Older Adult Care in the COVID-19 Context

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Please note that at this time, the content on this page is not being regularly updated.

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, August 10, 2021). 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:

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What's new, what's changed

Putting it into practice

See Chronic conditions/disease management for information to help manage individual older adult patients with chronic conditions.
If possible offer immunization when it can be combined with another medical visit. Offer multiple vaccines if required in order to minimize the risk of acquiring COVID-19 and to reduce the number of health care encounters (Government of Canada, May 13, 2020).
It may be possible to adjust the timing of scheduled vaccines as long as the injection series is eventually completed (Canadian Pharmacist Association, March 26, 2020).

Immunization guidance

COVID-19 Vaccine: Discuss COVID-19 vaccine when engaging in care with older adult patients. For additional guidance, see COVID-19: Vaccines Resource, September 20, 2021
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)

See the Toronto Public Health Immunization Update (April 23, 2020) for more information.
Consult the Canadian Immunization Guide (Government of Canada, 2017) for more detailed guidance on specific vaccines.

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.

See the Institute for Healthcare Improvement’s “What to Say During Telehealth Visits with Older Adults” for suggested scripts to follow during these visits.

Resources

For patients

Combatting isolation and supports

Student-Senior Isolation Prevention Partnership (University of Toronto and UHN Toronto Western Family Health Team, 2020).
Senior’s Centre Without Walls (Good Companions Seniors’ Centre, 2020).
COVID-19 Information for Seniors (City of Toronto). Multilingual versions of this handout can be found in the “Seniors” section of this City of Toronto site.
Activities to do while physical distancing (Canadian Coalition for Seniors Mental Health)
Tips for older adults WITHOUT technology to avoid social isolation (Canadian Frailty Network)
Important support lines:
- 1 866 299 1011 (For elder abuse/safety).
- 211 Ontario: call 2-1-1 (For older adults in need of assistance).
- A Friendly Voice: 1 855 892 9992 (For older adults feeling lonely or isolated)

Local resources

Virtual activities

COVID-19: Stay, Play & Learn at Home: access free virtual and phone-based activities. Search by ‘Seniors’ or ‘Older Adults’ to find many types of free virtual activities for seniors (City of Toronto).
A Guide to Virtual Creative Engagement for Older Adults (Baycrest Centre for Geriatric Care, 2020).
Tips for older adults WITH technology to avoid social isolation (Canadian Frailty Network)

Older Indigenous adults

See the section “For older Indigenous adults” in the resource COVID-19: Resources for seniors and their caregivers (PHAC, 2021)

For providers

Immunization guidance

Virtual care

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

Acknowledgement and legal

The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach.

They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

Clinical Working Group

A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:

• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP

In addition to our clinical working group the CEP also obtained feedback from others, including:

• Arun Radhakrishnan, MSC, MD, CM, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH

Thank you to everyone who supported the development of this resource.

Conflict of interest

• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)

The Older Adult Care in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Older Adult Care in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).