by Camilla de Fazio
In social welfare and health facilities, where people with disabilities, with serious neurological diseases or the elderly live in close contact with each other and with the staff who assist them, the effects of the health emergency have been particularly serious.
19 MAG –
In the first phase of the pandemic, Covid-19 hit RSAs even in regions with a lower spread of the virus, affecting both guests of the facilities and health workers.
The new episode of National Summit, the format of Everyday Sanitto e Popular Science on the major issues of medicine and health and created with the unconditional support of GSK, it was dedicated to the problems and perspectives of governance and assistance in the world of nursing homes (nursing homes).
They intervened Roberto BernabeiPresident of Italy Longeva; Matteo MarastoniHead of Clinical Governance of the La Villa Group; Claudio MastroianniFull Professor of Infectious Diseases at Sapienza University of Rome, Director of the Infectious Diseases Unit at the University Hospital, Umberto I Polyclinic, Sapienza University of Rome and President of SIMIT (Italian Society of Infectious and Tropical Diseases); Luca PallaviciniNational President of Confcommercio Health, Health and Care ed Ernesto PalummeriAlisa Manager for the Covid emergency in Ligurian RSA.
“We are the oldest country in the world, along with Japan, and the population continues to age. Today in Italy there are almost 15,000 centenarians, while at the beginning of the 1900s there were 46 ”, observed Roberto Bernabei. “There are 800,000 over 90s, of which nearly 600,000 are women. Of these, half suffer from dementia ”. Considering also the decrease in births, the picture emerges of an aging country, and in which the elderly will be able to count less and less on the support of family members. “In the future it will not be possible to ignore a health organization that allows the elderly to be accommodated in structures”. RSAs therefore play and will play a fundamental role.
The pandemic has severely hit the most vulnerable, especially the elderly and people suffering from various previous diseases, with a devastating effect on RSAs. “In reality, all the closed communities, the RSAs but also the cloistered convents and prisons have been affected”, explained Ernesto Palummeri. “The result in the nursing homes was different because these places host the most fragile of the fragile. During the first wave, the structures with more beds were mainly affected, because no measures had been implemented. The smaller structures, with a shortage of personnel, instead suffered more from the following waves. According to the data of the Istituto Superiore di Sanità, patients with dementia have particularly suffered from the pandemic, especially in the RSA, due to the lack of psycho-social interventions “. And he gives the example of Liguria, where thanks to a series of interventions, mortality due to Covid-19 in the RSA has been reduced by 65%.
The importance of prevention: vaccinations in RSAs
“Before the vaccines, the average age of Covid-19 victims was 81, they were elderly and multi-pathological people, with an average of three diseases,” says Bernabei. “Defending oneself from frailty is in some way one of the secrets of longevity, which can be achieved thanks to a healthy lifestyle (adequate nutrition, exercise, etc.) and thanks to the prevention and use of vaccines“.
The administration of vaccines against Covid-19 has in fact made it possible to significantly reduce mortality. The average age of mortality among vaccinated people increased to 84 years, while that of the unvaccinated fell to 78 years.
Yet in Italy there is still a lack of awareness of the importance of vaccines for the most vulnerable adults, Claudio Mastroianni observed. “Vaccination coverage rates in this population are extremely low and expose these people to preventable infectious diseases, which can lead to a whole host of complications.”
Herpes Zoster, for example, is a very disabling disease, which affects the elderly in particular, or in any case adults in case of a lowering of the immune defenses. It can involve cardio-vascular and cerebro-vascular consequences and post-herpetic neuralgia, its most common complication. Moreover, the analysis of data collected between March 2020-February 2021 of nearly 2 million Americans and collected in a study published in the journal Open Forum Infectious Diseases published by the Infectious Diseases Society of America, indicates that patients diagnosed with COVID-19 may be more likely to develop shingles in the six months following diagnosis.
“Today we have a recombinant vaccine available that may be effective in older people, but especially in immuno-compromised people who cannot receive a live attenuated vaccine. With this vaccine we are able to reach a protection of more than 90% ”, explained Mastroianni. The post-Covid will be an opportunity to rethink health care, and to give greater value to vaccinations. “We have been accustomed to the fact that vaccination was carried out by the local area, by the AUSL, but it is important that it can also be carried out in hospitals or in RSAs, we must take the opportunity to vaccinate patients in any place of care” .
“The PNRR provides for the construction of community homes and community hospitals and the increase in home care among the over 65s,” Bernabei added. “I believe that we need to rediscover the RSAs, which in the period of time between now and the implementation of the PNRR can become a spoke of health. Vaccinating in the facilities, spread throughout the territory, would be very easy, because there are all the skills “.
Matteo Marastoni, Head of Clinical Government of the La Villa Group, which manages many reception facilities in Lombardy, Piedmont, Emilia Romagna, Liguria and Tuscany, agreed. “For the future we imagine the RSAs as a place of prevention and care, for guests who are often patients but who are above all people who live in the structures. Vaccination, against Zoster for example, is a fundamental weapon for prevention and carrying it out in the structures would be ideal, even from a logistical point of view “.
The Lombardy Region and the Piedmont Region in transposition of a circular from the Ministry have provided precise indications about the possibility of vaccinating frail elderly patients at the same time with both Covid Booster and Zoster. According to Marastoni, it is essential to inform patients and families of the importance of vaccinations and these opportunities. To do this, “collaboration with the public body and with the local area is necessary. We need useful and functional guidelines. And in this we observe a difficulty, because Lombardy and Piedmont have given precise indications while the other Regions, for example, have not done so “.
“The world of nursing homes is radically changing and must do so from a proactive point of view”Luca Pallavicini then commented. “The future of the RSA also passes through our commitment”, he concluded. “Confcommercio’s commitment is serious and must go to review all the aspects concerning the accreditation of the structures, the national legislation and that in some way resume action towards the needs of elderly people and towards the awareness that these people must be assisted to the best in the last years of their life “.
Camilla de Fazio
19 maggio 2022
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