Introduction:
COVID-19 have been a challenge for healthcare, mainly in elderly patients in Nursing Homes
(NHs) and Long-Term Care Facilities (LTCFs). We present a pioneering novel experience in addressing healthcare of very
elderly patients with COVID-19 in these facilities by a reconversion of a NH in a medicalized NH.
Methods:
All patients admitted to the center were included, recording clinical and epidemiological variables. We conducted a
descriptive analysis and a multivariate analysis to identify variables linked to mortality and persistence of positive PCR test.
Results:
we included 84 patients (40% men), women presented more symptomatology. We found a positive correlation
between the duration of symptoms and the days required to obtain a negative PCR test (r=0.512, P<0.001). We also found
an independent and significative association between asthenia (OR=2.58; IC95% 1.22–5.46) and mutism (OR=5.21; IC95%
1.58–17.15) and a longer time to achieve a negative PCR test. All patients, except contraindication, were treated with
hydroxychloroquine and azithromycin, which was the recommended treatment during the period of the study. The early start
of corticoid treatment (within the first 72 hours since the start of symptoms) was linked to a lower mortality in patients with
moderate-severe symptoms. Mortality was lower than expected (which was higher than 20% in that period and group of
age), reaching 14%, the main factors linked to mortality were the presence of mutism (OR=19; IC95% 3.4–108; P=0.001)
and dyspnea (OR=12; IC95% 1.3–111; P=0.029).
Conclusions:
We present an alternative system for the care of these patients through the reconversion of a basic NH in a
medicalized one, which showed a significant reduction in the expected mortality.
El 31 de diciembre de 2019 China informó sobre un brote de neumonía susceptible de provocar síndrome de distress respiratorio del adulto. El agente etiológico causante se identificó poco más tarde como un nuevo coronavirus, que se denominó SARS-CoV-2. La enfermedad transmisible causada por este coronavirus, conocida por el acrónimo COVID-19, se extendió progresivamente a nivel mundial, lo que obligó, para controlar su expansión, a la adopción de medidas como el distanciamiento social, el confinamiento de la población y el aislamiento estricto de los enfermos. Este aislamiento estricto provocó, de manera disruptiva, cambios importantes en la comunicación profesional sanitario-paciente/familiares, que fueron especialmente significativos en la comunicación de malas noticias. Este texto refleja, en el momento álgido de la epidemia en Galicia (España), la experiencia en la comunicación de malas noticias a familiares de enfermos ancianos COVID-19 positivos. Finalmente, proponemos un decálogo de consejos sobre la comunicación telefónica de malas noticias.
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