COVID-19 in Older People: A Rapid Clinical Review

Fiona E. Lithander; Sandra Neumann; Emma Tenison; Katherine Lloyd; Tomas J. Welsh; Jonathan C. L. Rodrigues; Julian P. T. Higgins; Lily Scourfield; Hannah Christensen; Victoria J. Haunton; Emily J. Henderson

Disclosures

Age Ageing. 2020;49(4):501-515. 

In This Article

Abstract and Introduction

Abstract

Introduction: the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials.

Methods: we searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively.

Results: screening of over 1,100 peer-reviewed and pre-print papers yielded n = 22 on COVID-19 testing, n = 15 on treatment and n = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period.

Conclusion: given the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research.

Introduction

In January 2020, a cluster of pneumonia cases in Wuhan city, Hubei province, China, was identified as having been caused by the SARS-CoV-2 virus, leading to the disease now termed COVID-19. The subsequent global transmission led to the outbreak being classified as a pandemic by the World Health Organisation (WHO) on 11 March 2020. In the United Kingdom, public health measures to control the spread of disease have, to date, included directives to self-isolate, socially distance and so-called lockdown whereby activity and movement within a community are contained or limited.

Older adults, and those with comorbidities, are at particular risk of having severe infection[1] and are at higher risk of dying as a result of the disease.[2–4] In one of the largest case series so far published, of 72,314 cases reported by the Chinese Centre for Disease Control and Prevention, case fatality was 8.0% (312 of 3,918) in patients aged 70–79 years and 14.8% in patients aged ≥80 years (208 of 1,408).[8] Older adults appear to be more susceptible to the virus; 75% of known infections are in persons aged 50 and over.

In the United Kingdom and Europe, we are seeing an increasing number of cumulative cases and a rising trend in the daily number of confirmed COVID-19 cases. As such, we have recognised an urgent need to provide clinicians, who may be less familiar with geriatric medicine, with a comprehensive overview of COVID-19 infection in older people. The overarching aim of this article is to provide a rapid semi-systematic review of both peer-reviewed and pre-print evidence relating to COVID-19 testing, drug treatment and prognosis, as of late March 2020. We have presented these findings within a broader context discussing clinical presentation, supportive care strategies and social distancing in older people. Our findings, coupled with evaluation of the landscape of current and future clinical trials, have highlighted areas of priority for future research directed toward COVID-19 infection in older people.

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