COVID-19 and the Future of Aging: The Medical Path Forward for Older Adults
What's needed to protect their health during, and after, the pandemic
Editor’s note: This article is the 13 in a weekly joint series on COVID-19 and the Future of Aging from the Milken Institute Center for the Future of Aging and Next Avenue. The articles are Q and As with thought leaders in fields ranging from health care to retirement planning to work to intergenerational relationships.
Milken Institute Center for the Future of Aging: What does the path forward look like for COVID-19 in older adults in the months ahead?
Dr. Philip Pizzo: While our knowledge about the coronavirus (SARS-C0V-2) and the disease it causes known as COVID-19 has evolved considerably since the pandemic took hold in March 2020, some early observations remain unchanged.
Among these is that the mortality from COVID-19 is highest for older adults, increasing sequentially with each decade. For individuals between 40 and 49, there are 8.6 deaths per thousand individuals from COVID-19, while it is 105 per thousand for those between 65 and 74 and then jumps to 210 per thousand for those between 75 and 84 and up to 304 per thousand for those over 85.
Even if a COVID-19 vaccine is effective, the level of protection should be expected to be less in adults over 60.
With nearly 40% of deaths during the first months of the pandemic occurring in older adults and staff in nursing homes and congregate senior living facilities, COVID-19 has been clearly identified as a disease that is particularly severe for vulnerable older individuals.
Unfortunately, the risks for older adults has exacerbated ageism, with some opining that, if it weren't for old people, the impacts of COVID-19 would be much more tolerable. While that is true at one level, mortality and severe morbidity with the coronavirus has been observed in all age groups.
It should not be forgotten that for other respiratory infections, including influenza, the mortality can be highest in individuals between age 20 and 40 due to their robust immune system response to infection. It is also important to remember that vulnerability and fatality can vary from one pandemic to another and that blaming any one group for outcomes they can't control is inappropriate.
While age is among the most important determinants of death from COVID-19, a number of co-morbidities including hypertension, obesity and diabetes contribute to adverse outcomes. These co-morbidities are also associated with increasing age.
In addition, the fatality rate for COVID-19 is higher in men than women and is also negatively associated with race and socioeconomic status. For example, Black Americans experience 3.5 times more deaths from COVID-19 than white Americans.
Going forward, it seems older individuals, especially those with comorbidities and people of color are more vulnerable to dying from COVID. That means that until the population has received an effective vaccine and/or treatments, older individuals will need to shelter whenever possible and to practice social distancing, with masks and hand hygiene.
Importantly, if older adults are living in multigenerational homes, they must be attentive to potential transmission from younger household residents. Household acquisition of the virus is much higher than in other settings.
Similarly, in senior living facilities, the major risk for transmission has come from custodial or care providers. Thankfully, most facilities are now better prepared to address these issues than when the pandemic began.
Are there new avenues, interventions and ideas that should be explored to modify the health risks of COVID-19 to our aging population?
Two vaccines have recently been authorized in the United States and efforts are now underway to distribute the limited doses currently available as production ramps up. We still await effective antiviral therapies that can be instituted early in infection, similar to the way that Tamiflu is given for influenza. While such a drug doesn't exist today, effective antiviral agents are being developed and at least one (Remdesivir) has demonstrated efficacy in hospital settings. Formulations of Remdesivir that can be administered as a nasal inhalation are being developed.
It is also highly probable that other drugs will become available over the next months to years.
It's worth remembering that even if a COVID-19 vaccine is effective, the level of protection should be expected to be less in adults over 60 because of age-related declines in immune function.
This likely reality can be partially offset if the vast majority of the population is vaccinated, since that would reduce the community levels of SARS-CoV-2 through population or herd immunity.
Lack of vaccine acceptance would threaten herd immunity, and is a concern given rising protest from anti-vaccination groups. Monoclonal antibodies produced by the body against SARS-CoV-2 administered in protective concentrations could also serve as a bridge to an effective vaccine or even as an alternative.
With innovations driving rapid change in health care delivery and services, what are the most significant impacts of COVID-19 that you foresee for older adults, their health and well-being and the health care system?
Progress is being made toward a pandemic response based on what has been learned over the past months. We are aware of the risks of age-related chronic disease and of the public health practices that can prevent spread of the virus. Collaborations across the research ecosystem are encouraging and can contribute to further advances.
The practice of health care delivery is also changing with the increased use of telemedicine which, post-pandemic, can offer increased accessibility to health care providers. This necessitates that older individuals become more conversant and comfortable in using information technology.
Moreover, the processes being used to develop therapies and vaccines offer a roadmap to prevent the terrible loss of life in the event of future pandemics that we have seen with COVID-19.
Science is doing its part, and policymakers must as well. Lives can be saved if evidence is followed and leadership responds accordingly. If that happens, older adults and people of all ages can look forward to healthier futures, even though it may take time to get there.
