From places of assistance to centers where health is promoted: the theme was at the center of the National summit “From emergency to excellence – the future of RSA in post Covid-19”, an event organized by Quotidiano Sanità and Popular Science, with the non-conditioning contribution of GSK, which saw institutions and stakeholders confront each other in the light of the management of the pandemic emergency. The impact of Covid19 has put a strain on nursing homes and the most fragile patients, from which the need for new governance has emerged, also with a view to prevention. “We have an elderly population of fifteen thousand centenarians in Italy and almost eight hundred thousand over ninety – declared Roberto Bernabei, president of Italia Longeva -. The majority are women also affected by forms of dementia and the tendency is towards a growing loneliness due to the lack of generational change. Healthcare in general must therefore provide shelter and invest in effective prevention tools that are not burdensome for the patient. Vaccinations are free and prove to be a long-term defense over the years “. Therefore, health planning is needed, continued Bernabei, which makes RSAs “hubs and spokes” for health. Indeed, the vaccination of the population within these structures would be very easy also thanks to the fact that they are widespread throughout the territory. The address of the PNRR is to have the relationship of a community house for 50 thousand inhabitants and a community hospital for 60 thousand ”. An aspect that according to Ernesto Palummeri, Alisa responsible for the Covid emergency in the Rsa of Liguria is not well outlined in the guidelines of the Pnrr because it is unclear. “The RSAs are also a place of knowledge and can be open to the territory. There are experiences in rendering services outside the walls of the structure, the development potential is enormous to enhance skills “. In the oldest region of Europe, Covid has heavily affected the population not only of healthcare residences, but also of all closed communities such as prisons and convents. “In RSA there are the most fragile of the frail, the elderly with chronic polypathologies, dementia, fragility. So it was essential to distribute a questionnaire among the operators that showed us what measures to take. We have thus reduced mortality by up to 65.6% and at the same time we have vaccinated over 95% of guests and staff. Today there are 1% of patients with Covid in the Ligurian RSAs “. Compared to the objectives set by the National Vaccine Prevention Plan, it is now necessary to implement coverage even in nursing homes, as reported by Claudio Mastroianni, president of the Italian Society of Infectious and Tropical Diseases SIMIT, full professor of Infectious Diseases at Sapienza in Rome and director UOC Infectious Diseases at Umberto I. “Vaccines, in particular anti-pneumococcus and anti-influenza, have the role of reducing the silent pandemic of antimicrobial resistance. Avoiding infection allows you to avoid having to resort to antibiotics, reduce hospitalization and other public health interventions, as well as prevent the development of multidrug-resistant germs that affect the elderly, a classic event in Rsa. And this also applies to anti herpes zoster, which can cause a very disabling post-herpetic neuralgia. Now the new recombinant technology, recently introduced, allows to extend the vaccination also to immunocompromised subjects and can give protection up to 95% even in old age “. “There is still a lack of vaccination culture for adults, who are thus exposed to preventable and predictable diseases – continued Mastroianni -. Furthermore, specialists are often not aware of having important and effective prevention weapons in addition to the therapy of the pathology of their competence. But vaccination courses are also needed that coincide with the time of treatment, including RSAs to reach the most fragile “. And precisely about herpes zoster, the data of a new large-scale observational study conducted by GSK in the United States (almost 2 million patients involved) and published in the Open Forum Infectious Diseases journal published by the Infectious Diseases Society of America, show how Covid -19 could create, in the first six months following diagnosis, a vulnerability to the so-called “Shingles” in people over the age of 50. In this retrospective cohort study, in fact, those over 50 who contracted Sars Cov-2 infection are 15% more likely to develop shingles than those who had not contracted Covid. Furthermore, in those who have had a hospitalization for Covid, this percentage rises to 21% more likely. The awareness therefore concerns a vision of the network, because the presence of principals in the area that intercept needs, as happened for example during the pandemic with pharmacies, must now also involve nursing homes. “They are professionalism to be put together to give answers to the elderly and give a better future to those who age – said Luca Pallavicini, national president of Confcommercio Health, Health and Care -. They are places where it is possible to give space to relationships, to favor social relationships with families and to give quality of a peaceful life. For future planning, we need to provide information and cohesion between public and socio-health and accredited private services “. “RSAs are not seen as a closed place to be avoided – highlighted Matteo Marastoni, head of clinical governance of the La Villa Group – and the Covid emergency has closed its doors even more for security reasons. The future of RSA will instead be different than two years ago. Prevention and treatment will make their function even more effective. For example, vaccination against shingles is practicable in our facilities and it is very useful for the elderly to be able to get a vaccine in the place where they are assisted, also for better monitoring in the following days. Faced with a difference in presence and guidelines in the various regions, it is essential that the RSA are an active part of the health institutions so that they become a place of prevention and treatment ”, he concluded.
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