Raising awareness of the needs of older COVID patients after hospital discharge
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EDITORIAL
Raising awareness of the needs of older COVID patients after hospital discharge Jean‑Pierre Michel1 · Stefania Maggi2 · Fiona Ecarnot3,4 Received: 5 May 2020 / Accepted: 3 June 2020 © Springer Nature Switzerland AG 2020
Introduction Ten years ago, a task force of the Society of Critical Care Medicine (SCCM) examined the onset or worsening of mental health, physical, and cognitive outcomes arising after critical illness, and coined the term “Post Intensive Care Syndrome” (PICS) to describe the phenomenon [1]. The concept was subsequently broadened to encompass the mental health status of the patient’s family (PICS-F) [2]. Before the pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), approximately 19 million individuals per year developed life-threatening acute organ dysfunction secondary to sepsis necessitating admission to the intensive care unit (ICU). Among these, 14 million survive, half of these survivors recover, one third die during the year following ICU discharge, and one sixth experience permanent functional disability [3, 4], requiring partial or total help with the activities of daily living [5]. There is a paucity of literature devoted to the problem of PICS after COVID-19 [6–8], and no data on PICS in older survivors of severe COVID-19. Yet, to date, worldwide, more than 3 million people have been infected with COVID-19, of whom approximately 3% will require intensive care and mechanical ventilation. The length of stay in ICU and the duration of ventilator reliance are considerably longer in COVID-19, at up to 3 weeks, than in more typical ICU populations [9]. Every day, the media update the death toll, which has already exceeded 400,000 and continues to * Fiona Ecarnot Fiona.ecarnot@Univ‑fcomte.fr 1
Medical University of Geneva, Geneva, Switzerland
2
National Research Council, Neuroscience Institute, Padua, Italy
3
Department of Cardiology, University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France
4
EA3920, University of Franche-Comté, Besancon, France
rise. Among patients requiring admission to the ICU, almost all need respiratory support, and 88% require mechanical ventilation [10]. Although roughly one-third of infected patients are over 60 years of age, more than two-thirds of deaths occur in this age group [11]. Old patients recovering from severe respiratory illness present secondary disability resulting from intensive treatments. This includes (but is not limited to) acute unit-acquired weakness, long-term cognitive impairment, and poor mental outcomes [4, 5, 12], while the patient’s family members, especially the older ones, will suffer a high psychological burden [13, 14]. Geriatricians need to be aware of these alarming data. Indeed, the COVID-19 pandemic will soon reveal the public health burden of PICS among survivors of intensive care and mechanical ventilation. There are numerous studies and reviews devoted to the management of acute COVID-19 and its immediate sequelae [12, 15–
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