This article describes the likely impact of the COVID pandemic on rehabilitation needs for the elderly population and then discusses potential rehabilitation strategies to combat the increased demand created during this pandemic.

Introduction

COVID-19 is an infection that can cause multisystem manifestations and will often require post-illness rehabilitation. COVID-19 disproportionally affects the elderly population who are often frail or living with multimorbidity. Aside from the physical symptoms caused by COVID, older adults are subject to stricter isolation which places them at risk of increased sedentary behavior and the associated outcomes of deconditioning, balance deficits, increased fall risk and worsening and/or new mental health issues. In this patient population, rehabilitation is profoundly important in recovering from acute illness. New rehabilitation strategies during this pandemic will need to be effective in delivering rehabilitation to a patient population with large amounts of pre-existing conditions.

Identifying who will need rehabilitation

• Rehabilitation needs will vary from country to country, largely because of different health and social care systems in addition to prior management of spread.
• Not all older patients who develop COVID-19 infection will require rehabilitation. This is largely dependent on the severity of disease and the number of pre-existing conditions or functional impairment prior to infection.
• Rehabilitation services should be proactive in identifying patients discharged from the hospital with COVID-19 or those who have been diagnosed by their primary care physicians.
• There is a risk that older patients with impaired function due to acute conditions other than COVID-19 infection will not seek rehabilitation services due to fear of catching COVID-19 from healthcare facilities.
• Older patients with other acute conditions will also require new rehabilitation strategies that allow for the maximization of recovery with minimal risk of COVID-19 infection.

Rehabilitation post COVID-19

• Services that are focused solely on hospital care can collaborate with primary care, community services, and with agencies outside of healthcare. These integrated systems may be more effective for patients requiring rehabilitation and may be more resilient to future pandemics.
• The capacity to deliver rehabilitation must increase in order to meet an anticipated demand in rehabilitation services. Rather than training additional specialist practitioners, we can use the capacity and skills from agencies outside of health organizations, such as exercise instructors, to create a more diverse rehabilitation workforce.
• There is likely to be a larger emphasis on services being delivered at a patient’s residence or remotely versus at the clinic or hospital. Older adults may not have digital literacy or may be confined to their homes in isolation. Care must be taken to ensure that a change in the location of rehabilitation services addresses these issues.
• Research will be essential for improving rehabilitation services for both those with and without COVID-19 infection.

De Biase S, Cook L, Skelton DA, et al. The COVID-19 rehabilitation pandemic. Age and Ageing. Published online May 29, 2020. doi: https://doi.org/10.1093/ageing/afaa118