Jun 9, 2020

Interviewer: The highest risk factor for becoming hospitalized and suffering the worst effects of COVID-19 is being 65 and older. We're with gerontologist Dr. Mark Supiano, who is the Dhief of the Division of Geriatrics at U of U Health. Let's start out with the question, why is that?

Dr. Supiano: We do know that there are underlying changes in the immune system in an older person that puts them more at risk of getting an infection. They cannot mount the same immune defenses to fight it off. So that's first. Secondly, there are other physiologic changes in the lungs and the heart, in other responses to an infection that put older people at risk for more complications. So they don't have the functional reserves to compensate for the devastating effects of the COVID infection itself.

Interviewer: In addition to the immune system changes, which apparently starts at 65, is that what you're saying or ish?

Dr. Supiano: Yes. It's not a hard and fast number, but the older you are, the more likely those changes will be present.

Interviewer: Got you. So it's a linear kind of a decline.

Dr. Supiano: Yeah.

Interviewer: All right. In addition to that, are there other reasons why individuals over 65 are more likely to get COVID-19 and suffer the worst effects from it?

Dr. Supiano: I think related to that, and particularly as you go up in years above the age of 65, so it's a very heterogeneous group, but for 75 and older, or particularly 85 and older, the likelihood that you have multiple chronic conditions that are also associated with higher risk of COVID, such as high blood pressure, diabetes, obesity, renal disease, those other risk factors can accumulate. And the more risk factors you have the higher your risk would be.

Interviewer: So it sounds like if I have a mother or a grandfather that has some of those conditions and they're over 65, I might want to take additional precautions than perhaps if my parent was healthy?

Dr. Supiano: Exactly.

Interviewer: But still over 65, that in and of itself.

Dr. Supiano: Even without those underlying conditions, the current information suggests that just age 65 and higher, again, the higher, the more risk, but that age alone would be a significant high-risk factor.

Interviewer: How about the symptoms for people that are 65 and older for COVID-19? Are they the typical symptoms that we see in other people?

Dr. Supiano: So they can be. So the most common symptoms would include fever, cough, fatigue, or loss of energy, sometimes diarrhea. Those are the most common symptoms that have been reported. But as is true with many other infections in older populations, there's more often unusual presentations of that infection. So, for example, there may not be a fever. So older people may not mount a fever in response to the infection. So the absence of a fever should not make you think that the COVID is not a possibility.

Another possibility is that someone who presents with confusion or an acute change in their mental status, that in fact could be a presenting symptom of COVID. There's also evidence to suggest that an unusual symptom of losing taste or smell could be the first presenting symptom of COVID. So we need to have a heightened level of awareness for unusual ways that COVID might present in an older adult.

Interviewer: But the trick there to me is how do you differentiate that from just part of the normal aging process? If I understand correctly, loss of taste and smell, kind of common when you start getting older. Confusion can start developing when you get older. How do you determine if it's COVID or not?

Dr. Supiano: So it's really separating out what we would think about as being usual aging from a potential infection, and the general rule of thumb that I use and I teach our trainees is that age alone is almost never the answer, right? If someone's coming with some new concern or complaint, we need to think it's our job to find out what's going on, and in this case, have a very low threshold to think, is this possibly related to COVID?

Interviewer: If somebody in your life who is 65 or older then develops one of these COVID symptoms, whether normal or not quite as normal, what should you do at that point? Should you get to the hospital immediately? I suppose a test probably would be the first thing.

Dr. Supiano: So I think the first . . . exactly, Scot. And fortunately, with our health system now is very well-equipped to evaluate people with potential COVID-related illness in an environment actually outside of the hospital. We really don't want you bringing that patient into our clinic or directly into the emergency room. They should be evaluated at one of the testing centers where there's the outdoor testing facility. You don't have to leave your car, get the tests done. Then if further evaluation needs to be done, certainly going to urgent care or an emergency room that's equipped to appropriately isolate and manage someone as a potential COVID infection and has the appropriate personal protective equipment and so forth to also protect the other staff and other patients.

Interviewer: Of course, if you have severe symptoms, difficulty breathing, any of that sort of stuff, then . . .

Dr. Supiano: Do not pass go.

Interviewer: Yes.

Dr. Supiano: Yes, go straight to the emergency room.

Interviewer: All right. You're the expert. I always love to ask this last question when I've got an expert here behind the microphone. What's the one thing, when we're done talking, that you would want someone to take away from our conversation?

Dr. Supiano: Wash your hands. No, seriously, I think the main point is that people 65 and older are considered high-risk, and high-risk individuals need to be extremely vigilant about maintaining these precautions, hand washing being one of them, but maintaining physical distance, wearing a mask, minimizing your exposure. All of the things that are on that list, we need to not let down our guard and not be complacent. We need to keep up with those protective measures if we're going to get through this.

Interviewer: And as a loved one, also do those same things to protect those that I love.

Dr. Supiano: Exactly.

For Patients