COVID-19 in older adults: The urgent need for more research in this vulnerable group
Dr Fiona Lithander is a nutrition scientist and dietitian, and the Manager of PRIME, a programme of research in the Ageing and Movement Group at the University of Bristol led by geriatrician Dr Emily Henderson. She Tweets using @FionaLithander, @PdPrime and @chiefpd2.
Early on in what has since become the coronavirus pandemic, it became evident that older adults are at an increased risk of severe COVID-19 infection. In contrast to the publicised symptoms of cough and fever, clinical practice revealed that older adults presented atypically and non-specifically with delirium, postural instability or diarrhoea. We recognised the importance of examining the research landscape to investigate what studies had been carried out in older adults on various aspects of COVID-19. To this end, an interdisciplinary group of clinicians and scientists was assembled to carry out a rapid review of the COVID-19 literature, which has just been published in Age and Ageing.
There are a few key findings in our semi-systematic review. The first relates to testing for the virus. Much of the recent news cycle relating to COVID-19 has been occupied with the question of testing. Given that older adults may present with atypical symptoms as described, there is a need for the adoption of a lower threshold for testing older adults who may present atypically, where the result would alter the management at an individual or at a population level.
The second finding relates to management strategies for clinical COVID-19 infections. When we examined the research around the effectiveness of various classes of drugs, such as antivirals, corticosteroids and immunotherapies, no clear conclusions could be drawn. Moreover, very little research has been carried out looking specifically at the effectiveness of drugs in older adults. Not only that, but when we looked at the hundreds of clinical trials that are currently underway, 37% of these exclude people over the age of 75 years. Given that older adults are particularly at risk, it is important that this vulnerable group is included. We are however very encouraged that the large multicentre UK clinical trials such as RECOVERY are pragmatically designed and enrolment criteria do not exclude older adults.
Since there are no known effective drug treatments available, the public health guidance advocates isolation and quarantine, social distancing and community containment. It is known from other studies however that older adults who are socially disconnected and isolated from family, friends and their support networks, are at an increased risk of both mental and physical health problems. Current social distancing policies in place in the UK could have negative consequences for the health of older adults, especially if they are in place for an extended period. The risk-benefit balance for these strategies is likely to remain somewhat precarious and worthy of future research.
We sought to meet an urgent clinical need to provide a synopsis of the evidence. There were many challenges that we encountered as a team. We screened over a thousand peer-review and pre-print papers and adapted, like many research groups, to working remotely, over a period of 48 hours. New research is emerging so quickly that we had to be reasonably pragmatic about where to draw a line in order to submit the paper for publication. We are encouraged however that the rapidly expanding field, whilst providing challenges for researchers, offers much hope and promise for strategies, drugs and interventions to tackle COVID-19. It is also heartening to see so much government and philanthropic investment being urgently directed towards the search for prevention and treatment of the disease.
It would be fair to say that the challenge of assembling authors, establishing remote collaboration tools and software, and coordinating the review and analysis of papers in seven days was considerable. We remain very encouraged by the rapidly expanding developments in the COVID-19 field. Keeping the needs of older people in the spotlight is even more relevant during this pandemic. We hope that the rapid review will prove helpful for those working with older people now and provide a springboard for potential research into the acute and rehabilitation care needs of this vulnerable group in future.
Read the Age and Ageing paper COVID-19 in Older People: A Rapid Clinical Review