WCM-Q research probes vulnerability of older people to COVID-19

Population health experts at Weill Cornell Medicine-Qatar (WCM-Q) have published research examining why COVID-19 poses such a severe threat to older people compared to other age groups.

The paper highlights that 80 percent of deaths in confirmed COVID-19 cases in the United States have been in adults aged over 65, and that data from April 2020 shows a COVID-19 mortality rate of 4–11 percent for those aged 65-84 and 10-25 percent in those aged 85 and over.

The research details the biological, social, demographic, behavioral and healthcare-related factors which increase the vulnerability of people aged 65 and over to respiratory pandemics. It also highlights that governments around the world have failed to learn from earlier coronavirus outbreaks, overlooking the threat posed to older people by the current pandemic and consequently failing to take adequate action to protect this vulnerable group.

Dr. Sathya Doraiswamy, Assistant Director of the Institute for Population Health (IPH) at WCM-Q, is the lead author of the research. He said: “Qatar has been very proactive in terms of protecting its population of older people, but in many other countries there has been complacency, a failure to learn the lessons of previous respiratory disease outbreaks like SARS and MERS, and poorly coordinated responses leading to avoidable illness and mortality. This research calls for a more proactive approach to protecting the heath, wellbeing and dignity of older people.”

The research, which takes the form of a commentary, is entitled Respiratory epidemics and older people, and has been published in Age and Ageing, a leading UK medical journal. Other named researchers of the study are Dr. Ravinder Mamtani, Vice Dean for Student Affairs-Admissions, Population Health, and Lifestyle Medicine, Dr. Sohaila Cheema, Assistant Dean of the Institute for Population Health, Dr. Amit Abraham, Projects Specialist and Instructor of Population Sciences, and Dr. Marco Ameduri, Associate Professor of Physics and Senior Associate Dean for Pre-Medical Education, all of WCM-Q.

The researchers looked at data on COVID-19 and past pandemics from a number of countries, including the United States, the United Kingdom, South Korea, China and Italy to determine the factors contributing to the increased vulnerability of older people to COVID-19 and similar respiratory pandemics. Physiologically, old age is associated with a diminished immune system, cognitive impairment, and higher rates of chronic conditions such as diabetes, coronary heart disease, hypertension, kidney disease and cancer, all of which make individuals more vulnerable to the coronavirus. Recovery from any illness is less likely in frail people, recovery takes longer and those recovering are more prone to further episodes of illness.

In addition, older people are more likely to have sedentary lifestyles, poor nutrition, difficulty communicating, and lower levels of health literacy. Social isolation, loneliness and inadequate housing are also more common among older people and negatively affect health outcomes. Furthermore, many older people live in residential care homes or receive in-home care from health visitors, providing routes for disease transmission during epidemics. Older people are also more likely to need to attend hospital, increasing their risk of exposure to pathogens. 

Dr. Cheema said: “COVID-19 has placed unique pressures on healthcare services all over the world and has highlighted the vulnerability and needs of older people. We believe urgent action is needed to improve the preparedness of healthcare systems to take account of the special needs of older people and ensure their rights, wellbeing and lives are protected.”

Dr. Doraiswamy, Dr. Cheema and Dr. Mamtani also had a letter to the editor of Age and Ageing published, in which they called for older people to be treated with kindness and empathy, and for health messages aimed at them to be clear, simple and unambiguous. The letter, written in part as a response to a viral video of an old woman on a bus in China refusing to wear a mask, sparking outrage on social media, stated: “This situation is an illustration of how some older people might behave in outbreaks of infectious diseases. We all know that the ageing process can hamper cognitive skills…it is important for stakeholders to acknowledge that older people are a special group and that their lives are as precious as other physiologic age groups. It is critical to be able to design health campaigns and messages that are tailored to their needs during epidemics.”

Dr. Mamtani said: “We must ensure that older people are treated with respect, care and understanding so that they can be gently helped to follow healthcare guidelines during the pandemic. Haranguing and abusing older people for failing to follow guidelines is not only ethically wrong but also an ineffective way of helping them adhere to official guidance for the good of themselves and the wider community.”