Greater (or lesser) access to hospitals for elderly Milanese with Covid has not affected the mortality rate of patients.
I study
These are the countertrend conclusions reached by a study published in the scientific journal Plos One carried out by a group of researchers from the Department of Clinical and Community Sciences of the University of Milan and the IRCCS Ca ‘Granda Foundation of Milan, coordinated by Professor Giorgio Costantino. The purpose of the study was to evaluate if hospitalization for elderly Covid-19 patients reduced their mortality. To do this, the number of hospitalizations for Covid were analyzed divided by age of patients who presented themselves in three large hospitals in the city of Milan (Policlinico, Niguarda and San Carlo) during the month of March 2020 (the peak phase of first wave) and were related to mortality for age, in that same period, among residents in the city of Milan. The same analysis was subsequently repeated considering the number of hospitalizations for Covid in April 2020 (the phase following the first peak of the Italian epidemic).
The unexpected conclusions
The interesting fact that it was not expected that, comparing the two periods, it emerges that in correspondence with the marked increase in the number of hospitalizations, no corresponding reduction in mortality was observed. Our data – the researchers write – confirm that the hospitalization rate for patients over the age of 80 was lower during the peak phase of the epidemic compared to a non-peak phase. However, mortality did not differ between the two periods for these elderly patients. The conclusion that the mortality of Covid-positive elderly patients would be related to disease itself and not a lack of adequate care: the major predictor of survival is patients’ medical history and state of health, age, and the lack or presence of comorbidities.
The explanation of the results
How can this be? The researchers also started from the assumption that the lack of beds in intensive care could worsen the prognosis of the sick, especially the elderly. In fact it turned out that there is no evidence that hospitalization positively affects the prognosis of older individuals, especially those with severe respiratory failure: not known if hospitalization and aggressive treatment are helpful in such patients.
What can be said and who can explain the results, in the first place, that in the analyzed period no therapy used proved effective against the coronavirus. Second, it must be remembered that hospitalization itself for the elderly can have dramatic consequences and increase morbidity and mortality, due to higher rates of complications (such as nosocomial infections, delirium, bed confinement and thrombosis).
More assistance at home
Finally, the study itself, as the researchers write in the appropriate section, has limits due to its being of an observational type. Ideally, a randomized controlled trial should be conducted to validate the current results. In addition, we considered overall mortality regardless of context (in-hospital vs out-of-hospital) and cause of death. The data on deaths were simply numerically compared from ISTAT and the hospital database.
In any case, the result – the scientists conclude -, if confirmed in other contexts, should be taken into consideration by health organizations and could influence their decisions regarding the optimization of available resources. For example, the intervention for the treatment of elderly patients at home or in nursing homes could help better allocation of resources by providing them with the best assistance.
April 28, 2021 (change April 28, 2021 | 07:43)
© REPRODUCTION RESERVED