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KMID : 1146320200080010009
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Journal of Health Technology Assessment
2020 Volume.8 No. 1 p.9 ~ p.13
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What Explains COVID-19’s Lethality for the Elderly?: Community Care Strategies for the Vulnerable Elderly
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Suh Guk-Hee
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Abstract
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This review aims to answer the question of why the elderly mortality rate after SARS-CoV-2 infection is greatly higher than younger population, and to propose practical ways for caring older disabled people in time of COVID-19 pandemic. Three databases (MEDLINE, EMBASE, and Cochrane library) up to May, 2020 with the search terms (SARS-CoV-2, COVID-19, mortality, dementia, disability) were searched. Among searched papers, 55 were selected to review. Bloodbrain barrier (BBB) dysfunction has been proposed as a mechanism of neuro-invasion or neuro-inflammation caused by SARS-CoV-2 from peripheral to brain. ApoE4 is linked to BBB dysfunction, which may possibly increase the risk of central nervous system infection in Alzheimer’s disease (AD) patients even more. Korean Centers for Disease Control and Prevention indicates age-related steep increase in the mortality rate caused by COVID-19, which were 2.8% for those 60 to 69 years, 10.8% for those 70 to 79 years, and 25.5% for those 80 years or older. In light of the fact that older people with dementia show much higher mortality, elderly care strategies should aim to protect them from SARS-CoV-2 infection and to minimize the negative impacts associated with implementation of public health interventions (i.e., lock-down, physical distancing). There are some evidences of neuro-invasion of SARS-CoV-2, which means older people with BBB dysfunction might be greatly vulnerable to brain infection leading to death. At-home and institutional care strategies for older disabled people are suggested.
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KEYWORD
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SARS-CoV-2, COVID-19, Elderly, Brain, Neuroinvasion, Care, Telemedicine
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