COVID-19 in Older Adults- A Practical Review for Emergency Providers in 2022

Abstract

OVID-19 has posed a considerable threat to all aspects of older Americans' lives. The pandemic generated acute illness, emergency department (ED) visits, hospitalization, respiratory failure, and death. Pandemic-associated social isolation and loneliness further endangered older adults. Recovery from COVID-19 illness has commonly been followed by chronic symptoms, which may also precipitate ED visits. While vaccination has mitigated risks of serious illness requiring hospitalization, a booster dose is required to sustain protection. New treatments and therapies, including monoclonal antibodies and antiviral agents, have shown efficacy for older adults who are at risk of hospitalization. Older adults remain vulnerable in 2022, after two years of the COVID-19 pandemic. Emergency care for older patients is now challenged with health system staffing shortages and diminished access to care in community programs & skilled nursing facilities. This article attempts to synthesize the avalanche of discovery and innovation into a narrative review focused on the emergency and immediate post ED care of the aging adult patients both during and as a result of the COVID-19 pandemic. A 79-year-old Laotian woman who lives in the community with her family was seen by her primary care provider at a routine follow-up visit in early January 2022. She was noted to have a cough with congestion. She had no loss of smell and no gastrointestinal symptoms. She had no known sick contacts. Past Medical History: Diabetes mellitus, osteoarthritis, peripheral neuropathy, depression, osteopenia, subclinical hypothyroidism, and hypertension. She received a COVID vaccination (Feb and March 2021) but did not get a booster dose. She needed assistance for bathing but otherwise was independent in her self-cares. Medications include: lisinopril 5 mg daily, metformin XR 500 mg daily, vitamin D 2,000 units daily, atorvastatin 20 mg daily, meclizine 12.5 mg daily prn, and gabapentin 100 mg each night. BP 173/96. Pulse 89/ minute. Pulse ox=97% on room air. Respiratory rate= 20 per minute. Temperature= 98.6. BMI= 25. Physical examination was remarkable for normal attention and level of consciousness. Her cardio-pulmonary examination was normal. Her COVID-19 test in the primary care office was positive. • Which medication or treatment could be considered? • How would you counsel the patient regarding her co-morbid illnesses?