COVID 19 - Clinical Picture in the Elderly Population: A Qualitative Systematic Review

Abstract

The SARS-CoV-2 tendency to affect the older individuals more severely, raises the need for a concise summary isolating this age population. Analysis of clinical features in light of most recently published data allows for improved understanding, and better clinical judgement. A thorough search was performed to collect all articles published from 1st of January to 1st of June 2020, using the keywords COVID-19 and SARS-CoV-2 followed by the generic terms elderly, older adults or older individuals. The quality assessment of studies and findings was performed by an adaptation of the STROBE statement and CERQual approach. Excluding duplicates, a total of 1598 articles were screened, of which 20 studies were included in the final analysis, pertaining to 4965 older COVID-19 patients (≥60 years old). Variety in symptoms was observed, with fever, cough, dyspnea, fatigue, or sputum production being the most common. Prominent changes in laboratory findings consistently indicated lymphopenia and inflammation and in some cases organ damage. Radiological examination reveals ground glass opacities with occasional consolidations, bilaterally, with a possible peripheral tendency. An evident fraction of the elderly population (25.7%) developed renal injury or impairment as a complication. Roughly 71.4% of the older adults require supplementary oxygen, while invasive mechanical ventilation was required in almost a third of the reported hospitalized older individuals. In this review, death occurred in 20.0% of total patients with a recorded outcome (907/4531). Variability in confidence of findings is documented. Variety in symptom presentation is to be expected, and abnormalities in laboratory findings are present. Risk for mortality is evident, and attention to the need for supplementary oxygen and possible mechanical ventilation is advised. Further data is required isolating this age population. Presented literature may allow for the construction of better predictive models of COVID-19 in older populations.

Clinical Characteristics and Survival Analysis in a Small Sample of Older COVID-19 Patients with Defined 60-Day Outcome

“…Guzik et al further described heart-related conditions as detrimental risk factors for patients infected with the novel coronavirus [ 25 ]. In accordance with existing literature [ 26 , 27 , 28 ], it should be noted that comorbid hypertension was not a point of contention when distinguishing between survivors and non-survivors in our study, as it was found to be of insignificance when comparing the two groups ( p = 1).…”

Clinical characteristics on admission predict in-hospital fatal outcome in patients aged ≥75 years with novel coronavirus disease (COVID-19): a retrospective cohort study

“…As of September 2020, the overall mortality of COVID-19 was 3.2% globally and 5.2% in China [ 8 ]. However, mortality in the elderly (≥60 years) was consistently reported as high as 20% [ 9 , 10 ] from different centers worldwide, suggesting that advanced age is associated with increased mortality and case fatality rate. Kremer S et al [ 6 ] showed that old COVID-19 patients had more neurological symptoms.…”

Public Database-Driven Insights Into Aging Stress-Associated Defective Gut Barrier With Low SARS-CoV-2 Receptors

“…Such severe complications are prominent in subjects with underlying health conditions including cardiovascular diseases, diabetes, or obesity, requiring hospitalization and intensive care (4)(5)(6)(7). Moreover, based on the population-based studies, the elderly group (particularly aged 70 years or older) among the patients with COVID-19 presented high case-fatality rate with severe complications in Italy and China (3,8,9). A quantitative systemic review demonstrated that ∼25 and 71% of the elderly subjects developed renal injuries and required supplementary oxygen, respectively (8).…”

“…Moreover, based on the population-based studies, the elderly group (particularly aged 70 years or older) among the patients with COVID-19 presented high case-fatality rate with severe complications in Italy and China ( 3 , 8 , 9 ). A quantitative systemic review demonstrated that ~25 and 71% of the elderly subjects developed renal injuries and required supplementary oxygen, respectively ( 8 ). Although the complications of COVID-19 with aging are evident, its mechanistic assessments are required for developing precise interventions for the susceptible population.…”