Jun 08, 2020 4:00 PM

Author: Kylene Metzger

As medical experts continue to study and learn more about COVID-19, current available information and clinical expertise finds that older adults and people of any age who have serious underlying medical conditions are at higher risk for severe illness from COVID-19.

According to the Centers for Disease Control and Infection (CDC), those at high risk for severe illness from COVID-19 are people 65 years and older and people who live in a nursing home or long-term care facility.

Mark Supiano, MD, Chief of the Division of Geriatrics at University of Utah Health, answered questions about COVID-19 and the impact it can have on older adults.

Who is at high-risk for COVID-19?

Most people may be familiar with high-risk individuals for COVID-19 as those who are immunocompromised, undergoing cancer treatment, have diabetes, and are on dialysis for kidney failure. Those are all true, but beyond that, anyone age 65 years or older is considered in the high-risk group.

We’ve been very fortunate in Utah that only 8% of people who are infected with COVID-19 have required hospitalization. Most people are able to get over the infection and recover at home. However, half of these hospitalizations have been in people 65 years and older. A disproportionate rate in the geriatric population further emphasizes just how at risk this group is.

What are some concerns for high-risk individuals if Utah moved from “yellow” to “green?”

We may need to heighten our vigilance. As things have relaxed and more people are out and potentially exposed, people at higher risk are even more at risk. The people in contact with high-risk individuals could have a heightened risk of exposure to COVID-19.

What can high-risk individuals do to protect themselves?

High-risk individuals should maintain physical distancing and minimize the risk of connections with other people. If you are in a public space where you may encounter someone, wear a mask. Don’t overlook frequent handwashing and avoid touching your face.

If someone is in the 65 and older age group but is fit and healthy, are they high risk?

The age group 65 years and older is extremely heterogeneous. You have people who at age 66 are healthy and running marathons. You also have people who are 86 years old, wheelchair bound, with diabetes or other chronic conditions. The person at that advanced stage in life is going to be more high risk opposed to the 66-year-old. That said, based on physiologic changes that happen in the immune system, even at age 66, these individuals would still be considered high-risk and should take the same precautions.

Is it safe to visit parents who are in their 60s and 70s?

It’s balancing the risk and benefit. If your parent has needs of getting their groceries delivered and getting their meals and medications, you can certainly interact. However, it should be done at a six-foot distance while wearing face masks and making sure you are frequently washing your hands. You should also limit the time you are exposed to them and the number of events.

Would you recommend visits to take place outside?

Yes. Airflow is better outside, sunlight has some benefit, and the ability to maintain distance in an outdoor space is safer than being indoors.

What can citizens do to protect high-risk individuals?

Aside from physical distancing, wearing masks, and frequent handwashing, we are starting to see the harmful effects that staying isolated can have on an older person, particularly if they live alone already. The lack of social contact can have bad consequences on someone’s health. What we can do to support those that are in this situation is to make sure their needs are being met.

Other things we can do include:

  • Connect virtually
    • Social connection is critical and can help minimize anxiety
  • It’s okay to not be okay
    • We are all going through this, it’s a stressful time, and it’s okay to accept that
  • Take a break from the 24/7 newsfeed and social media
    • Although people should stay informed, it may be provoking more anxiety
  • Take care of yourself and your body
    • Exercise can help both physical and mental health
    • Eat healthy
    • Don’t turn to alcohol or sedatives when dealing with anxiety
    • Get enough sleep

Is physical connection such as hugs okay?

Physical connection really adds value to a relationship, even if it’s just shaking hands. According to a new report, there may be a greater risk when talking to someone within six feet than giving a hug if the people involved are wearing masks and not making facial contact. That’s probably less risky than talking to someone across the table for half an hour. It’s possible this way to minimize the risk but maintain physical connection.

How can working older adults protect themselves in office environments?

We have a lot to learn about how we are going to gradually get back into the workplace. The CDC has published guidelines on how we need to restructure our office to reduce risk. Several things we consider in my own division include:

  • Stagger work schedules
    • This puts less people in a work area and allows better physical distancing
  • Create a physical barrier between people
  • Wash your hands frequently
  • Wear a mask

What precautions should be taken at long-term care facilities?

Almost half of the deaths from COVID-19 have been among residents in long-term care facilities or assisted living facilities. Some of my colleagues say we should be building a “moat” around these care facilities to protect their residents from COVID-19 infection. That means screening all the staff and visitors, or not even allowing visitors. Utimately, more widely available COVID-19 testing to screen residents and staff is needed to best protect these facilities. 

What underlying conditions are most worrisome among older adults?

In addition to age alone, we are more concerned about the 80-year-old group because they are likely to have more chronic conditions. Some chronic conditions that would impact this age group include diabetes, obesity, and anyone who is immunocompromised. That could mean they are undergoing therapy for cancer or using medication that suppresses their immune system. In addition, people on dialysis or with kidney disease/kidney failure are at greater risk. All these conditions are very common in the geriatric population. The more of these conditions that a person has, the greater the risk would be.

What precautions should older adults take if groceries are delivered to their home?

The strategy to avoid contact in a grocery store is a great step, and the same precautions should be practiced at home. This includes keeping six feet away from others while wearing a mask. When unloading, have a designated spot to unpack groceries and sanitize any items that’s appropriate. When groceries are put away, wipe off any surfaces and wash your hands.

The risk of acquiring COVID-19 from contact is fairly low. We’re more concerned about respiratory transmission.

What are the best practices for family gatherings during the summer?

Families should limit the number of people at a gathering. As we go from orange, to yellow, and to green, the numbers of people allowed in a gathering are going to change. You can minimize risk by gathering outside, staying six feet apart, limiting exposure time, and wearing a mask.

If the gathering includes food, it’s best to avoid potlucks and not share food. Everyone should have their own plates and utensils.

What are recommendations for older adults who want to travel?

Looking at the number of COVID-19 cases, I would recommend we look at coronavirus as a chronic illness that we’ll be dealing with for the unforeseeable future until there’s an effective therapy—or, ideally, a vaccine. Sadly, I think the idea of us being able to travel as we once did, without current restrictions and precautions, is in the distant future.

Do COVID-19 symptoms in older adults vary from younger adults?

Like many things in geriatrics, older adults present in uncommon ways because of underlying physiology. For example, an older adult may not have a fever if they have an infection, which is a common symptom for coronavirus.

We’ve also learned that the loss of smell and taste are unusual symptoms, so that’s something to keep in mind.

Beyond that, it turns out presenting with confusion, altered mental status, or not being able to remember—also known as delirium—are common symptoms of a COVID-19 infection in an older adult. Don’t assume just because they don’t have other common COVID-19 symptoms such as cough and fever that it’s not related to COVID-19.

Kylene Metzger

Public Affairs

coronavirus covid-19 older adults

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