An Aging Spanish Population Vulnerable to COVID-19

Spain is an aging country where people over 65 years of age already represent almost 19.0% of the total population and we are already the longest-lived in the European Union. The population pyramids have been inverted with the decrease in the birth rate and the increase in life expectancy, where, according to official demographic data, Spanish women are already 86 years old on average and men are almost 81 years old. These data justify the existence in our country of a large number of people vulnerable to the possible effects of the aggressive COVID-19, which leads to the observed high mortality, especially among this fragile and multi-pathological elderly population.

Coronavirus transmission is mainly through hand and airway contact, which justifies that there is a greater risk of spreading the infection in areas of high population density and, therefore, the health authorities indicated the confinement in our homes and avoid group meetings. However, this measure is very difficult to apply in nursing homes, which are still large “homes”, structured and organized to provide the comfort and warmth of a home and designed to facilitate social interaction. For this reason, geriatric centers are becoming a point of massive transmission of COVID-19, aggravated by the profile of their users.

What is the profile of an elderly resident in a nursing home like?

The profile of the elderly person who is admitted to a geriatric center usually corresponds to a person who can no longer be cared for at home due to their high physical or cognitive dependence, or because they have multiple pathologies, that is, the most vulnerable of our elderly. If we add a reduced physical structure, where a large number of people live together, plus their fragile baseline health, we would justify the high rate of infection in nursing homes and the high mortality rate, as happens in other epidemic situations, such as the seasonal flu each year. However, it is true that nursing homes are not health centers and this is probably the great weakness of the current geriatric care system that has flourished in the face of the current health care collapse, but this does not mean that we should convey the idea that the elderly are left to die in nursing homes, since the mortality of the elderly admitted to hospital is also very high given the aggressiveness of COVID-19.

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We cannot forget another group at special risk of any epidemic, such as people with intellectual disabilities, since many live in residential centers or attend day centers, where there is the same problem as that described for the elderly population, with the difference that in this environment we can find relatively young people but also at high risk of health complications in the event of an infectious process.

How can we protect our elderly and other vulnerable groups from COVID-19?

The measures to protect our elderly and other vulnerable groups from new infections are based on avoiding direct contact with them, as I mentioned in my article “The elderly and COVID-19”. We should not go to visit them at their homes and, if necessary, take special isolation measures (gloves, gown, face mask) and hand hygiene, especially for caregivers. However, epidemiological experts have already confirmed that the key to stopping infection and thus controlling the pandemic lies in knowing the “asymptomatic carrier”, since COVID-19 can remain active at the level of infection without producing any symptoms in some people. This point is particularly important in the residential setting, both for the elderly and for the professionals working in these centers. If we know which elderly people have the virus asymptomatically, we can group them in separate areas from those who have not had any contact with the coronavirus and avoid their possible infection, although this segmentation in geriatric centers is quite complicated, given their current organizational structure. Likewise, if we detect professionals who are asymptomatic carriers and probable vectors of virus transmission among the elderly, we will proceed to remove them from their work until they are negative.

Together we will overcome this exceptional health emergency. Then we will have to review and analyze the most appropriate social and health care system for our most vulnerable groups, especially considering that demographic forecasts indicate an increasing increase in the geriatric population in our country in the coming decades with the consequent impact on our society with the arrival of a new pandemic.

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