Older Adult Care in the COVID-19 Context

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The Older Adult Care in the COVID-19 Context tool is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: October 13, 2020
Last updated: October 23, 2020

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Your one-stop shop for all of your COVID-19 related needs, including clinical guidance, maintaining regular primary care practice in the COVID-19 context, social care guidance, local services and more.

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for older adults.  While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Seek support: The following information is for primary care providers who are proficient in geriatric care and management. If you need support providing the best care possible for your patients, consult specialists via OTN eConsult.

Key takeaway

Older adults ≥ 80 may be at an increased risk for contracting COVID-19 and have the highest mortality rate due to COVID-19 in Ontario (Public Health Ontario, October 21, 2020). It is therefore important to put measures in place to ensure continuity of care for chronic conditions and immunizations in order to help older adults during this time.

Click on the sections below to get started:

What's new, what's changed

Management

Older adults are at increased risk of adverse events (e.g. kidney), especially if they are also dehydrated, due to age related changes.

Putting it into practice

Immunization guidance

  • Ages 65+: Pneumococcal (pneu-C13 & penu-P23).
  • For adults 50+ who have received the first dose of recombinant zoster vaccine, the second dose can be deferred until the 6-12 month interval (doses are typically recommended 2-6 months apart, and may be considered up to 12 months apart) assuming that COVID-19 risk will be lower by that time. If an interval longer than 6-12 months after the first dose has elapsed, the vaccine series does not need to be restarted; the decision when to complete the series should take into consideration the local COVID-19 community transmission risk, recognizing that individuals may remain at risk of herpes zoster during a longer than recommended interval between doses 1 and 2 (Government of Canada, May 13, 2020).
  • Flu vaccination reminder: high dose trivalent inactivated influenza vaccine (HD TIV) is the preferential vaccine for adults 65 years and older without contraindications. Don’t delay vaccination: if HD-TIV is not available, provide standard QIV dose. For more information on why the HD TIV is beneficial for older adults, please refer to the Planning for influenza vaccination during COVID-19 pandemic (Toronto Public Health, October 6, 2020)
Delivering remote/virtual care

When engaging in remote/virtual care with older adults, utilize the guidance in Dr. Shelley Veinish and the Baycrest team’s virtual comprehensive geriatric assessment (March 20, 2020) for information on planning and scheduling a virtual comprehensive geriatric assessment, and instructions on how to conduct the assessment and the examination itself.

Putting it into practice

As a supplement to the virtual comprehensive geriatric assessment above, apply the points from the 4Ms Framework (What Matters, Medication, Mentation, Mobility) (Institute for Healthcare Improvement, July 9, 2020) to enhance the components of the assessment:

Ask “what matters most?”: this will help to convey that what matters to the older adult is also important to the provider.

Medications check: make sure that the older adult has enough of each medication and ask if they need refills? do they understand how and why they are taking the medications? are there medications that can be discontinued?

  • Remember, before a new medication is added to work in combination with a current medication, consider gradually increasing the current medication to the maximum dosage to avoid polypharmacy.
  • When prescribing a medication that’s new for the patient, remember to consider starting with a lower dose and gradually increasing as needed.

Mentation check: in addition to the mental status exam suggested in the virtual comprehensive geriatric assessment consult the virtual approaches to cognitive screening during pandemics from the Canadian Geriatrics Society (May 8, 2020) for other possible assessment tools that can also be used.

Mobility check: ask what the older adult is doing to keep moving inside or around their home. Suggest a plan to do steps or laps around a room or join an online exercise class. Also suggest 5-10 sit-to-stand repetitions 3-4 times a day. Stress the importance of remaining active even while staying home.

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