‘It's just a virus’ – viral illness in older people: prevention and management

Abstract

SummaryMany viral infections that cause minor illness in younger adults can lead to significant mortality and morbidity in older people, particularly as co-morbidities tend to accumulate with increased age. Respiratory and gastrointestinal viruses are ubiquitous and frequently cause outbreaks, with major impact on those in care homes or residential accommodation. Advances in medicine have opened the way for increased impact of the herpes viruses (varicella zoster virus, herpes simplex virus, Epstein–Barr virus and cytomegalovirus), as immune systems are manipulated. People are also leading more active lives in older age; human immunodeficiency virus (HIV) will be increasingly prevalent, as those living with HIV grow older in good health. In addition, new diagnoses of HIV, viral hepatitis and travel-related infections will present to those working in health care of older people. This review article of viral infections aims to highlight relevant pathology, with specific reference to management in older people.

A decade of norovirus disease risk among older adults in upper-middle and high income countries: a systematic review

“…Recent reports indicate that, since the introduction of vaccination against rotavirus disease, which has decreased the burden of this childhood illness, NoV has become the leading cause of pediatric AGE and hospitalizations in diverse settings such as the US, Finland and Nicaragua [ 41 – 48 ]. There is also evidence to suggest that older adults may be at increased risk of severe NoV illness [ 49 – 51 ]. This may be due to intrinsic factors such as age-related alterations in B and T cell function as a result of immunosenescence or the presence of comorbidities (such as immunosuppression, renal disease, cardiovascular disease and/or functional disability) that can reduce an individual’s ability to mount a successful immune response to infection and result in more severe/extended symptoms or exacerbation of underlying conditions [ 49 , 52 , 53 ].…”

“…There is also evidence to suggest that older adults may be at increased risk of severe NoV illness [ 49 – 51 ]. This may be due to intrinsic factors such as age-related alterations in B and T cell function as a result of immunosenescence or the presence of comorbidities (such as immunosuppression, renal disease, cardiovascular disease and/or functional disability) that can reduce an individual’s ability to mount a successful immune response to infection and result in more severe/extended symptoms or exacerbation of underlying conditions [ 49 , 52 , 53 ]. Extrinsic factors such as institutionalized housing may further influence exposure potential or be a proxy for poor underlying health status [ 33 , 54 – 57 ].…”

Norovirus: An Overview of Virology and Preventative Measures

“…The two age groups facing the largest risk are younger children below the age of 5 and elderly above the age of 85, with the former being at a higher risk [68][69][70]. It is thought that these two groups are at higher risk due to their immunosenescence and acute dehydration of the elderly and young, respectively [2,71,72]. One of the other areas where knowledge regarding NoV is lacking concerns the hosts' acute immune response.…”

Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management

“…While noroviruses can cause both sporadic infections and outbreaks in all age groups, older people are at higher risks of hospitalization and death [3], owing to intrinsic factors, such as age-related immunosenescence or the presence of comorbid conditions, which result in more extended symptoms [7]. Additionally, elderly residents of LTCFs are at elevated risks of infection as a result of institutionalized confinement that promotes transmission by sharing rooms and touching common surfaces [8].…”