This is an overview of COVID-19 in older adults, who are more likely to be infected with the virus and have worse outcomes of COVID-19.
- Pathophysiology: Angiotensin-converting enzyme-2 (ACE-2) receptor may be a mechanism for cell entry. Since a large portion of older adults have comorbidities such as hypertension and chronic kidney disease (CKD) and these diseases are often treated with ACE-2 inhibitors and angiotensin-receptor blockers which upregulate the ACE-2 receptor the older adult population may have an increased risk of infection along with more severe symptoms once the infection is present. (Note: This potential mechanism is being studied and the American Heart Association has made a statement that patients should not be taken off ACEI or ARBs until more information is known.)
- Clinical Presentation: Common symptoms in older adults include shortness of breath, fever, and cough. Older adults who survive infection are often left with organ damage due to acute respiratory disease syndrome, acute kidney injury, cardiac injury, and liver dysfunction. Chest imaging may reveal bilateral lower lung involvement, ground glass opacities, and even pleural effusions among other potential findings.
- Mortality: Many studies have shown higher rates of mortality in older adults, especially in those over 80. At the time of this article’s publication 80% of COVID-19 deaths were in individuals over the age of 65. Comorbidities also result in an increase in mortality rates. Multiple studies have found increased mortality rates in diseases often associated with older adults such as diabetes, congestive heart failure, COPD, and CKD.
- Treatment: Good hand hygiene, social distance, and personal protective equipment have helped with preventing spread of the disease. Supportive care is currently the main goal of treatment as there are currently no FDA-approved treatments. There are, however, treatment options being tested. Chloroquine, hydroxychloroquine, and remdesivir are all currently being trial both in and outside of the United States. There is also currently a phase I trial of a potential vaccine. It is recommended that all of those who eligible receive the influenza vaccine to prevent influenza and unnecessary evaluation for SARS-CoV-2.