COVID-19 and the Elderly with Chronic diseases: Narrative Review

Document Type : Review

Authors

1 Babol MSU

2 Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

Abstract

One of the most at-risk groups for COVID-19 is elderly with chronic diseases. However, many elderly patients with COVID-19 may seem "silent" after being infected with the virus, or have non-specific symptoms such as decreased activity, drowsiness, reluctance to eat, indifference, confusion, delirium, loss of awareness of the environment, speech disorders, urinary incontinence, falling following a loss of balance and fainting. Fever is a hidden symptom in the elderly. If the elderly body temperature is 100 degrees Fahrenheit, it is necessary to undergo further diagnostic tests for COVID-19. On the other hand, other patients with heart failure, vascular diseases, and COPD experience normal symptoms of COVID-19 (cough, shortness of breath, etc.). That's why it's much harder to diagnose COVID- 19 in the elderly with chronic disease than others. In order to diagnose the disease in a golden time, it is necessary to carry out diagnostic tests in order to confirm COVID-19. Therefore, it can be concluded; elderly people with COVID-19, and with a history of chronic diseases have a more severe form of respiratory distress syndrome than other people with COVID-19, which can lead to death. Regardless of the severity of the disease, supportive care for these patients is essential.

Keywords


1. Zheng J. SARS-CoV-2: An emerging coronavirus that causes a global threat. Int J Biol Sci. 2020; 16(10):1678-85. doi:10.7150/ijbs.45053 2. The Lancet Infectious Diseases. COVID-19, a pandemic or not? Lancet Infect Dis. 2020; 20(4):383. doi:10.1016/S1473-3099(20)30180-8 3. Khafaie MA, Rahim F. Cross-country comparison of case fatality rates of COVID-19/SARS-COV-2. Osong Public Health Res Perspect. 2020; 11(2):74-80.doi:10.24171/j.phrp.2020.11.2.03 4. Ebrahimi M, Saki A, Rahim F. Laboratory findings, signs and symptoms, clinical outcomes of Patients with COVID-19 Infection: An updated systematic review and meta-analysis. MedRvix. 2020. doi:10.1101/2020.03.25.20043703 5. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19).Stat Pearls. Treasure Island (FL): Stat Pearls Publishing LLC; 2020. 6. Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol. 2020; 92(4):418-23. doi:10.1002/jmv.25681 7. Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020; 9(1):221-36. doi:10.1080/22221751.2020.1719902 8. Cao Y, Li L, Feng Z, Wan S, Huang P, Sun X, et al. Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations. Cell Discovery. 2020; 6(1):11. doi:10.1038/s41421-020-0147-1 9. Zhang H, Penninger JM, Li YT, Zhong N, Slutsky AS. Angiotensin converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: Molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020; 46(4):586-90. doi:10.1007/s00134-020-05985-9 10. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int JOralSci.2020; 12(1):8. doi:10.1038/s41368-020-0074-x 11. Farnoosh G, Ghanei M, Khorramdelazad H, Alishiri G, Shahriary A, Hosseini Zijoud SR. Are Iranian Sulfur mustard-exposed survivors more vulnerable to SARS-CoV-2: some similarity in their pathogenesis. Disaster medicine and public health preparedness. 2020:1-12.doi:10.1017/dmp.2020.156 12. Nikpouraghdam M, Farahani AJ, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. Journal of Clinical Virology. 2020. doi:10.1016/j.jcv.2020.104378 13. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(13):382-6. doi:10.15585/mmwr.mm6913e2 14. He XW, Lai JS, Cheng J, Wang MW, Liu YJ, Xiao ZC, et al. Impact of complicated myocardial injury on the clinical outcome of severe or critically ill COVID-19 patients. Zhonghua Xin Xue Guan Bing Za Zhi. 2020; 48. 15. Rogers LC, Lavery LA, Joseph WS, Armstrong DG. All feet on deck-the role of podiatry during the COVID-19 pandemic: Preventing hospitalizations in burdened health care system, reducing amputation and death in people with diabetes. J Am Podiatr Med Assoc. 2020. doi:10.7547/20-051 16. Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020; 48. 17. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab ResRev. 2020. e3319. doi:10.1002/dmrr.3319 18. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020: 1-8. doi:10.1007/s00392-020-01626-9 19. Muniyappa R, Gubbi S. COVID-19 pandemic, corona viruses, and diabetes mellitus. Am J Physiol Endocrinol Metab. 2020; 318(5):E736-41 doi:10.1152/ajpendo.00124.2020 20. Noroozian M. The elderly population in Iran: an ever-growing concern in the health system. Iran J Psychiatry Behav Sci, 2012; 6(2):1-6. 21. Benksim A, Addi RA, Cherkaoui M. Vulnerability and Fragility Expose Older Adults to the Potential Dangers of COVID-19 Pandemic. Iran J Public Health. 2020; 49(1): 122-24 doi:10.18502/ijph.v49iS1.3682 22. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model based analysis. Lancet Infect Dis. 2020; 3099, 1-9. 23. Santesmasses D, Castro JP, Zenin AA, Shindyapina AV, Gerashchenko MV. COVID-19 is an emergent disease of aging. MedRxiv. 2020. doi:10.1101/2020.04.15.20060095 24. Kline KA, Bowdish DME. Infection in an aging population. Current Opinion in Microbiology. 2016; 29: 63-67. doi:10.1016/j.mib.2015.11.003 25. Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020; 42:505-514. doi:10.1007/s11357-020-00186-0 26. Li JY, You Z, Wang Q, Zhou ZJ, Qiu Y, Luo R, et al. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes and infection. 2020;22(2):80-5. doi:10.1016/j.micinf.2020.02.002 27. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection in China. MedRxiv. 2020. doi: 10.1101/2020.02.06.20020974 . 28. Yang Y, Lu Q, Liu M, Wang Y, Zhang A, Jalali N, et al. Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China. MedRxiv. 2020. doi:10.1101/2020.02.10.20021675 29. Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. Journal of travel medicine. 2020. doi:10.1093/jtm/taaa021 30.Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. Journal of Infection. 2020. doi:10.1016/j.jinf.2020.03.019 31. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. Journal of Infection. 2020. doi:10.1016/j.jinf.2020.03.005 32. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368.. doi:10.1136/bmj.m606 33. Novel CP. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi. 2020; 41(2):145. doi:10.46234/ccdcw2020.032 34. Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223):497-506. doi:10.1016/S0140-6736(20)30183-5 35. Guan WJ, Ni ZY, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. 36. Hase R, Kurita T, Muranaka E, Sasazawa H, Mito H, Yano Y. A case of imported COVID-19 diagnosed by PCR-positive lower respiratory specimen but with PCR-negative throat swabs. Infectious Diseases. 2020; 52(6):423-6. doi:10.1080/23744235.2020.1744711 37. Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP, et al. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: A preliminary report of the first 28 patients from the Korean Cohort study on COVID-19. J Korean Med Sci. 2020; 35(13). e142. doi:10.3346/jkms.2020.35.e142 38. Yi Y, Lagniton PNP, Ye S, Li E, Xu RH. COVID-19: What has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci. 2020;16 (10): 1753-66. doi:10.7150/ijbs.45134 39. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-9. doi:10.1001/jama.2020.1585 40. Gorse GJ, O’Connor TZ, Hall SL, Vitale JN, Nichol KL. Human coronavirus and acute respiratory illness in older adults with chronic obstructive pulmonary disease. The Journal of infectious diseases. 2009;199(6):847-57. doi:10.1086/597122 41. High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48: 149-71.doi:10.1086/595683 42. Fang L, Karakiulakis G, Roth M. 'Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020. doi:10.1016 /S2213-2600(20)30116-8. 43.Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS, et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. 2020;15 (5):e0233147. doi:10.1371/journal.pone.0233147 44. Liua K, Zhangb W, Yangc Y, Zhangc J, Lia Y, Chend Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary Therapies in Clinical Practice. 2020. 39:101166. doi:10.1016/j.ctcp.2020.101166 45.Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, Wang M. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14): 1406-7. doi:10.1001/jama.2020.2565 46.Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid19. N Engl J Med. 2020. doi:10.1056 /NEJMoa2001282 47. Jafari Shirvani N, Ghaffari F, Fotokian Z, Monadi M. Association between perceived family social Support and Self-Care Behaviors in the elderlies with Chronic Obstructive Pulmonary Disease (COPD): a medical Center-Based study. The Open Nurs Journal. 2020; 14: 1-7. 48. Sam khanian Z, Ghaffari F, Jannat Alipoor Z, Fotokian Z. Designing and validating an empowerment questionnaire for the elderly with chronic obstructive pulmonary disease. Heliyon. 2020; 6: 03909. doi:10.1016/j.heliyon.2020.e03909 49. Pourhabib A, Fotokian Z, Nasiri M, Abrotan S. Effects of a group-based aerobic and resistance exercise program on physiological-psychological adaptation in elderly with heart failure. J Clin Gerontol Geriat. 2018; 9(2):59-66. doi:10.24816/jcgg.2018.v9i2.05