Marshall Health, Marshall University, 1600 Medical Center Drive, Huntington, WV 25701, USA
West Virginia University School of Public Health, Department of Social and Behavioral Sciences - Office of Health Services Research, 64 Medical Center Drive, Morgantown, WV 26506, USA
Rural Remote Health. 2021 Jan;21(1):6122. doi: 10.22605/RRH6122. Epub 2021 Jan 18.
Older adults, especially those aged 85 years or older, remain at significantly higher risk for COVID-19. This group, along with those with pre-existing heart and lung disease and diabetes, have accounted for 80% of hospitalizations and an even higher percentage of COVID-19 related deaths in the USA. West Virginia, the only state in the USA located completely within Appalachia, has a higher percentage of elderly than all but two states in the nation. Rural seniors are hesitant to use hospital emergency departments and attend routine care visits for fear of exposure to the virus. Restricted cell phone and internet service may limit effective technological outreach to more isolated rural older adults. More information is needed to develop effective, safe, and acceptable approaches to care for rural, isolated older adults.
Telephone interviews were conducted with 124 community-dwelling residents in four counties in rural Appalachia between 1 and 22 April 2020. Participants were aged 75 years or older. Descriptive statistics were calculated and Fisher's Exact Test was used to examine for associations among variables.
Participants consisted of 86 (69.4%) women and 38 (30.6%) men with an average age of 82.5 years. Telephone contact was the preferred method of contact among all but four participants (96.8%). Seventeen calls (13.7%) resulted in some form of intervention, including arranging for emergent home repairs, treatment of severe hypertension, scheduling urgent laboratory testing, arranging for terminal care, treating acute conditions, and providing durable medical equipment. The 17 participants requiring intervention were significantly more likely to be aged 85 years or older (p=0.004), and report two or more chronic conditions (p<0.001). Those describing themselves as 'lonely' were significantly more likely to live alone (p=0.009) and describe themselves as 'anxious' or 'depressed' (p<0.001).
A telephone call appears to be the most effective means of communication with patients in these rural Appalachian counties. Patients aged 85 years or older and those living alone should be given highest priority for regular outreach by healthcare providers. In this population, systematically calling rural elderly patients during the COVID-19 epidemic and its aftermath represents an effective strategy for providers who care for elderly rural patients.
老年人，尤其是 85 岁及以上的老年人，感染 COVID-19 的风险仍然显著更高。在美国，这一人群以及那些患有预先存在的心脏和肺部疾病以及糖尿病的人群，占住院治疗的 80%，COVID-19 相关死亡人数的比例甚至更高。西弗吉尼亚州是美国唯一一个完全位于阿巴拉契亚地区的州，其老年人口比例高于全国除两个州以外的所有州。农村老年人由于担心接触病毒，不愿使用医院急诊室和常规护理就诊。受限的手机和互联网服务可能会限制对更偏远的农村老年人进行有效的技术推广。需要更多信息来制定针对农村偏远地区老年人群体的有效、安全和可接受的护理方法。
2020 年 4 月 1 日至 22 日，在阿巴拉契亚农村的四个县对 124 名社区居民进行了电话访谈。参与者年龄在 75 岁或以上。计算描述性统计数据，并使用 Fisher 精确检验检查变量之间的关联。
参与者包括 86 名（69.4%）女性和 38 名（30.6%）男性，平均年龄为 82.5 岁。除了四名参与者（96.8%）外，电话联系是所有参与者首选的联系方式。17 次通话（13.7%）导致某种形式的干预，包括安排紧急家庭维修、治疗严重高血压、安排紧急实验室检测、安排临终关怀、治疗急性疾病和提供耐用医疗设备。需要干预的 17 名参与者明显更年长（p=0.004），并报告有两种或两种以上的慢性疾病（p<0.001）。那些自称“孤独”的人独居的可能性明显更高（p=0.009），并表示自己“焦虑”或“抑郁”（p<0.001）。
电话似乎是与这些阿巴拉契亚农村县患者进行沟通的最有效手段。85 岁及以上的患者和独居患者应成为医疗保健提供者定期外展的重中之重。在这一人群中，在 COVID-19 流行及其余波期间，系统地给农村老年患者打电话是为照顾农村老年患者的提供者提供的一种有效策略。
