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COVID-19 mortality and its predictors in the elderly: A systematic review
Omid Dadras1,2, SeyedAhmad SeyedAlinaghi1, Amirali Karimi3
1Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors Tehran Iran.
Insights
Elderly individuals face higher COVID-19 mortality rates due to comorbidities. Key risk factors include age, male gender, dementia, and low oxygen saturation, while certain treatments and vaccinations may reduce mortality.
Area of Science:
- Gerontology
- Infectious Diseases
- Public Health
Background:
- Older adults exhibit increased susceptibility to severe inflammatory responses and comorbidities.
- This demographic experiences disproportionately higher mortality rates from COVID-19.
Purpose of the Study:
- To systematically review mortality rates in elderly patients diagnosed with COVID-19.
- To identify key predictors of mortality in this vulnerable population.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Web of Science, and Science Direct.
- Eligible studies were identified through a two-step screening process (title/abstract and full-text).
Main Results:
- Older patients demonstrated significantly higher mortality compared to younger individuals.
- Identified risk factors included advanced age, male gender, dementia, impaired daily activities, chest X-ray consolidations, hypoxemic respiratory failure, and low admission oxygen saturation.
- Biomarkers such as high d-dimer, vitamin D deficiency, elevated C-reactive protein, and abnormal lymphocyte counts predicted poor outcomes.
- Treatments including renin-angiotensin-aldosterone system inhibitors, corticosteroids, and antibiotics, alongside influenza vaccination, were associated with reduced COVID-19 severity and mortality.
Conclusions:
- COVID-19 outcomes and presentation vary significantly in the aged population, necessitating tailored care strategies.
- Mortality is independently linked to patient age, underscoring the vulnerability of elderly COVID-19 patients.
- Strict preventive measures, prompt diagnosis, and aggressive management are crucial to mitigate severe complications like acute respiratory distress syndrome in older adults.
Background And Aims:
Older people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID-19) patients and its predictors in this age group.
Methods:
We searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two-step screening process consisting of title/abstract and full-text screenings to identify the eligible studies.
Results:
Summarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X-ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d-dimer levels, 25-hydroxy vitamin D serum deficiencies, high C-reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin-angiotensin-aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti-CD6 monoclonal antibody) in combination with other antivirals reduces COVID-19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID-19 mortality.
Conclusion:
Overall, a critical consideration is necessary for the care and management of COVID-19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID-19 is independently associated with the patient's age. Elderly patients with COVID-19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.
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