This review of the literature explores the impact of COVID-19 on the elderly, reasons for susceptibility, clinical features of the disease, and treatment challenges.
Pathophysiological Changes in Older Adults
Aging has been strongly associated with worse COVID-19 outcomes via mechanisms such as increased numbers of comorbidities and the pathophysiological changes of the respiratory tract occurring with increased age. These changes include reduced ability to clear particles from airways, decreased ciliation of the airways, greater upper airway collapsibility, a decrease in nasal resistance and decreased ACE2 expression. Additionally, the impaired expression of Toll-like receptors and decreased levels of lymphocytes seen in older patients increase susceptibility to viral infection. Upregulation of TLR-4 in this population favors inflammation and may explain the contribution of hypertension in SARS-CoV-2 expression. Analysis of sex-specific differences in mortality suggest that aging males may be at increased risk due to higher rates of upper airway collapsibility, a greater decrease in ACE2 expression, and a larger inverted CD4/CD8 T-cell ratio.
Presentations Influencing Clinical Decision-Making
- Atypical clinical presentations in older patients included delirium, low-grade fever, and abdominal pain.
- Laboratory findings showed decreased lymphocytes and increased C-reactive protein, prothrombin time, serum urea, creatinine, D-Dimer, and myocardial markers.
- CT displayed bilateral multilobar ground glass opacities.
- Pharmacological interventions have suggested future trials involving Remdesivir, corticosteroids, interferon nebulized inhalation, Tocilizumab, and ACE-Is/ARBs may be promising.
In the case of aging residents living in skilled long-term care facilities, clinical decision-making also includes maintaining infection protocols, staffing ratios, and palliative support therapy.
Perrotta F, Corbi G, Mazzeo G, et al. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res. Published online June 16, 2020. doi:10.1007/s40520-020-01631-y
This review was posted on behalf of Lauren Albert, IU School of Medicine student, and reviewed by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist.