Frailty Pathogenesis, Assessment, and Management in Older Adults With COVID-19

Abstract

The 2019 coronavirus disease (COVID-19) is a highly contagious and deadly disease. The elderly people are often accompanied by chronic inflammation and immunodeficiency, showing a frail state. The strength, endurance, and physiological function of the elderly are significantly decreased, and the ability to deal with stress response is weakened. They are the high-risk group that suffering from COVID-19, and rapidly developing to critical illness. Several recent studies suggest that the incidence rate of COVID-19 in elderly patients with frailty is high. Early assessment, detection, and effective intervention of frailty in COVID-19 patients are conducive to significantly improve the quality of life and improve prognosis. However, there are insufficient understanding and standards for the current evaluation methods, pathogenesis and intervention measures for COVID-19 combined with frailty. This study reviews the progress of the research on the potential pathogenesis, evaluation methods and intervention measures of the elderly COVID-19 patients with frailty, which provides a reference for scientific and reasonable comprehensive diagnosis and treatment in clinical.

Patterns of Comorbidity and In-Hospital Mortality in Older Patients With COVID-19 Infection

“…COVID-19 has emerged as a potent inducer of systemic, uncontrolled inflammation, which can worsen pre-existing conditions (e.g., heart failure, kidney failure, COPD, dementia) and, ultimately, frail patients often succumb to this severe infection owing to multisystem damage and failure to thrive (12)(13)(14).…”

“…In addition, both dementia and stroke are known risk factors for advanced clinical frailty in very old individuals, reflecting the massive burden of diseases related to severe COVID-19 complications and mortality (15). Similarly, the presence of cardiovascular diseases may be responsible for an impaired hemodynamic response to COVID-19 infection with the development of acute organ decompensation, poorer cardiovascular fitness, and higher rate of hospitalization and unfavorable clinical outcomes, including mortality (10)(11)(12)(13)(14)(15)(16).…”

“…At present, there is no clinical understanding of the pathogenesis of very poor COVID-19-related outcomes and frailty in older adults, nor are there recognized interventions or measurements for this a highly vulnerable population (13).…”

“…A thorough clinical understanding to provide the appropriate assessment and early identification of older adults with frailty who are prone to worsened COVID complications with unfavorable clinical outcomes is still needed (13,21). At present, there is an insufficient clinical understanding of the exact pathogenesis of frailty in older adults with COVID-19 (13).…”

Convalescent Covid-19 plasma: Back-to-basics and ethics, and next steps

“…Efficient vaccines have been made available against the first viral strains within an amazingly short period of time [1] . Despite this tremendous achievement, too few people can get full vaccination schedule to successfully stop the virus progression, and many places in the world are currently struggling to fight both the virus transmission and the disease especially in the most vulnerable populations [2] . Vaccination is recognized as the sole protective measure that can be set in place readily to limit the pandemics and to eventually allow coming back to normal life.…”