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All the charts of the spread of the infection in Västra Götaland have turned into steep hills. The number of covid patients who have been admitted to Västra Götaland hospital is now as large as in early April, when the spread of the infection skyrocketed.
In Västra Götaland, among other places, regional guidelines have been issued that go against the intention behind the Swedish Health and Medical Services Act. They claim that instead of following the “sickest first” principle, it may be necessary to prioritize the frail elderly so that intensive care units with ventilators are available to younger patients who have a higher chance of surviving an infection. by covid-19.
The disease has He also entered several nursing homes in Gothenburg, where now half of the districts have confirmed cases in one or more homes.
Statistics from the National Board of Health and Welfare show that at the end of May this year, more than half of those who died in covid-19 in Västra Götaland came from what is called Säbo, especially housing for the elderly. As a second wave of infection grows in the country, Yngve Gustafson, a professor of geriatrics at Umeå University, worries that elderly covid patients are not getting the care they need.
– There is a risk that there will be discrimination against a group of people who will not have access to basic hospital care, he says.
Yngve Gustafson, professor of geriatrics at Umeå University.
Photo: David Dahlberg
Yngve Gustafson strongly criticizes the lack of doctors in Swedish elderly care. This spring, he addressed the media and advocated for elderly covid patients to receive care at the hospital.
– Each person must receive an individual evaluation by a physician. If you need oxygen, you must get oxygen, if you need a drip medicine and blood thinner, you must get it, he says and continues:
– Older people with Covidis often become very confused and then it is interpreted to mean that they have worsened in their dementia and are starting palliative care.
The opinion that one The physician’s assessment should be the basis for the decision to urgently bring an elderly covid patient to hospital, shared by Maria Taranger, interim area manager at Sahlgrenska University Hospital in Gothenburg. However, he states that it is almost always better to care for frail older people where they live than in the hospital and believes that the chances of surviving infection may be increased and that care in the final stages of life is significantly better at home than in the hospital.
– My experience tells me that some of those who were rushed to the hospital this spring died because they received difficult transportation. I can’t prove it, but I’m afraid of it, he says.
How should one look at the cases in which covids infected by the elderly have died because they have not received hospital care?
– Some say “I fought and fought and then dad came in and took oxygen and then recovered.” But we have so many who are staying in the house and who are recovering. In a number of cases, it is very difficult to say whether hospital care was helpful, although of course there are cases where it was good that the elderly were allowed to go to hospital.
Maria Taranger, area director of the Sahlgrenska University Hospital.
Photo: Veronika Ljung-Nielsen
Maria Taranger believes that oxygen is overestimated as a treatment for COVID-19 in this group.
– If it is so severe that COVID-19 completely destroys the lungs, a respirator is needed and then it is evaluated whether the patient can withstand a respirator treatment and intensive care. At the group level, very few frail older people benefit from it. But it is clear that there are those who can have it and there it is important to have an individual assessment.
She spins against Yngve Gustafson’s statements on covid care of the elderly and says that Sahlgrenska’s concern is that she will once again be forced to accept large numbers of seriously ill elderly people in hospital emergency rooms.
– This spring I was the head of Östra and my doctors cried because then the elderly came, dying, in batches and minutes for two weeks after Yngve Gustafson’s statement. They died like flies in a very unworthy way. I was very upset that they went so lightly on this.
The Sahlgrenska University Hospital, under the leadership of Maria Taranger, has instead created what is called mobile teams made up of doctors and nurses who will be able to visit the sick elderly where they live. The team now also collaborates with ambulance care.
Read more: Large increase in home visits: Sahlgrenska provides care for cancer patients outside the hospital
Hospital statistics show, however, that very few of the elderly seeking emergency hospital care have been evaluated by a doctor and even fewer have seen a doctor face-to-face before going to the emergency room.
– What we can see in our statistics from 2012 to 2019 is that only in seven percent of cases have you talked to a doctor before sending the elderly to the emergency room. 93 percent have entered without, as we understand it, trying to see what can be resolved on the spot. And in our numbers, it’s only one or two percent where a doctor has been brought to the scene for an evaluation, says Maria Taranger.
How those actions She doesn’t know what it was like this spring, but Maria Taranger says that mobile teams doubled the number of home visits during the spring.
On behalf of DN, it produces figures showing that the number of people aged 80 to 109 who sought care in one of the three emergency departments at Sahlgrenska University Hospital this spring decreased by 39 percent compared to 2019. The figures are They apply to all applicants and not just covid patients.
Calculated for all age groups, the number of acute care seekers decreased by 26 percent, making the difference between elderly patients and the entire population large. The difference was smaller in October, when the number of people aged 80 to 109 decreased by 18 percent compared to the same month last year and by 13 percent in all patients.
– What I can read from these figures is that older people to a greater extent than young people avoided seeking care in order not to become infected. But it is also to be expected that in the primary care team, the municipality and the hospital we would be better at going to his house and helping on the spot, says Maria Taranger.
Babbs Edberg is responsible for coordinating the work against covid-19 in the care of the elderly in the city of Gothenburg.
Photo: Veronika Ljung-Nielsen
Babbs Edberg has Responsibility for coordinating the work of the districts against covid-19 in the care of the elderly in the city of Gothenburg. She says the township’s operations are better equipped today than they were last spring.
– There are big differences. Knowledge about the disease is greater, now we know what applies and what we should do. The important parts of infection testing and tracking weren’t in place this spring, but we’re dealing with infection much faster now than we did in the spring, she says.
The city of Gothenburg follows a line based on the position of Maria Taranger that home care is preferable where possible.
– Most importantly, physicians must individually assess whether or not they receive hospital care. Our task is to contribute to such an evaluation, says Babbs Edberg.
How is it ensured that a doctor will be consulted in all cases where the choice is between end-of-life care or going to the hospital in an emergency?
– It is the responsibility of the health center and the doctor to do so. So it’s obvious that as a nursing home nurse, you are responsible for having contact with the doctor, says Babbs Edberg.
Yngve Gustafson is not reassured by the insurance of the municipalities and regions.
– I’m worried about how it will go. You get angry and angry at the same time, he says.
Read the DN news from Gothenburg.
