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“Telemedicine and clinical support paths, the network between hospital and facilities is strengthened”

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In the Forlì area, the elderly population responded to the anti-covid vaccination campaign, with 89% between the ages of 70 and 79 having completed the cycle of administration, a percentage that leaps over 97% for those over 80. Numbers, highlights Giuseppe Benati, head of Geriatrics at the Forlì hospital, which represent “an element of extreme importance both for limiting the spread of the virus and the severity of symptoms”.

Those over 80 were among the first to receive the first vaccine administrations. Having shown that effectiveness is decreasing as the months go by, are you worried about an increase in infections in the month of autumn?

More than worried, I think we need to be careful. It is only thanks to the diffusion of the vaccine that it has been possible to restore normality in the life of self-employed people over 80 who live in their homes or those who live in residential structures.

As a consequence of the reduction in the number of infections among the elderly there was also a decrease in mortality. In the last two weeks, however, the number of deaths from covid has returned to update also in the Forlì area.

There is no doubt that vaccinated seniors who have become positivized do not express disease or show mild symptoms. Even if the serious consequences of the infection are more evident in the unvaccinated, in cases of particular fragility the consequences of the infection can remain important. It is for this reason that it remains a social duty also towards people of advanced age to limit the circulation of the virus through a reduction of infections even in the younger age groups. In this sense, widening the adhesion to the vaccine, maintaining correct behaviors and early tracing the contacts at risk are factors capable of influencing the trend also in the geriatric population.

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The vaccination campaign has actually contributed to reducing, if not eliminating, hospital admissions, with positive repercussions on hospital activity. What is the situation in your department?

At the moment the epidemiological picture determines a situation for our ward of moderate normality. The operators have now assumed an awareness and a habit of adopting appropriate behaviors to reduce as much as possible the risk of contagion in the hospital. The mission of our department in the hospital has remained the management of pathologies not directly related to the covid, to always guarantee the care pathways of geriatric patients. However, the commitment of geriatrics isn’t just in the hospital alone. The strengthening of an integrated network between the hospital and the local structures for the older populations has finally become a reality. In recent years, the experience of community hospital has been developed and consolidated, integrated with the acute hospital but with management and vision methods in the territory.

Particularly?

We are developing clinical support paths for doctors in social welfare structures to limit access to the hospital and in particular the use of the emergency room. The paths inside and outside the hospital have been strengthened to identify assistance projects as well as care for people with greater complexity. The contribution to the clinical management of a social assistance structure is active for positive covid people who do not need a hospital, but have important care needs. It is no longer time to think in a solo way, but only and only online. The doctor is one of the many actors of the network together with the nurse, the physiotherapist, the social worker, the psychologist, the dietician and many others. Professionals of the hospital, of the territory, of the municipalities, health and non-health, work in the supply chain to give shared answers. Of course, much must and can be done but many walls that existed in the past in taking charge of this slice of the population have been demolished.

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What have been the major problems encountered in recent months? Have you had to deal with patients who have neglected chronic diseases for fear of going to hospital during the peak of the pandemic?

The offer in the way of communicating and evaluating people with chronic diseases has changed in recent months. Many of the telematic communication systems developed in the most acute phases of the pandemic have remained active and have found their rightful place in taking charge. For example, people with dementia have been attending our center for some time, but rehabilitation systems or telematic communication methods have become part of the offer and will need to be further developed. In the same way, the clinics of chronicity in health homes that general practitioners and chronicity nurses are developing have as their founding principle a medicine that proactively deals with the prevention of exacerbations and hospitalization. Telemedicine projects also for these activities are already under construction and further development. The issue of bringing care closer to the citizen’s home has become a priority for the development of a post-covid organization.

There are no longer the summers of the past and even that of 2021 has been characterized by frequent and lasting waves of African heat. Has there been an increase in hospitalizations due to dehydration or on this aspect have families and the most vulnerable groups raised the level of attention?

The situation was no different from that of other years. The pictures of dehydration in the elderly can be dramatic. For some time now, our region has started the organization of summer plans aimed at addressing the issue of heat waves involving both health companies and municipalities. Awareness of the importance of fluid intake in the elderly must be further stimulated both in families and in operators, at home and in the facility.

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Could the elderly, who consider themselves abandoned, be inclined to pay less attention to the intake of drugs, to respect a balanced diet and to be prone to trauma due to falls?

These are all factors that increase the risk of loss of people’s autonomy, of loss of quality of life. A community, family members and operators must be created around the elderly, which also takes into account these aspects that seem banal but are not banal.

Returning to the covid discourse, how are the elderly who are healed, but who are still struggling with the after-effects of the virus, assisted?

It is always the network work that must work, trying to avoid ageist attitudes and at the same time proportioning the follow-up modalities to the real needs of the person.

Covid, flu and chronic diseases. Is another autumn in the trenches announced?

The trench evokes war and extraordinary events. Instead, we must work harder and harder to be able to deal with complexity both in the health and social fields in an ordinary way, by providing new answers and models, by personalizing the answers and above all by guaranteeing networking.

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