Covid and caring for the elderly
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The document discusses caring for the elderly during the COVID-19 pandemic. It notes that the elderly are highly vulnerable to more severe cases of COVID-19, with those aged 80-89 having the highest case fatality rate of 15.89%. It recommends protecting elderly individuals by wearing personal protective equipment, maintaining social distancing, keeping relatives aware of risks, and ensuring vaccinations are up to date. It also advises performing comprehensive geriatric examinations, optimally controlling comorbid conditions, regular lab exams, nutritional management including supplements, exercise therapy, and stress management to care for the elderly during this time.
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Covid and caring for the elderly
- 1. CARING FOR THE ELDERLY IN THE TIME OF COVID-19 MARC EVANS M. ABAT, MD, FPCP, FPCGM Internal Medicine-Geriatric Medicine Head, Center for Healthy Aging The Medical City
- 2. OUTLINE • Some concepts on aging • COVID-19 in the older age group • Taking care of the older person in the time of COVID-19
- 3. Some concepts on aging….
- 4. …. accumulation of changes responsible for the sequential alterations that accompany advancing age and the associated progressive increases in the chance of disease and death. Harman D, Proc National Academy of Science USA, 1991 Aging…
- 5. Biochemical composition changes Physiologic capacity decreases Decline in homeostasis Susceptibility to disease increases Mortality increases with age
- 8. High Vulnerability Low Vulnerability Less Noxious Insult Very Noxious Insult Predisposing Factors or Vulnerabilities Precipitating Factors or Insults
- 9. Frailty Refers to a loss of physiologic reserve that makes a person susceptible to disability from minor stresses. An inherent vulnerability to challenge from the environment. Not dependent on age, diagnosis or functional ability
- 10. TIME PHYSIOLOGIC CAPACITY Ideal setting Usual trajectory Sudden illness or stressor Full recovery Less optimal recovery
- 11. COVID-19 in the older age group
- 14. Data from DOH COVID-19 Tracker from January 30, 2020 to April 3, 2020, by age Age Confirmed Cases, N (%) Deaths, N (%) Case Fatality Rate, % 90 and above 8 (0.27) - - 80-89 107 (3.55) 12 (12.5) 15.89 70-79 381 (12.62) 30 (22.06) 7.87 60-69 588 (19.48) 27 (19.85) 4.59 50-59 627 (20.78) 15 (11.03) 2.39 40-49 436 (14.41) 6 (4.41) 1.38 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3568934
- 15. TAKING CARE OF THE OLDER PERSON IN THE TIME OF COVID-19
- 18. Protect yourself (e.g. mask, goggles)
- 21. Vaccination
- 23. • Detailed History • Physical and Neurological Examination • Cognitive Evaluation • Behavioral/Emotional Evaluation • Functional Evaluation • Environmental Evaluation • Social Evaluation • Nutritional Evaluation
- 24. Optimal control of all comorbid conditions
- 26. •Nutritional management •Caloric intake regulation •Vitamin and micronutrient supplementation •Nutraceuticals
- 28. Mental Health and Stress Management
- 29. Thank you!
Editor's Notes
- This is the outline of our talk for today. First we will be establishing some basic concepts surrounding aging. This is important so that we can have a better grasp of what can then happen to an older patient who contracts COVID-19. Finally, we will discuss how to take care of an older person during this COVID-19 pandemic.
- Aging is what happens when accumulation of changes (which can happen on multiple levels of complexity from the genome, epigenetic levels, biochemical processes, macromolecules and tissues, organ systems) responsible for sequential alterations with advancing age Associated with increased chance of disease and death
- Changes start at genomic and molecular levels. These eventually lead to decreases in physiologic capacity. This explains why as some people age, they start complaining of not being able to do the things they usually do despite being generally well. A decline in homeostasis happens. We will discuss this further in the next slide. This leads to an increased susceptibility to disease (even with minor insults for some persons). All of this eventually lead to increased mortality as one ages.
- Now we obviously see that not all older people are the same. We know of people in their 70s or 80s who are still very active and functional for their age. There are stories of what we call SUPER SENIORS who are master athletes in their respective fields (the Indian marathoner, bodybuilders like Schwarzenegger, etc.) On the other hand there are other persons who are in their 50s or 60s yet are already functionally limited, or even disabled due to the accumulated effects and complications of diseases This is the concept of chronological age vs biological age. The former is the numerical count of time of a person’s existence. The other is the actual manifestations of changes in the function of the entire body that may be phenotypically discordant with time
- As one ages, and due to numerous factors like baseline health, presence of vices, or disease, the amount of physiologic reserve (the amount of bodily resources that are used to overcome stress) decreases. This is because the body starts to use more of these resources to maintain equilibrium. This is the concept of homeostenosis-the ability to maintain equilibrium becomes narrower. At some point, if the physiologic reserve remaining is overcome, adverse outcomes happen like what we call geriatric syndromes, hospitalization and death As was discussed earlier on biological age, the physiologic reserve may vary from person to person depending on inherent and modifiable factors like genetics, lifestyle, presence of comorbidities, vices, environment, education, etc.
- Those who are vulnerable due to the multiplicity of their risk factors only needs a minor insult to manifest with problems. On the other hand, those with minimal risk factors or with minimal vulnerability would take either one big insult or successive moderate insults to manifest with problems In older patients, the slopes and baselines are variable, and may be challenging to document or measure. In real life, this can be estimated by a number of maneuvers.