[Update 2021: Coronavirus pandemic - challenges for geriatrics]

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has profoundly impacted global health systems and daily life.
• Initial concerns focused on the oldest and multimorbid populations, but evolving virus strains and vaccination have shifted the demographic of severe cases.
• Long-term care facilities experienced high mortality in early waves, a situation now altered in some European countries.

Purpose of the Study:

• To discuss the evolving landscape of geriatric medicine during the COVID-19 pandemic.
• To address the changing vulnerability of older adults to SARS-CoV-2 infection and mortality.
• To explore the implications for resource allocation and intensive care unit (ICU) admission criteria.

Main Methods:

• This is a discussion paper, not an empirical study.
• It synthesizes observations and expert opinion on the pandemic's impact on geriatric care.
• It reviews changes in patient demographics, mortality rates, and healthcare system responses.

Main Results:

• Mortality from COVID-19 has decreased in vaccinated, multimorbid elderly individuals.
• The oldest old remain particularly vulnerable to severe outcomes and death from SARS-CoV-2.
• Healthcare systems, including long-term care facilities, face new challenges and anticipated situations regarding bed availability and patient flow.
• The pandemic has spurred the development of new guidelines for resource allocation and ICU admissions.

Conclusions:

• Geriatric care paradigms have shifted significantly due to the pandemic.
• Vulnerability to severe COVID-19 outcomes persists in the oldest populations, despite vaccination efforts.
• The pandemic necessitates a re-evaluation of healthcare resource allocation and the development of adaptive guidelines for critical care, even post-pandemic.