COVID-19 in

Elderly Patients
Amelia Ganefianty, S.Kep., Ners., M.Kep., Sp.KMB
Background
❖ Evidence suggests that advanced age is the most important predictor
for fatal outcome of Covid-19 (Wang L, He W, Yu X et al, 2020) .
❖ Among patients infected, several conditions are linked to increased
virus susceptibility and elevated COVID-19 burden
❖ As comorbidities often increase with aging, the elderly population
may in turn experience a more severe COVID-19.
❖ Aging itself has been strongly associated with worse outcomes,
because of the pathophysiological changes that characterize the
respiratory system (Libertini G, Corbi G, Cellurale M et al, 2019).
❖ Based on current epidemiological data, SARS-CoV2-infected patients
aged>80 show a greater risk of death in comparison with younger
patient (Zhou F, Yu T, Du R et al, 2020).
Background
Clinical Profile of Elderly Patients with COVID-19
Hospitalized in Indonesia’s National General Hospital
(Azwar et al., 2020)

❖ Older people contributed to 38.6% of death cases related to COVID-19 in Indonesia.

❖ The most common symptoms were fever, cough and shortness of breath (classic
symptoms of COVID-19), whereas the most common chronic diseases were diabetes
mellitus, hypertension, and malignancy.
❖ Multimorbidity was only found in 14% of patients, all of whom remained alive following
SARS-CoV-2 infection.
❖ The death rate among elderly inpatients with COVID-19 in this study was 23%, and male
older adults contributed to 90% of death cases.
COVID-19 and Respiratory System Disorders
(Brosnahan et al., 2020)
Respiratory function in the elderly (Lima et al., 2019)
Several aging-related factors may associate chronic infammation to cytokine
storm in elderly patients of COVID-19 (Meftahi et al., 2020)
Cliical Presentation of Covid-19 in the elderly
(Shahid et al., 2020)

Shortness of breath (76%),

Fever (52%)
Cough (48%)

Up to 86% of older adults presented with

comorbidities, and the most significant ones were
CKD (48%), congestive heart failure (43%), chronic
obstructive pulmonary disease (COPD) (33%), and
diabetes (33%)

Acute respiratory disease syndrome (71%)

Acute kidney injury (20%)
Cardiac injury (33%)
Liver dysfunction (15%)

67% required vasopressor support for treatment.

COVID-19
Number of patients aged ≥65 years hospitalised for COVID-19 (blue boxes)
and percentage of deaths (red dots) according to age (Becerra-Muñoz et al.,
2021)
A triage
model for
the ICU
(American
College of
Chest
Physicians,
2020)
 Assesment
Suitable assessment at ICU for elderly patients with COVID-19
(Azienda, 2020)
Assessment of acute situation Assessment forms
Frailty Frailty Rockwood Clinical Frailty Scale
Comorbidities Charlson comorbidity index
Polypharmacy Identify anticholinergic burden
Identify drug interactions
Malnutrition Albumin serum concentration
Body mass index BMI
Cognitive impairment Mini-Mental State Examination MMST
Delirium CAM-ICU
Activities of daily life ADL scale
IADL
Oxygenation & Ventilation

(Azienda, 2020)
Oxygenation & Ventilation
High-flow nasal canule
 HFNC
❖ Explain the procedure for using HFNC
❖ Start low, with an oxygen flow of 25-30 liters per
minute
❖ Ensure that the nasal prong is in a good position,
that the temperature and humidification settings
are adequately filled, and that the tube is not file
❖ FiO2 according to the needs and condition of the
patient
❖ Encourage breathing through the nose, not from
the mouth
❖ The flow can be increase according to the
patient's condition
❖ Monitor vital signs, especially respiratory rate,
oxygen saturation, and blood gas analysis results
❖ Suggest prone position to the patient
❖ Monitor ROX index value
Prone position (Ali & Kamble, 2020)
Prone position
 Nursing
Management of
Prone Positioning in
Patients With
COVID-19
(Binda et al., 2021)
Recommendations for the prevention of prone
position pressure ulcer (Moore et al., 2020)
The Pain, Agitation, and Delirium (PAD) bundle
(Ogza et al., 2020)
Prevention and treatment of delirium is essential in
the old and very old patients at ICU

(Azienda, 2020)
Nutrition algorithm for the management of
Covid-19 in patients (Weber et al., 2020)
Addressing Loneliness in Older Adults During the COVID-19
Pandemic (Van Orden, 2021)
References
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