The Pulse

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)

History:
This woman was referred to a skilled nursing facility due to severe debility following a seven week hospitalization due to COVID-19. Her condition was complicated by diabetes, COPD, and pulmonary fibrosis. At the time of hospital discharge, she required 8 liters per minute of supplemental oxygen to maintain oxygen saturation level. Prior to hospitalization she lived with her family in a 2-story home, was independent with walking and all self-care, and worked as a construction supervisor.

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)

According to the CDC, in the U.S. there have been more than 33.9 million cases since January 2020. As many as 1 in 10 of those who develop COVID-19 exhibit new and prolonged symptoms lasting 12 weeks or longer. This is known as long COVID and occurs regardless of the severity of the acute illness. These individuals may have multisystem involvement with the most common symptoms after 6 months being fatigue, post-exertional symptom exacerbation (PESE), and problems with memory and concentration (brain fog). Therapists should screen for PESE, a worsening of symptoms typically 12 to 48 hours following even minimal cognitive, physical, emotional, or social activity that may last for days or weeks. (World Physiotherapy, 2021)

According to the CDC, 78% of adults over 55 in the U.S. have one or more chronic conditions. The ability to perform activities of daily living (ADLs) such as transfers, dressing, and bathing along with instrumental activities of daily living (IADLs) such as shopping, cooking, and cleaning informs healthcare professionals regarding the individual’s level of independence. With chronic conditions such as COPD, chronic heart failure, stroke, and diabetes, individuals may have dyspnea, weakness, and poor aerobic capacity which in turn may lead to impaired ability to perform ADLs and IADLs.

Respiratory diseases are among the leading causes of death and disability in the United States. In 2019, chronic lower respiratory disease including asthma, but predominately chronic obstructive pulmonary disease (COPD), was the 4th leading cause of death and influenza and pneumonia the 9th leading cause of death (Kochanek et al., 2020). The ranking for 2020 will likely change due to COVID-19-related deaths at greater than 500,000.

Patient Information: Female, Age 85

Diagnosis: Chronic Heart Failure (CHF) / Chronic Obstructive Pulmonary Disease (COPD) / Muscle Weakness

Heart disease is the leading cause of death for both men and women in the United States with greater than 600,000 deaths attributed each year. Along with other conditions such as diabetes and obesity, heart disease may lead to heart failure which affects 6.2 million Americans per year (CDC, 2020).

Muscle strength decline is associated with normal aging and may be accelerated by illness, disease, or injury. Decreased physical activity resulting from COVID-19 mitigation efforts is exacerbating the incidence of muscle disuse atrophy in older adults. Strength declines may lead to functional and mobility deficits with increased risk of falls, injury, or death. According to the CDC, each year three million adults are treated in emergency departments for injuries related to falls. By 2030 fall deaths are anticipated to rise to seven per hour. Accurate assessment of strength using validated tests and objective measures is crucial to creating an appropriate treatment plan and achieving outcomes that reduce fall risk.

Speech-language pathologists (SLPs) are commonly involved in the rehabilitation of patients with cardiopulmonary disorders. Patients hospitalized with respiratory diseases such as COPD and heart failure (HF) are identified as at risk for development of oropharyngeal dysphagia. Additionally, patients who experience prolonged endotracheal intubation have an increased risk of developing dysphagia. (Malandraki et al., 2016) This is often seen in patients hospitalized for COVID-19.

Physical and occupational therapists treat many individuals who present with impaired coordination, motor control, balance and tone. These individuals may have a wide range of diagnoses, from neurologically involved, such as cerebral vascular accident (CVA) and Parkinson’s disease, to orthopedic involvement such as post-total knee replacement (TKR). The common goal of improving functional mobility and outcomes may be achieved by the addition of research-supported cycling and biophysical agents.