Human talent in geriatrics in Colombia and its relevance for the management of COVID-19
Authors: William Arbey Gutiérrez Cortes, Cesar Augusto Rivera Tovar
Journal: The Lancet Healthy Longevity (2021)

The COVID-19 pandemic has caused a substantial increase in treatment in hospital for patients with pneumonia and multiorgan disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can be asymptomatic or can cause a wide range of symptoms and life-threatening sepsis.1Wiersinga WJ Rhodes A Cheng AC Peacock SJ Prescott HC Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review.JAMA. 2020; 324: 782-793Crossref PubMed Scopus (3313) Google Scholar Since the first reported case in Colombia on March 6, 2020, interventions have been implemented to decrease the rate of infections, the effective reproduction number (Rt), and consequently mortality. When the quarantine began in Colombia, on March 22, 2020 Rt was believed to be around 2·28, with international evidence showing an average Rt of 2·28–5·27. Mandatory preventive isolation was effective in achieving physical distancing and led to a substantial reduction in cases, resulting in a national average Rt to 1·17 by July 20, 2020.2Roselli DiegoCovid-19 en Colombia: los primeros 90 días.Acta Neurol Colomb. 2020; 46: 1-6Crossref Google Scholar, 3Gutiérrez Cortes WA Papel del geriatra colombiano ante la pandemia por COVID 19.Rev Esp Geriatr Gerontol. 2020; 55: 358-359Crossref PubMed Scopus (5) Google Scholar Geriatric services are the basis of health-care provision for older people in Europe and the USA. Historically, Colombia has had a deficit in health care with quality standards for older people due to the small number of geriatricians and specific geriatric care units, and the COVID-19 pandemic has brought it to attention. In 2015, Colombia had only 51 specialist geriatricians; additionally, there is evidence for there being a number of difficulties for the practice and the development of geriatrics in Colombia.4Gutiérrez WA Situación actual del médico geriatra en Colombia.Univ Méd. 2015; 56: 163-177Google Scholar Given that older people have been the most affected by the pandemic and their mortality exceeds 70% (22 098 of 29 464; data as of Oct 22, 2020) due to age-specific conditions, such as frailty, multimorbidity, and inmunosenescence, that predispose this population to worse outcomes, it is important to establish Colombia's capacity for specialised geriatric care.5Hewitt J Carter B Vilches-Moraga A et al.The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study.Lancet Public Health. 2020; 5: 444-451Summary Full Text Full Text PDF PubMed Scopus (449) Google Scholar, 6Vellas C Delobel P De Souto Barreto P Izopet J COVID-19, virology and geroscience: a perspective.J Nutr Health Aging. 2020; 24: 685-691Crossref PubMed Scopus (62) Google Scholar Consequently, we did a cross-sectional, descriptive, observational study to establish the number of specialists in geriatrics, to continue to build a solid structure at the regional level that contributes to the most appropriate care of older people. In July, 2020, we identified that Colombia had 116 geriatricians and 64 doctors in the training process. Our data showed that 70 geriatricians were members of the Colombian Association of Gerontology and Geriatrics, that is, 60% of the country's specialists. More than 80% (58 of 70) of geriatricians work in large departments or the capital city, Bogotá. According to projections in Colombia, a minimum of 1400 geriatricians are required (based on international recommendations of one geriatrician for every 5000 people >60 years or one geriatrician for every 4000 people >75 years),4Gutiérrez WA Situación actual del médico geriatra en Colombia.Univ Méd. 2015; 56: 163-177Google Scholar given that 13% of the population is older than 60 years. Currently, there is less than 10% (116 of 1400) of the required geriatricians and they are mainly found in large cities where the specialty is recognised and there are specific geriatric care units. Difficulties (eg, little knowledge of the specialty, no specific role for geriatricians, and care of older people by other medical specialties) arise in rural regions for geriatricians' recognition and employment since most patients are cared for by different specialties, contrary to the comprehensive care route for older people, which involves elements of geriatrics for multidimensional assessment. By Oct 22, 2020, 981 700 cases of COVID-19 had been reported in Colombia, and 29 464 people had died (table). Mean percentage of overall mortality that can be attributed to people older than 60 years in Bogotá, Caldas, Valle del Cauca, and Antioquia is 78%. Although there are a greater number of geriatricians in these regions than in elsewhere in Colombia, this is still far too few to adequately care for people over the age of 60 years. Additionally, sometimes geriatricians' specific role is not clear within the hospital setting; where they can be of great help for decision making in patients with complex multimorbidities, frailty, and functional dependence, which are the mainstay of geriatric care.8Landi F Barillaro C Bellieni A et al.The new challenge of geriatrics: saving frail older people from the SARS-CoV-2 pandemic infection.J Nutr Health Aging. 2020; 24: 466-470Crossref PubMed Scopus (83) Google ScholarTableMortality in people aged over 60 years by regionPopulation >60 yearsGeriatricians requiredGeriatricians availableOverall COVID-19 mortalityProportion of overall mortality >60 years (%)Bogotá995 0292003473685591 (76%)Caldas150 4253015220182 (83%)Valle del Cauca609 176120524531972 (80%)Antioquia818 096160429112352 (81%)Data from Instituto Nacional de Salud between March 6 and Oct 22, 2020.7Instituto Nacional de SaludBoletín COVID-19 en Colombia.https://www.ins.gov.co/Noticias/Paginas/Coronavirus.aspxDate: Oct 22, 2020Date accessed: October 25, 2020Google Scholar Open table in a new tab Data from Instituto Nacional de Salud between March 6 and Oct 22, 2020.7Instituto Nacional de SaludBoletín COVID-19 en Colombia.https://www.ins.gov.co/Noticias/Paginas/Coronavirus.aspxDate: Oct 22, 2020Date accessed: October 25, 2020Google Scholar International experience suggests the importance of involving geriatricians for the correct evaluation and management of older patients with COVID-19. These patients have adverse outcomes and die due to their advanced age and high comorbidity, which is why they need physicians who can deal with such conditions.9Colenda CC Reynolds CF Applegate WB et al.COVID-19 pandemic and ageism: a call for humanitarian care.J Am Geriatr Soc. 2020; 68: 1627-1628Crossref PubMed Scopus (15) Google Scholar According to the results of our research, we observe a large deficit of geriatricians in Colombia, making it more difficult to have an approach to care for the older population in hospital settings. Despite these adverse circumstances, geriatricians in Colombia have been committed to the health of older people since the beginning of the pandemic, actively participating in the drafting of national recommendations and guidelines for the management of older people with COVID-19.10Torres W Pérez D Gómez B et al.Ruta de manejo del adulto mayor con sospecha de infección por SARS CoV-2/COVID-19 en centros de protección de larga estancia para adultos mayores en el departamento del Valle del Cauca—Colombia.Rev Asoc Colomb Gerontol Geriatr. 2020; 34: 29-44Google Scholar, 11Dwolatzky T If not now, when? the role of geriatric leadership as COVID-19 brings the world to its knees.Front Med. 2020; (published online May 15.)https://doi.org/10.3389/fmed.2020.00232Crossref Scopus (10) Google Scholar We make a call to action, to understand that Colombia is in a stage of moderate ageing, which in the short term will require more personnel to be trained in the care of older people to be able to respond to this population group, particularly with the threat of COVID-19. The country has four medical schools with postgraduate degrees in geriatrics, and there are many doctors in training who will serve to multiply efforts and found geriatrics units in rural regions. We declare no competing interests. Community of practice for healthy longevity: reconfiguring geriatric care during a pandemicWilliam Arbey Gutiérrez Cortes and Cesar Augusto Rivera Tovar, in their recent Comment,1 urged the creation of a cadre of geriatrics health workers in Colombia. The authors describe how geriatricians, being far too few in number, faltered in meeting the demands of caring for people aged 60 years or older during the COVID-19 pandemic. This is an important concern, because older people are of increased susceptibility to any adversity and are the most at risk during a catastrophic situation.2 Commensurate with population ageing, health systems in low-income and middle-income countries (LMICs) have tried in the past decade to address the steadily rising complex health-care needs and challenges of the growing number of older adults. Full-Text PDF Open Access