COVID-19 in Older Patients: Considerations for Care

Nurse is comforting an older COVID-19 patient at the ICU

The crowded hospitals. The quiet shopping centers. Masked faces everywhere. While it’s no longer news, the coronavirus continues to upend life as we know it. Thankfully, our understanding of COVID-19 has grown in the last year, as has the range of effective treatment options. However, COVID-19 still poses a risk, especially to vulnerable populations. In this article, we discuss COVID-19 in older patients and provide considerations for care.

COVID by the numbers

Among older adults, COVID-19 has delivered a devastating one-two punch. Not only are older adults more likely to contract COVID-19, but they’re also more likely to develop severe—possibly life-threatening—complications.

According to data from the Centers for Disease Control, nearly 8 out of 10 COVID-19-related deaths in the U.S. were in adults over 65 years old. Of those with confirmed COVID cases, 31% to 59% of adults ages 65 to 84 required hospitalization, compared to 31% to 70% of adults 85 and older.

Who is at risk?

Not everyone who gets COVID-19 will require hospitalization or develop a severe illness. However, the general weakening of the pulmonary and immune systems inherent in aging puts those in the 65-plus demographic at a much higher risk than other populations.

Additionally, because COVID-19 spreads most easily between people in close proximity, residents of nursing homes or assisted living facilities are more likely to be at risk for mass infection.

Underlying conditions also increase the possibility of severe illness, regardless of age. Some common conditions include:

  • Chronic lung disease
  • Moderate to severe asthma
  • A compromised immune system (whether due to HIV/AIDS, cancer treatment, smoking, prolonged use of corticosteroids, organ transplant, etc.)
  • Severe obesity (BMI of 40 or higher)
  • Chronic kidney disease with dialysis
  • Diabetes
  • Liver disease

To learn more about COVID-19 in older patients, enroll in the 1-hour HomeCEU course, COVID-19 in the Geriatric Patient.

Symptoms and management

At the outset, COVID-19 may present with symptoms that look like pneumonia, including shortness of breath or inability to breathe. Unlike pneumonia, however (which is caused by inflammation in the tissues of the lungs), COVID-19 behaves more like ARDS—acute respiratory distress syndrome—because it gets into the bloodstream.

Other common symptoms of COVID-19 include a dry cough, fever, fatigue, and a sudden loss of taste or smell.

Acute management of a patient’s symptoms will not only depend on what they’re experiencing, but also what (if any) underlying conditions they may have. Antibiotics, ventilation, prone positioning, and even extracorporeal membrane oxygenation (ECMO) are all methods for treating the symptoms of a severe COVID-19 case.

Post-acute considerations

COVID-19 keeps no timetable. While pneumonia or the flu may run its course in seven to 10 days, COVID-19 patients may present post-acute symptoms similar to those of people with chronic conditions. Functional activity performance may be impaired, and they may demonstrate a decrease in physiological reserve.

Hospitalizations for COVID-19 may also result in a patient developing isolation psychosis, delirium, fatigue, muscle wasting, low endurance, and depression.

Additionally, patients may develop Post-Intensive Care Syndrome, or PICS, where health problems linger long after a critical illness. The stress and uncertainty of COVID-19—coupled with isolation and the physical toll the virus takes on the body—have a profound effect not only on the patient’s physical health, but also on their mental, emotional, social, and psychological wellbeing.

For this reason among many, it’s critical for healthcare professionals to consider an interdisciplinary approach to post-acute care for COVID-19 survivors, particularly in older patients. Physical therapists, occupational therapists, respiratory therapists, nurses, doctors, speech therapists, and psychologists all play a part in helping restore a patient to mobility.

The cost of isolation

The isolation required for COVID-19 patients is a double-edged sword. On the one hand, separating a sick person from family and friends may reduce the spread and stop others from getting sick. On the other hand, in older adults, social isolation and cognitive inactivity are risk factors for developing depression and dementia.

As a healthcare professional, it’s critical to take the social aspect of recovery into account when treating an older COVID-19 patient. Sharing photos, sending cards, or setting up a video chat with family members might not be traditional treatment options, but providing a connection to loved ones may nevertheless help the patient toward a quicker recovery.

This article is based on the 1-hour course, “COVID-19 in the Geriatric Patient,” written by Suzanne Greenwalt, PT, DPT, CCS, GCS and presented in partnership with Elite’s sister school, HomeCEU.

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