COVID-19 and the elderly: insights into pathogenesis and clinical decision-making
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REVIEW
COVID‑19 and the elderly: insights into pathogenesis and clinical decision‑making Fabio Perrotta1 · Graziamaria Corbi1,2 · Grazia Mazzeo3,4 · Matilde Boccia3 · Luigi Aronne3 · Vito D’Agnano3 · Klara Komici1,2 · Gennaro Mazzarella3 · Roberto Parrella5 · Andrea Bianco3,4 Received: 18 May 2020 / Accepted: 6 June 2020 © Springer Nature Switzerland AG 2020
Abstract The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viralinduced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19. Keywords Sars-Cov-2 · Coronavirus · COVID-19 Elderly patients · Nursing homes · Palliation
Background The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has spread quickly: by April 26th 2020, 193.710 deaths worldwide had been reported by World Health Organisation (WHO) and COVID-19 has emerged as a very large-scale pandemic [1]. Evidence suggests that advanced age is the most important predictor for fatal outcome [2]. Fabio Perrotta and Graziamaria Corbi equally contributed to the article. * Fabio Perrotta [email protected] 1
Department of Medicine and Health Sciences, “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis, 86100 Campobasso, Italy
2
Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
3
Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”/Hosp. Monaldi, 80131 Naples, Italy
4
COVID‑19 Unit, Infectious Disease Department, University of Campania “L. Vanvitelli”, 80131 Naples, Italy
5
COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
Coronaviruses represent a heterogeneous cluster of large single-strand RNA viruses, widely distributed among mammals and birds and grouped in the family of Coronaviridae [3]. The genera of interest for humans are alpha and betacoronavirus which compose the subfamily of Coronavirinae, along with gamma and delta coronavirus, not recognised as human pathogens [4]. At the end of the second decade of the twenty-first century, the world has witnessed an outbreak of a novel coronavirus, designated SARS-CoV-2, and taxonomically allocated into the species of severe acute respiratory syndrome-related coronavirus (SARS-CoV), subgenus Sarbecovirus, genus betacoronavirus [5, 6]. The term coined to refer to SARS-CoV-2-related disease is COVID-19 [7]. Droplets and close contact have been recognised as the ma
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