Managing osteoporosis in care homes and social care during the COVID-19 pandemic

John Bowis OBE

Managing osteoporosis in care homes and social care during the COVID-19 pandemic

The COVID-19 pandemic has transformed every aspect of our lives, including our access to healthcare. While the impact has been felt for many groups of older people, those with osteoporosis and living in care homes may be particularly affected.

The effect of the pandemic on care home residents

Care homes have been forced to implement restrictions to prevent the spread of COVID-19. Family visits are often not possible, while the ability of residents to leave their home is also constrained. Social activities have been cancelled or curtailed, and access to clinics and physiotherapy has also been reduced.1 While these restrictions are necessary to prevent COVID-19 infections, they may be putting residents with osteoporosis at an increased risk of potentially serious fragility fractures.2

Osteoporosis patients staying indoors may be protected from COVID-19 in the immediate term – but those unable to stay active safely could be at greater risk of falls. Weakened bones mean that falls among older people with osteoporosis are more likely to lead to a fragility fracture than falls among people who do not have osteoporosis.3

We have seen that people in care homes are highly vulnerable to COVID-19 infection.4 However, they are also at risk of a host of other infections and complications. In the long term, we must reconsider the design of these spaces such that they are well-ventilated (without letting in drafts), with opportunities for residents to stay safely mobile, both outside and indoors – whether they have osteoporosis or not.

In addition, care homes must consider how to support socially distant interactions with family and friends. It has been immensely difficult for relatives to be apart this year, waving through windows and waiting in isolation. We must find better solutions to protect people from infection without sacrificing their mental and physical wellbeing.

Disruption to healthcare services

The COVID-19 pandemic has disrupted the delivery of care for people with osteoporosis.1 The challenges associated with ongoing check-ups or treatment for chronic conditions in a hospital during the pandemic are not limited to this disease area: we have seen ongoing care affected for all chronic diseases, including cancer, diabetes, cardiovascular diseases and osteoporosis, while health systems struggle to cope with the more immediate threat of COVID-19. Appointments are being postponed or turned into virtual consultations which may be especially difficult for older patients to adapt to. It can be difficult to relate health and wellbeing concerns to a healthcare professional when you cannot see them.

In addition, many people have avoided seeking care for fear of infection.5 This can only lead to greater problems down the road. We must not underestimate the impact that COVID-related changes to the delivery of healthcare services are having on the lives of people living with osteoporosis. We need to ensure that people are able to access the ongoing care and support they need from healthcare professionals to manage their condition and prevent fractures.

The importance of collaboration between health and social care

The relationship between a patient and their place of care is a critical one, and while this is true at all times, it is especially relevant as we navigate this global pandemic. Hospitals, as good as they are, have a practical tendency to send people home after treatment as soon as possible, perhaps not always ensuring that the receiving end – be it a care home or their private home supported by social care – is equipped to look after the person and continue their care and recovery.

Managing the handover between health and social care providers in a way that is safe for both patients and staff will require strengthening the collaboration between the two sectors. This is, of course, quite challenging – in most parts of Europe, these two systems are largely separate from one another. Fundamentally, though, we must agree that to ensure the wellbeing of older people with osteoporosis in the community, social care must be well-equipped to support them, with funding for specialised equipment and training, while having the systems in place to support strong collaboration with colleagues in the healthcare sector.

We need a regime in place now that breaks us out of our silos and offers a whole-person approach. We must build a better relationship between care homes and private homes, and hospitals and clinics. And regardless of location, we must secure the best possible circumstances for the individual. There must be a constant focus through our health and social services on quality of life, and the person must be listened to if we are going to ensure their quality of life.

 

John Bowis OBE is a member of the Osteoporosis and Fragility Fracture Policy Network’s Expert Advisory Group. He is also an Honorary Patron of Health First Europe, a former Member of the European Parliament and former Health Minister for the UK

This blog post reflects the opinions of the author and does not represent the views of other Network members, nor those of Amgen. References are provided for the data and statistics cited in this blog post but all other information is given as the opinion of the author.
Date of preparation: March 2021    Hub-PRO-1220-00010
References +
  1. Paskins Z, Crawford-Manning F, Bullock L, et al. 2020. Identifying and managing osteoporosis before and after COVID-19: rise of the remote consultation? Osteoporosis International 31(9): 1629-32
  2. Girgis CM. 2020. Considering Osteoporosis During the COVID-19 Pandemic. [Updated 08/08/20]. Available from: www.physiciansweekly.com/considering-osteoporosis-during-the-covid-19-pandemic [Accessed 06/12/20]
  3. National Institute for Health and Care Excellence. 2017. Osteoporosis: assessing the risk of fragility fracture. London: NICE
  4. Burton JK, Bayne G, Evans C, et al. 2020. Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK. The Lancet Healthy Longevity 1(1): e21-e31
  5. NHS England. 2020. Help us help you: NHS urges public to get care when they need it. [Updated 25/04/20]. Available from: www.england.nhs.uk/2020/04/help-us-help-you-nhs-urges-public-to-get-care-when-they-need-it [Accessed 06/12/20]