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How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity.
Smorenberg, Annemieke; Peters, Edgar Jg; van Daele, Paul LA; Nossent, Esther J; Muller, Majon.
  • Smorenberg A; Department of Internal Medicine, section Geriatric Medicine, Amsterdam UMC, VU medical center, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
  • Peters EJ; Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Institute for Infection and Immunity, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
  • van Daele P; Department of Allergology and Clinical Immunology, Erasmus Medical Center, Doctor Molewaterstraat 40, 3015 GD, Rotterdam, the Netherlands.
  • Nossent EJ; Department of Pulmonary Medicine, Amsterdam UMC, VU medical center, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
  • Muller M; Department of Internal Medicine, section Geriatric Medicine, Amsterdam UMC, VU medical center, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
Eur J Intern Med ; 83: 1-5, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065035
ABSTRACT
IMPORTANCE Among COVID-19 cases, especially the (frail) elderly show a high number of severe infections, hospital admissions, complications, and death. The highest mortality is found between 80 and 89 years old. Why do these patients have a higher risk of severe COVID-19? In this narrative review we address potential mechanisms regarding viral transmission, physical reserve and the immune system, increasing the severity of this infection in elderly patients. OBSERVATIONS First, the spread of COVID-19 may be enhanced in elderly patients. Viral shedding may be increased, and early identification may be complicated due to atypical disease presentation and limited testing capacity. Applying hygiene and quarantine measures, especially in patients with cognitive disorders including dementia, can be challenging. Additionally, elderly patients have a decreased cardiorespiratory reserve and are more likely to have co-morbidity including atherosclerosis, rendering them more susceptible to complications. The aging innate and adaptive immune system is weakened, while there is a pro-inflammatory tendency. The effects of SARS-CoV-2 on the immune system on cytokine production and T-cells, further seem to aggravate this pro-inflammatory tendency, especially in patients with cardiovascular comorbidity, increasing disease severity. CONCLUSIONS AND RELEVANCE The combination of all factors mentioned above contribute to the disease severity of COVID-19 in the older patient. While larger studies of COVID-19 in elderly patients are needed, understanding the factors increasing disease severity may improve care and preventative measures to protect the elderly patient at risk for (severe) COVID-19 in the future.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study / Reviews Limits: Aged / Humans Language: English Journal: Eur J Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: J.ejim.2020.11.024

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Observational study / Prognostic study / Reviews Limits: Aged / Humans Language: English Journal: Eur J Intern Med Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: J.ejim.2020.11.024