Eastern Mediterranean University (EMU) Faculty of Health Sciences, Physiotherapy and Rehabilitation Department academic staff member Assoc. Prof. Dr. Gözde İyigün wrote an article titled "Is Physiotherapeutic Perspective Necessary for the Elderly During the COVID-19 Pandemic?" on the occasion of 18-24 March Seniors Week. Assoc. Prof. Dr. İyigün stated the following in her article:
As Ingmar Bergman said “Old age is like climbing a mountain. You climb from ledge to ledge. The higher you get, the more tired and breathless you become, but your views become more extensive.” Aging is not a disease, but a natural process that begins with birth and continues until death. With advancing age, some changes are seen in various systems, especially respiratory, cardiovascular and musculoskeletal systems. In addition, a series of changes occur in the kidneys, endocrine system, immune system and nervous system during aging. All these changes reduce the adaptability of the elderly by affecting their resistance to environmental factors and pathological processes.
Chronic diseases, cognitive problems and physical problems in elderly people cause complex healthcare needs. Many different health professionals need to work together in order for the healthcare of older people with complex health problems to be successful. Working in cooperation with the elderly individuals themselves and their families, the team consisting of doctors, physiotherapists, occupational therapists, speech therapists, nutritionists, psychologists, nurses and social workers increases the success of rehabilitation by ensuring the active participation of the elderly person in the rehabilitation process.
Rehabilitation practices applied in order to maximize and protect the existing functional capacity of elderly people are called "geriatric rehabilitation". Physiotherapy is an integral part of geriatric rehabilitation. The rehabilitation process includes all approaches to bring elderly people to the highest possible functional level in their environment. In this sense; One of the main goals of the rehabilitation process is to maximize physical functions, psychological health and social integration. Due to the COVID-19 pandemic, both the direct effects of the disease and the indirect social isolation, the restriction of physical movements and the health system disruptions, the need for rehabilitation for elderly people arises.
What Are the Effects of COVID-19 Disease?
“COVID-19 is a respiratory infection associated with many systems. Disease severity ranges from asymptomatic infection to severe and fatal illness. COVID-19 infection can cause dysfunction in multiple organs. Inactivity and insufficient food intake constitute a very important risk factor for loss of muscle mass and strength in patients, also called sarcopenia.
In addition, it has been identified that COVID-19 also causes various neurological symptoms such as delirium (especially in elderly patients, a temporary condition that manifests itself in the form of confusion, focusing problems and anger) and stroke. Additionally, those who survive severe illness (especially those admitted to the intensive care unit) may experience post-traumatic stress disorder. Therefore, COVID-19 disease can affect physical, cognitive and psychological functions in various ways.
It is clear that COVID-19 affects older people disproportionately. This is the group most likely to require hospitalization and most likely to die from COVID-19 infection. Since this infection picture may cause elderly fragility (decrease in physiological reserve which is effective in daily activities and response to stress as a result of the decline of many organ and system functions due to biological aging), individuals living with chronic diseases will be more affected. Therefore, rehabilitation strategies need to be developed by targeting not only the wide variety of problems caused by COVID-19 disease, but also those with a high pre-existing vulnerability and disease burden.
What are the Indirect Effects of the COVID-19 Outbreak?
“Many countries have implemented a lockdown process to contain the pandemic. During this period, older adults, especially those with vulnerabilities and various diseases, were often subjected to a stricter isolation from the general population. Isolation conditions required the elderly to spend longer time in their homes, bringing along physical problems such as inactivity, balance problems and the risk of falling, as well as decreased social communication with their families and friends. Broader societal problems such as loneliness, loss and poverty have negatively impacted the older people’s life quality.
Who Needs Rehabilitation?
"Due to different health and social care systems and different effects of COVID-19, rehabilitation needs differ from country to country. Not all elder people with COVID-19 infection will need rehabilitation. Rehabilitation needs can range from minimal to intensive for those with very few symptoms or intensive and long-term rehabilitation for patients who have been in intensive care for a long time, or suffered a major loss of function.
It is known to all that people most severely affected by COVID-19 become subject to functional decline due to the long hospitalization period and generally spending most of this time in bed. The need for rehabilitation depends not only on the severity of the disease, but also on the degree of pre-existing frailty and functional problems ”.
What are the Rehabilitation Practices for People Recovering from COVID-19 Infection?
“COVID-19 rehabilitation should be capable of managing all the consequences of Covid-19 infection, including shortness of breath, fatigue, muscle weakness, delirium, post-traumatic stress disorder and other problems. In this sense, each patient will need a customized rehabilitation program that includes aerobic exercise, strength training, balance training, shortness of breath management, energy saving, functional and occupational rehabilitation and psychological support.
Where Can the Rehabilitation Services Be Applied?
“The pandemic process has brought many difficulties with it. For example, after the pandemic, there has been a need to integrate physical activity and exercise practices into daily life through remote communication. The places where rehabilitation can be implemented should be set up with more emphasis on services provided at or near patients' own homes rather than clinical or hospital-based services, as COVID-19 infection is still ongoing. Therefore, the use of digital connections to support rehabilitation has come into question. Even in cases where face-to-face rehabilitation can be resumed, it is anticipated that such practices can create permanent changes in our lifestyle in order to ensure effective implementation of rehabilitation on a large scale.
As a result, physiotherapy applications in the elderly are required for various reasons in the COVID-19 pandemic. In these rehabilitation practices, various arrangements should be made considering the need for social isolation. These rehabilitation practices should be shaped taking into account the conditions and according to personal needs, and aim to increase the quality of life and social needs of elderly individuals as much as possible. "