The Covid-19 pandemic presents a doubly complicated situation for older people: Not only are they at higher risk of contracting the disease, and more likely to develop severe infections and die from it, but they are also the most likely to struggle with—and suffer from— the consequences of prevention strategies like social distancing. For people with dementia, Alzheimer’s disease, or severely reduced mobility, social-distancing guidelines can be impractical and nearly impossible to follow, making prevention and treatment even more complicated.
Seniors, especially those above age 80, have been hard hit by the virus. That’s in part because they often have comorbidities like diabetes and hypertension, which make them more likely to be hospitalized. Doctors aren’t sure why those conditions make the effects of the virus worse, but both conditions are associated with greater expression of the ACE2 receptor, a protein on human cells that the coronavirus latches onto to start replicating.
Many older adults also have chronic, low-grade inflammation, a state called “inflammaging,” in which the body is unable to control the release of cytokines, small proteins that are supposed to help modulate the body’s immune response. This dysregulation could put seniors at great risk of “cytokine storms,” a condition reported in severe Covid-19 cases during which a patient’s immune system spins out of control and starts damaging healthy organs.
Seniors are also more vulnerable because of immunosenescence, a slow deterioration of the immune system that is a normal part of aging. When people are young, the immune system has a big reservoir of T-cells and B-cells ready to fight infections. These are called “naive cells,” meaning they haven’t encountered any bacteria, viruses, or other pathogens yet. When those naive cells encounter an infection, some of them learn to recognize that pathogen and become ready to fight it off if the body gets exposed to it again.
Immunosenescence also means that diseases present differently in seniors, which may make it difficult for their doctors or caretakers to recognize a Covid-19 infection. While many Covid-19 cases include fever, for example, in seniors the symptoms might also include confusion, delirium, sleepiness, or loss of appetite. That may be because the virus has reached important organs like the brain, kidneys, or digestive system.
Not only are seniors more biologically susceptible, but many of them live in situations that make catching the virus more likely because they interact daily with other people, many of whom are themselves more likely to catch the virus. Some seniors live in their own homes and get assistance from health aides who may take public transit, serve multiple clients, and—like many other essential workers—are unable to shelter in place while doing their job.
The situation is analogous to what has happened in some long-term care facilities, where the coronavirus has spread like wildfire between staff and residents. Even though seniors are more likely to develop a severe infection, many are instead asymptomatic carriers, making it hard to catch the virus without testing an entire facility.
Whether they live in a long-term care facility, nursing home, or in a family home, many seniors have unique needs that make it impossible for them to socially distance. Some need help eating, washing, going to the bathroom, or moving around.
Yet for older adults living in their homes, social distancing can cause isolation and loneliness. Most of the places people would go to socialize—senior centers, libraries, churches, temples, or synagogues—are closed. Families are discouraged from visiting.
While older adults are the most likely to catch Covid-19, they also may be less likely to benefit from a vaccine. Because seniors don’t raise the same immune response that younger adults and children do, they generally don’t respond as well to vaccines. They also aren’t always included in clinical trials. If you look at the last many decades of research, the vast majority of randomized control trials do not include older adults. And if they do, they don’t include frail older adults, who are at risk for this.
For people with dementia or other kinds of cognitive decline, things get even more complicated. people with dementia may not remember they need to wash their hands more often or refrain from touching their face. And dementia patients often wander. In communal living or care facilities, they might walk in and out of other patients’ rooms, down the hall, or into common living areas, all of which increase the likelihood of catching and transmitting the disease. Diagnosing Covid-19 in those patients could be even harder, too.
Patients with dementia also have unique challenges if they end up in the hospital. Covid-19 symptoms can worsen their confusion and delirium, as can being in an unfamiliar setting like a hospital room. These patients may be terrified when they’re separated from their family or their usual caregivers and are being tended to by staff covered head-to-toe in protective gowns and masks. With nurses trying to limit patient interactions to reduce the need for this protective gear, patients are often isolated for much of the day.
While mortality rates are higher for older adults with Covid-19, many do survive. What recovery looks like for them is more complicated.
None of these issues—loneliness, immunosenescence, difficulty recovering from hospital stays—are new problems, and none are unique to the virus. But the novel coronavirus exacerbates the many challenges older patients already face.
Covid-19 intensifies and complicates everything
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