Geriatrics in the face of war
Authors: Karolina Piotrowicz, Monika Rzeźnik, Barbara Gryglewska, Tomasz Grodzicki, Jerzy Gąsowski
Journal: The Lancet Healthy Longevity (2022)

A 78-year-old retired director of a research institute was recently admitted to our acute geriatric unit (University Hospital, Kraków, Poland) with pneumonia. Upon presentation, the patient had hypoactive delirium and mild fever. Other vitals were normal. Apart from having COVID-19 a month ago, the medical history reported by his daughter was unrevealing. He had moderately elevated C-reactive protein, creatine kinase, myoglobin, and creatinine, all of which were suggestive of rhabdomyolysis. The patient had spent the past 2 days in his car or outside in the cold. There would have been little that was extraordinary about this patient had he not been our first patient who fled the war in Ukraine and drove from Kyiv to Kraków (Poland), where his daughter has been living. Until Feb 24, 2022 people in Europe took peace for granted. True, now and then, here and there, we were hearing of war. Europe went through a major refugee crisis caused by the war in Syria. However, from that Thursday morning onwards, war in Europe became our new reality. Many of older people in Europe, especially in central and eastern Europe, lived through instability and deprivations in the years that shortly followed the end of World War 2. These hardships, for half of the continent, included living in an inhumane totalitarian system imposed by the Stalinist Soviet Union. Worse still, those old enough to remember the war itself went through the unspeakable hardship and depredations of the Nazi German occupation. Some survived the Nazi German concentration camps. A great number of those who fell under the shadow of Stalinist Moscow were deported to Siberia or Kazakhstan, which also caused death and misery and left its mark on the survivors' lives. Those who suffered most were those who did not comply with the communist line, or simply those who were the wrong nationality as the post-war borders shifted. Years later, many of those who had survived the ordeal had post-traumatic stress disorder, which, apart from the mental problems, constituted a substantial risk for somatic health, including cardiovascular and metabolic health.1Piotrowicz K Parnicka A Mielimąka M et al.Are all the former Siberian deportees with posttraumatic stress disorder patients at risk for unsuccessful aging?.Int J Geriatr Psychiatry. 2018; 33: 671-672Crossref PubMed Scopus (3) Google Scholar, 2Walczewska J Rutkowski K Cwynar M Wizner B Grodzicki T Comprehensive geriatric evaluation in former Siberian deportees with posttraumatic stress disorder.Am J Geriatr Psychiatry. 2014; 22: 820-828Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 3Walczewska J Rutkowski K Wizner B Cwynar M Grodzicki T Stiffness of large arteries and cardiovascular risk in patients with post-traumatic stress disorder.Eur Heart J. 2011; 32: 730-736Crossref PubMed Scopus (35) Google Scholar There is no knowing what the early life events of our Ukrainian patients were like. We can only presume that living among Stalinist terror must have left its mark. And now, seeing misery and death, living through air raids, queuing at the border among thousands of others fleeing to safety in Poland, the European Union, and NATO, is likely to have added stress that, on top of the acute medical aftermath of travelling under duress, might cause delirium in some. As of March 2, within only the first week of war, an estimated 450 000 refugees crossed from Ukraine to Poland. A week later, this number increased to 1 000 000 refugees, according to the UN. Poland, on both a societal and governmental level, has stood up to the challenge so far. The health-care system in Poland is adapting to the new situation of the possible influx of thousands of people in need of medical attention. Among these people will be growing numbers of older men and women who had to leave their homes and pack essential belongings into small suitcases. Europe needs to brace for an unprecedented humanitarian crisis, which will hit children and older people the most. Health, healthy ageing, and the right to access health care are part of our core values.4Ataguba JE Bloom DE Scott AJ A timely call to establish an international convention on the rights of older people.Lancet Healthy Longev. 2021; 2: e540-e542Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Accordingly, regarding older refugees fleeing Ukraine, a multitiered health-care system should come in place. First, acute care (both out-patient and inpatient), which is already being addressed in Poland and includes the entitlement to free medical care to all refugees from Ukraine. Second, despite the fact that COVID-19 is now less prevalent in Poland since the beginning of the COVID-19 pandemic, the newcomers will need vaccination. A multi-specialty care plan, including psychological and psychiatric support with appropriate access to interpreters, will be needed. A good example of such a system is the system currently being created at the University Hospital (Kraków, Poland) which, in addition to health-care specialists, will include personnel of Ukrainian origin as interpreters and so-called familiarisers (ie, people who provide comfort and assist Ukrainian people to access health care). Last, the system will need to take care of its staff, both psychologically and somatically. At the administrative level, there will be a need for bilingual documentation (eg, consent forms). All of these measures will require funding, so to meet these challenges, appropriate allowances will need to be made both at the national and the EU and NATO levels. The fates of wars are hard to predict, and yet we are all hoping that the present one will end soon. We must, however, be prepared for a prolonged stay of Ukrainian refugees, and must be prepared to adapt health-care systems and social systems to cope.5Scott AJ The longevity economy.Lancet Healthy Longev. 2021; 2: e828-e835Summary Full Text Full Text PDF Scopus (2) Google Scholar This online publication has been corrected. The corrected version first appeared at thelancet.com/healthy-longevity on March 21, 2022 This online publication has been corrected. The corrected version first appeared at thelancet.com/healthy-longevity on March 21, 2022 We declare no competing interests. Correction to Lancet Healthy Longev 2022; published online March 9. https://doi.org/10.1016/S2666-7568(22)00058-7Piotrowicz k, Rzeźnik M, Gryglewska B, Grodzicki T, Gąsowski J. Geriatrics in the face of war. Lancet Healthy Longev 2022; published online March 9. https://doi.org/10.1016/S2666-7568(22)00058-7—In the third paragraph of this Linked Comment, the estimated number of refugees who had crossed from Ukraine to Poland should have been 1 000 000 refugees. This correction has been made as of March 21, 2022. Full-Text PDF Open Access