CME INDIA Presentation by Dr. S. K. Gupta, MD (Med), FICP, CFM (France) Clinical Asst. Professor GS Medical College, CCSU, Uttar Pradesh, India. Visiting Consultant, Max Super Specialty Hospital, New Delhi.
In the post-COVID-19 era, the dynamics of “frailty” renders its transition to a worse level. We feel the devastating decline of functional ability and increasing frailty. Prolonged social isolation is known to weaken immune defences. Our geriatric population is suffering from multiple comorbidities. But there is hope for elderly in the predicted third wave.
Will elderly people have higher risk of infection in 3rd wave?
- No. Analysis of data of both earlier waves shows that elderly population (70 – 80 yrs.) had 4% infection rate, nearly as good as Children. However, higher mortality among elderly warrants their better protection.
- Higher Seroprevalence of ~77% among people with more than 45 years are another good news for elders. Higher sero prevalence may be because of priority vaccination offered to this age group.
How symptoms of Covid differ in Elderly?
Subtle symptoms of Covid in elderly
- Very Elderly and frail population may not present with classical symptoms of Covid because of impaired body response to inflammation.
- Fever may not manifest or may be ignored. So be careful about following subtle symptoms in Elderly.
- Fatigue & Weakness – Elderly must just stop taking their brief walk and may remain confined to bed.
- Loss of appetite for few days. They may just Stop Eating.
- Asymptomatic – Low SpO2 (May be first sign).
- May be Found drowsy (ARDS) esp. lonely elderly.
- Frequent falls in Bathroom.
- Presenting as drowsiness in lonely elderlies.
Social Factors leading to higher infection in Elderly
- Save the Elders from Young.
- Infection in Elders is caused by asymptomatic adults in family who move out.
- Elders have feeling of insecurity in isolation and love to remain in company.
- Elders may have issues using Mask and Hand Hygiene.
- Hearing Problems may lead to breach of physical distancing.
How to save the Elders further?
- Reach out to them.
- Speak out: Encourage them to speak out.
- Control comorbidities like diabetes and hypertension.
- Watch for early symptoms.
- Monitors SpO2 even in asymptomatic.
Why Elderly people are more prone to (Severe) Covid?
- Age-dependent decrease in nasal resistance.
- A gradual decrease in the number of cilia and ciliated cells in the airway with aging.
- Linear increase in nasal cavity volume with increasing age due to atrophy of bones.
- Immuno-senescence: disruption of both innate and adaptive arms of the immune system on one hand.
- Inflammaging – Higher inflammation: continual production of inflammatory mediators and cytokines, leading Cytokine Storm.
- Associated Comorbidities.
Vaccination brings Hope
Reference:
Briguglio Matteo, Giorgino Riccardo, Dell’Osso Bernardo, Cesari Matteo, Porta Mauro, Lattanzio Fabrizia, Banfi Giuseppe, Peretti Giuseppe M. Consequences for the Elderly After COVID-19 Isolation: FEaR (Frail Elderly amid Restrictions) Frontiers in Psychology VOLUME=11, 2020. URL= https://www.frontiersin.org/article/10.3389/fpsyg.2020.565052 DOI=10.3389/fpsyg.2020.565052.
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