Atypical Presentation of Covid in the Elderly
Original Editor - User Name
Top Contributors - Ewa Jaraczewska, Lucinda hampton, Tarina van der Stockt, Wanda van Niekerk, Kim Jackson, Jess Bell, Oyemi Sillo, Olajumoke Ogunleye and Aminat Abolade
Introduction[edit | edit source]
COVID[edit | edit source]
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the aetiology of a new type of viral pneumonia, the COronaVIrus Disease 19 (COVID-19)[1]. It affects people of all ages everywhere in the world, but the majority of deaths from this disease occur in the elderly. The study shows that in the group of individuals 65 years and older the most susceptible are those suffering two or more comorbidities. Furthermore elderly with a history of cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, malignancy and chronic kidney disease are the most at risk of dying from COVID[2].Additional factors include disabilities, cognitive and mood disorders, polypharmacotherapy, social isolation, and nutritional deficits often present in the residents of long-term care facilities[3].
Infection and Elderly[edit | edit source]
The immune system is responsible for overcoming infections due to the production of IgG anti-virus antibodies. The effectiveness of the immune system can be influenced by number of factors but one of the problems leading to its poor responsiveness may be nutritional deficits present in the elderly. It can lead to severe inflammatory disease affecting the heart, lungs, kidneys and vascular system[1].
Nutritional Deficits in Elderly[edit | edit source]
According to the study completed in the European hospitals, residential care and community settings[3] nutritional deficits in elderly can be caused by reduced dietary intake in addition to age-related problems such as malabsorption, increased nutrient losses and augmented metabolic demands[1]. Malnutrition caused by low intake of food high with vitamins, minerals and proteins directly effect body's immune responses:
- Low intake of food high with vitamins, especially:
- Vitamin A: plays a key role in the development and functioning of the immune system, increases the efficacy of T-cell-based viral vaccines[4]
- Vitamin B: affects cell and immune system function and energy metabolism. Its deficiency leads to inflammation[5]
- Vitamin C: promotes antimicrobial activity and production of the antibody. Tends to be depleted during infections resulting in coagulopathy[6]
- Vitamin D: reduces the risk of infections, plays important role in immune responses[7].
- Vitamin E: stimulates T-cell function[8]
- Low intake of food high with minerals, especially:
- Low protein intake: leads to wasting syndrome[3]
The risk of malnutrition can be assessed using Mini Nutritional Assessment[10] which helps to identify if the individual is well nourished, is at risk for malnutrition or is malnourished.
Sarcopenia[edit | edit source]
Sarcopenia is a disease that originates at the cellular level, is caused by faulty metabolism and is characterised by decrease muscle strength and muscle mass. The progressive cellular processes lead to negative outcomes in individual's strength, mobility, and functional capacity[11][12].
Definition for this clinical presentation was revised in 2018 by the the European Working Group on Sarcopenia in Older People (EWGSOP2) and is now used internationally for the diagnostic purpose[13].
Frailty[edit | edit source]
COVID and Elderly[edit | edit source]
Typical Presentation of COVID[edit | edit source]
Atypical Presentation of COVID in the Elderly[edit | edit source]
Hypoactive Delirium[edit | edit source]
Falls[edit | edit source]
Anorexia[edit | edit source]
Fatique[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Bencivenga L, Rengo G, Varricchi G. Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition. GeroScience 2020, 42; 1089–1092.
- ↑ Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2020 Mar 24;8(1):e35. PMID: 32232218; PMCID: PMC7096724.
- ↑ 3.0 3.1 3.2 Leij-Halfwerk S, Verwijs MH, van Houdt S, Borkent JW, Guaitoli PR, Pelgrim T, Heymans MW, Power L, Visser M, Corish CA, de van der Schueren MAE; MaNuEL Consortium. Prevalence of protein-energy malnutrition risk in European older adults in the community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas. 2019 Aug;126:80-89.
- ↑ Huang Z, Liu Y, Qi G, Brand D, Zheng S. Role of vitamin A in the immune system. J Clin Med. 2018;7:258
- ↑ 5.0 5.1 Shakoor H, Feehan J, Al Dhaheri AS, Ali HI, Platat C, Ismail LC, Apostolopoulos V, Stojanovska L. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19? Maturitas. 2021 Jan;143:1-9.
- ↑ Carr AC. A new clinical trial to test high-dose vitamin C in patients with COVID-19. Crit Care. 2020;24:133.
- ↑ Jakovac H. COVID-19 and vitamin D-Is there a link and an opportunity for intervention? Am J Physiol Endocrinol Metab. 2020;318:E589.
- ↑ Lee GY, Han SN. The role of vitamin E in immunity. Nutrients. 2018;10.
- ↑ Cherayil BJ. Iron and immunity: immunological consequences of iron deficiency and overload. Arch Immunol Ther Exp (Warsz). 2010 Dec;58(6):407-15.
- ↑ Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999 Feb;15(2):116-22.
- ↑ Tarantino U, Piccirilli E, Fantini M, Baldi J, Gasbarra E, Bei R J Bone Joint Surg Am. 2015 Mar 4; 97(5):429-37.
- ↑ Moreira VG, Perez M, Lourenço RA. Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies. Clinics (Sao Paulo). 2019 Apr 8;74:e477.
- ↑ Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. Erratum in: Age Ageing. 2019 Jul 1;48(4):601.
