Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations

Abstract

Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19.

Anti-coronavirus vaccines will not accelerate the transition of humanity to a non-pandemic period, but the pandemic will take fewer victims

“…Reports suggest that although COVID-19 is usually milder in vaccinated (i.e., when contracted after vaccination) than in unvaccinated individuals, mortality remains high among those who are hospitalized. Data from the International Severe Acute Respiratory and Emerging Infection Consortium show a mortality of 27% (400 of 1482 died) [ 103 , 104 ]. For example, after providing BNT162b2 mRNA vaccines for approximately 35,000 nursing home residents (mean age: > 87 years), the Norwegian government received 100 reports of suspected fatal adverse events.…”

“…Obese people, the elderly (especially those who are frail), and those living in poorer/deprived areas were found to be more likely to become infected with COVID-19 after receiving a single dose of vaccine than those in beter circumstances. It remains unknown whether vaccination reduces the risk of post-acute sequelae of SARS-Cov-2 (PASC; also known a long COVID) [ 103 ]. Nevertheless, there is a good objective reason why it is necessary to vaccinate the elderly first—the weakness of the immune response.…”

Profil Klinis Pasien COVID-19 Lansia yang Dirawat Inap di RS Immanuel Bandung

“…Temuan ini sesuai dengan hasil penelitian Pizano-Escalante, dkk. 7 yang menunjukkan bahwa lansia frail dengan COVID-19 cenderung mempunyai risiko mortalitas lebih tinggi dan lama rawat inap yang lebih panjang.…”

Statistical Inferences and Analysis based on the COVID-19 Data from the United States

“…In particular, people with underlying medical conditions such as cancer, cardiovascular ailments, chronic respiratory disease, or diabetes are at increased risk of developing a severe illness [12,13,14,15]. Similarly, the older populace tends to be more vulnerable in illness progression, leading to fatal situations [9,10].…”