院的标准应考虑对合并症进行评估、病情严重程度、是否存在严重认知障碍以及重症患者对通气支持的依赖程度或必要性。社会健康中心应制定应急预案,以便在出现新冠病例时做出应对。疫情期间的隔离可能会给居民带来重要的身体和心理社会后果。有必要从以人为主的护理方法出发,反思并倡导一种新的居住模式,这种模式追求健康和社会服务的整合。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f4f/7275190/2364c2ac2e9d/gr1_lrg.jpg

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