Hospital discharge and multidisciplinary guidelines for elderly patients with COVID-19: integrative review

Sousa, Wendy Chrystyan Medeiros de; Leite, Renata Clecia Neves; Barreto, Renata Gomes; Montenegro, Cícera Patrícia Daniel; Terra, Fábio de Souza; Robazzi, Maria Lúcia do Carmo Cruz

doi:10.1590/1981-22562022025.230033.en

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Review Articles • Rev. bras. geriatr. gerontol. 25 (4) • 2022 • https://doi.org/10.1590/1981-22562022025.230033.en copy

Hospital discharge and multidisciplinary guidelines for elderly patients with COVID-19: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to search for available scientific evidence on multidisciplinary guidelines offered by health professionals to older patients diagnosed with COVID-19 after hospital discharge.

Method

an integrative literature review was carried out on the databases/virtual library selected: Lilacs, MEDLINE/Pubmed, Scopus and CINAHL (EBSCO). The search strategy involved use of combinations with the following Health Science Descriptors (DeCS) and Medical Subject Headings (Mesh): Elderly (Aged); Covid-19; Aftercare and Patient Discharge combined using Boolean operators “AND” and “OR”.

Results

relevant articles published between January 2019 and January 2022 were identified, of which four were retrieved for inclusion and analysis. The selected studies addressed the theme of continuity of care with the perspective of intervention in health rehabilitation and symptom management and/or supervision of the functional recovery of older patients, with guidelines devised by an interprofessional team.

Conclusion

the study revealed the scarcity of publications on the topic of guidance provided by health care teams to older patients from the perspective of hospital discharge. The study also served to highlight the importance and need for future scientific output addressing the functional impact of COVID-19 on this population, from hospital admission to post-discharge at home, supported by strategic actions or institutional protocols that disseminate educational information preparing patients for hospital discharge and promoting self-care, well-being and quality of life of older people.

Keywords
Elderly; Patient discharge; COVID-19; Health Education

Databases/ Virtual libraries	Search terms	Results
LILACS	("Patient Discharge" OR "Patient Discharges" OR "Discharge Planning" OR aftercare OR "After Care" OR "After Treatment" OR "After Treatments" OR "Follow Up Care" OR "Discharge Plannings" OR "Alta do Paciente" OR "Alta Hospitalar" OR "Alta do Hospital" OR "Planejamento da Alta" OR "Alta del Paciente" OR "Alta Hospitalaria" OR "Alta de Paciente" OR "Alta del Hospital" OR "Planificación del Alta" OR "Salida del Paciente" OR "Assistência ao Convalescente" OR "Assistência de Seguimento" OR "Assistência do Seguimento" OR "Atendimento de Seguimento" OR "Atendimento do Seguimento" OR "Cuidado de Seguimento" OR "Cuidados de Seguimento" OR "Seguimento Assistencial" OR "Cuidados Posteriores" OR "Cuidado de Seguimiento" OR "Cuidado del Convaleciente" OR seguimiento) AND ("COVID-19" OR "covid 19" OR "COVID19" OR "SARS-CoV-2" OR "sars cov 2" OR "Novel Coronavirus" OR "2019 nCoV" OR "Novo Coronavírus" OR "Nuevo Coronavirus") AND (aged OR elderly OR "80 and over" OR "Oldest Old" OR nonagenarian OR nonagenarians OR octogenarians OR octogenarian OR centenarians OR centenarian OR geriatric OR "Middle Aged" OR "Middle Age" OR idoso OR idosos OR idosa OR idosas OR "Pessoa de Idade" OR "Pessoas de Idade" OR anciano OR ancianos OR "Adulto Mayor" OR "Persona Mayor" OR "Persona de Edad" OR "Personas Mayores" OR "Personas de Edad" OR "Idoso de 80 Anos ou mais" OR centenarios OR nonagenarios OR octogenarios OR velhíssimos OR "Anciano de 80 o más Años" OR viejísimos OR geriátrico OR geriátricos OR geriátrica OR geriátricas OR "Meia Idade" OR "Mediana Edad") AND ( db:("LILACS"))	49
Medline/Pubmed	("Patient Discharge"[MeSH Terms] OR "Patient Discharge"[All Fields] OR "Patient Discharges"[All Fields] OR "Discharge Planning"[All Fields] OR "Aftercare"[MeSH Terms] OR "Aftercare"[All Fields] OR "After Care"[All Fields] OR "After Treatment"[All Fields] OR "After Treatments"[All Fields] OR "Follow Up Care"[All Fields]) AND ("COVID-19"[Mesh] OR "covid-19"[All Fields] OR "covid 19"[All Fields] OR "COVID19"[All Fields] OR "SARS-CoV-2"[Mesh] OR "SARS-CoV-2" OR "SARS CoV 2" OR "Novel Coronavirus" OR "2019 nCoV") AND ("Aged"[MeSH Terms] OR "Aged"[All Fields] OR "Elderly"[All Fields] OR "aged, 80 and over"[MeSH Terms] OR "80 and over"[All Fields] OR "Oldest Old"[All Fields] OR "Nonagenarian"[All Fields] OR "Nonagenarians"[All Fields] OR "Octogenarians"[All Fields] OR "Octogenarian"[All Fields] OR "Centenarians"[All Fields] OR "Centenarian"[All Fields] OR "geriatric"[All Fields] OR "Middle Aged"[Mesh] OR "Middle Aged" OR "Middle Age")	893
Scopus	TITLE-ABS-KEY("Patient Discharge" OR "Patient Discharges" OR "Discharge Planning" OR Aftercare OR "After Care" OR "After Treatment" OR "After Treatments" OR "Follow Up Care" OR "Discharge Plannings") AND TITLE-ABS-KEY("COVID-19" OR "covid 19" OR "COVID19" OR "SARS-CoV-2" OR "sars cov 2" OR "Novel Coronavirus" OR "2019 nCoV") AND TITLE-ABS-KEY(Aged OR Elderly OR "80 and over" OR "Oldest Old" OR Nonagenarian OR Nonagenarians OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian OR geriatric OR "Middle Aged" OR "Middle Age")	704
CINAHL (EBSCO)	("Patient Discharge" OR "Patient Discharges" OR "Discharge Planning" OR Aftercare OR "After Care" OR "After Treatment" OR "After Treatments" OR "Follow Up Care" OR "Discharge Plannings") AND ("COVID-19" OR "covid 19" OR "COVID19" OR "SARS-CoV-2" OR "sars cov 2" OR "Novel Coronavirus" OR "2019 nCoV") AND (Aged OR Elderly OR "80 and over" OR "Oldest Old" OR Nonagenarian OR Nonagenarians OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian OR geriatric OR "Middle Aged" OR "Middle Age")	160

Identifier of study	Title / Authors/ Databases	Method / Country / Year of Publication	Objective	Principal Results
A1	Comparative effectiveness study of low versus high-intensity aerobic training with resistance training in community-dwelling older men with post-covid-19 sarcopenia: A randomized controlled trial / Nambi G, Abdelbasset WK, Alrawaili SM, Elsayed SH, Verma A, Vellaiyan A, Saleh AK. / MEDLINE/Pubmed	Randomized controlled trial / Saudi Arabia / 2022	To find and compare the clinical and psychological effects of low and high-intensity aerobic training combined with resistance training in community-dwelling older men with post-COVID-19 sarcopenia symptoms.	All participants (n=38) had post-COVID-19 sarcopenia and received resistance training to improve clinical and psychological measures; they were randomized into two groups: low-intensity aerobic training group and high-intensity aerobic training group. Low-intensity aerobic training exercises are more effective in improving the clinical (muscle strength) and psychological (kinesiophobia and quality of life) measures than high-intensity aerobic training in men with post-COVID 19 sarcopenia.
A2	Developing a pulse oximetry home monitoring protocol for patients suspected with covid-19 after emergency department discharge / Gootenberg DB, Kurtzman N, O’Mara T, Jennifer YG, Chiu D, Shapiro NI, Dagan A. / MEDLINE/Pubmed	Prospective observational study / United States of America(USA) / 2021	to assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and to determine rates of ED return, hospitalisation and hypoxia among participants.	The patients (n=76) used instructions at home for self-referral to the ED at a higher rate than direct referral during phone call checkin.
A3	Long-Term Decreased Exercise Capacity of covid-19 Patients Who Received Mechanical Ventilation in Japan: A Case Series / Saeki T, Ogawa F, Matsumiya M, Yamamura M, Oritsu H, Nonogaki M, Nakamura T. / MEDLINE/Pubmed	Case study / Japan/ 2021	To observe the long-term exercise capacity of patients who received mechanical ventilation due to COVID-19–associated ARDS (Acute Respiratory Distress Syndrome)	After hospital discharge, patients (n=4) were advised to engage in home exercises, such as walking, lower-limb muscle strength training using a closed kinetic chain, upper-limb strength training using the Thera-Band (Hygenic Akron,OH), and balance training.
A4	Discharge characteristics and care transitions of hospitalized patients with covid-19 / Loerinc LB, Scheel AM, Evans ST, Shabto JM, O'Keefe GA, O'Keefe JB. / MEDLINE/Pubmed	Retrospective review of medical records/ United States of America (USA) / 2021	To describe the demographics, baseline comorbidities,	Despite high levels of electrolyte abnormalities and Acute Kidney Injury (AKI) during admission, only 31 patients out of a total 52 were advised and instructed to perform follow-up bloodwork. -The majority of patients (225, 72.6%) had documented advice to continue isolation at discharge, but only 56 (18.1%) patients had documentation of specific instructions on the duration of isolation, most often 14 days from discharge (median 14 days, range: 3–14).

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[1] Correspondence Wendy Chrystyan Medeiros de Sousa wendychrystyan@gmail.com

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Hospital discharge and multidisciplinary guidelines for elderly patients with COVID-19: integrative review

Abstract

﻿Objective

Method

Results

Conclusion

Objective