COVID19 and Vulnerable Populations Part 1 The effects

  • Slides: 13
Download presentation
COVID-19 and Vulnerable Populations, Part 1: The effects on older adults Mindy J. Fain,

COVID-19 and Vulnerable Populations, Part 1: The effects on older adults Mindy J. Fain, MD Gregory K. Mayer, MD, MBA June 4, 2020

COVID-19 and Older Adults: An Overview ASU College of Health Solutions June 4, 2020

COVID-19 and Older Adults: An Overview ASU College of Health Solutions June 4, 2020 Mindy J. Fain, MD Co-Director, UArizona Center on Aging

Older Adults are at High Risk for COVID-19 • People 65+ suffer 80% of

Older Adults are at High Risk for COVID-19 • People 65+ suffer 80% of deaths • People 85+ suffer most severe outcomes • Over 35% of deaths occur in nursing home patients & staff • Minority groups affected disproportionately

Vulnerable Older Adult: Aging Immune System • Age impacts the innate and adaptive immune

Vulnerable Older Adult: Aging Immune System • Age impacts the innate and adaptive immune systems • Poor outcomes if “stuck” in innate • Progression to adaptive and antibody production associated with better outcomes • Implications for vaccine strategies

More About Older Adults & Vulnerability • • Aging physiology Chronic conditions Cognitive impairments

More About Older Adults & Vulnerability • • Aging physiology Chronic conditions Cognitive impairments Functional decline Frailty Congregate living Unique social determinants of health

How the Unique Transmission of COVID-19 Contributes to the Pandemic • • Spread by

How the Unique Transmission of COVID-19 Contributes to the Pandemic • • Spread by person-to-person and concern for indirect contact Long, silent incubation period (2 -27 days), median 5 -6 days >50% of asymptomatic people shed the virus Predilection for lower respiratory tract

Clinical Symptoms and Signs Older frail patients often have atypical presentations • Blunted or

Clinical Symptoms and Signs Older frail patients often have atypical presentations • Blunted or no fever • Unexplained hypoxia • Tachycardia, tachypnea • Delirium • Fatigue, functional decline or falls Consider COVID-19 in any older adult with new-onset fever or respiratory symptoms (e. g. , dry cough), or atypical complaints

Management Approaches • Primary prevention is most important Halt spread from infected persons •

Management Approaches • Primary prevention is most important Halt spread from infected persons • High suspicion/low threshold diagnosis and triage to appropriate level • Supportive care with close monitoring for late progression (hypoxia, respiratory distress) • Care aligned with patient/family goals

Public Ageism and COVID-19 • Public Discussion of Allocation of Scarce Resources w/age criteria

Public Ageism and COVID-19 • Public Discussion of Allocation of Scarce Resources w/age criteria • Public Ageism: “At least only old people are dying” • Public Guilt: responsible for widespread economic collapse • Sudden Dependency: withdrawal of supports • Sudden Exposure of Technological Gaps: telehealth, online activities • False impression that most older adults live in nursing homes (only 4. 5%)

It Takes a Village: We Are All Interdependent

It Takes a Village: We Are All Interdependent

References • Nikolich-Zugich J, et. al. SARS-Co. V-2 and COVID-19 in older adults. Gero.

References • Nikolich-Zugich J, et. al. SARS-Co. V-2 and COVID-19 in older adults. Gero. Science (2020) 42: 505 -514 doi. org/10. 1007/s 11357 -020 -00186 -0 • Applegate W, Ouslander J. COVID-19 Presents High Risk to Older Persons. JAGS 68: 681, 2020 doi: 10. 1111/jgs. 16426 • Nanda A, et. al. COVID-19 In Older Adults. Aging Clinical and Experimental Research (2020) doi. org/10. 1007/s 40520 -01581 -5 • Richardson S, et. al. Presenting Characteristics, Comorbidities and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the NYC Area. JAMA (2020) doi. I: 10. 1001/jama. 2020. 6775

Thank you!

Thank you!

Q+A

Q+A