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Older patients are putting off routine care – how to help them get to a doctor

Tips to avoid becoming “medically isolated” during the outbreak.
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/ Source: TODAY

When a heart failure patient was recently scared to come in for a medical appointment during the coronavirus outbreak, Dr. John Tabacco examined the person while sitting in their car.

The patient, who was worried about swollen legs, drove to the parking lot of the medical practice for a “curbside visit” that wouldn’t require entering a building or sitting in a waiting room.

Tabacco, an internal and sports medicine doctor in Arlington, Virginia, then climbed into the passenger seat — fully gowned for both of their protection — to check the driver’s level of edema.

“We’re able to do a lot for patients by thinking outside the box,” Tabacco told TODAY.

“We really had to change our entire playbook of how we saw patients... (because) there could be a surge of extra medical problems, extra deaths if we don’t take care of these chronic issues that are now having a lack of access to care.”

Many older Americans who are used to going to the doctor for regular check-ins, medicine management and other appointments can no longer do so as they stay home to avoid getting infected.

It concerns doctors like Tabacco, who worries they’ll become “medically isolated” and even more at risk for the severe form of COVID-19.

So physicians across the country are adapting, with most switching their offices to offer virtual appointments conducted in real time by phone or video. Medicare beneficiaries will be covered for those visits under a law that expanded telehealth benefits “on a temporary and emergency basis” starting March 6.

“We’ve really tried to transition as many of our patients as possible to that kind of setting and it’s worked out pretty well,” said Dr. Leo Cooney Jr., a rheumatologist and geriatric clinician at Yale Medicine in New Haven, Connecticut.

“The actual person-to-person contact is less essential maybe than it was 20 years ago.”

The frequency of his virtual visits has gone “from zero to a lot” since January, Cooney noted. Since he’s over 70 himself, he’s not allowed to see patients directly for his safety. On a typical day, he conducts about 10 virtual appointments — a mix of phone and video visits. The phone is good enough for the vast majority of the time, he said.

How virtual visits work:

A good place to start is to check with your health care provider, provider system or hospital’s app for a telemedicine portal, download it and follow the prompts, experts advised.

In Cooney’s practice, the video visits are conducted when patients connect to “MyChart,” an online portal people use to access their medical records.

Cooney asks patients the same kinds of questions he would normally ask during a visit; they go over medications and how the person is feeling. He can’t examine someone’s achy knee or check their blood pressure, but can go over blood pressure readings patients have recorded with their home monitors.

“I think they’re comfortable doing it over the phone. They want to see me at some point, but they’re very well aware these are extraordinary times,” he said.

“Telemedicine is a reasonable approach in these difficult times and it manages a lot of problems fairly well.”

Tabacco conducts about about 12-14 telemedicine appointments a day. All it takes is the FaceTime feature on an iPhone, but he tries to use whatever technology works for the patients. Plain phone calls work, too, he said.

Additional options to see a doctor:

Some physicians, including Tobacco’s doctor group, will see patients in the practice’s parking lot.

Patients don’t get out of their car and they keep their window just cracked while nurses and doctors — in personal protective equipment — approach and evaluate them that way.

Some doctors are also doing house calls while fully gowned. Still, the safest way in most cases is the virtual option.

“The problem is not where you see the patient. The problem is you have face-to-face contact. So whether the face-to-face contact is in my office or your home, it’s still a problem,” Cooney said.

How to help older adults in other ways:

Age is a substantial risk factor for COVID-19, even when older adults are healthy. That’s why the Centers for Disease Control and Prevention advises people who are 65 or older to stay at home.

Doctors advised everyone to check in with their older neighbors and loved ones while keeping a safe distance. Talking by phone or through a closed glass window may be best.

  • Ask if they need help with groceries.
  • Ask if they have enough prescription medicine.
  • Ask if they need help getting other medical supplies, like oxygen tanks, wound care or diabetic supplies. “You’d be amazed what people are willing to go without just thinking they shouldn’t leave the house. When the opposite is true: They really need to care for themselves and be extra careful this time,” Tabacco said.
  • Help them use the internet or navigate an iPhone (again, via a safe distance).
  • Encourage them to exercise inside their home. Taking a walk outside is fine, too, if there aren’t many other people around.
  • Let them know they’re part of a community that cares about them. “The most important thing is having a connection with people and that they know they can pick up the phone and call you if they have needs,” Cooney said. “It’s a challenging time, but I think people understand it.”