Respiratory viral infections in the elderly

Abstract

With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13-31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential.The reviews of this paper are available via the supplemental material section.

Keywords: COVID-19; RSV; SARS-CoV-2; elderly; influenza; polypharmacy; respiratory viruses; screening; therapeutics; vaccination.

Figure 1.

Interconnected factors that drive an increased susceptibility and impact of respiratory viral infections in the elderly. Figure was formed from images taken from The Noun Project. HCP, healthcare professional; LTCF, long-term-care facility. The Noun Project, 8800 Venice Blvd., Los Angeles, CA 90034. Work is licensed under the Attribution 3.0 Unported (CC BY 3.0) licence^©. Images used were downloaded from https://thenounproject.com on 8 December 2020, and from top left to bottom right were produced by: Confusion by Mohammed Rabiul Alam, BD; falling by Andrew Doane; heart attack by Gan Khoon Lay; heart disease by artworkbean, ID; liver and kidney problem by Gan Khoon Lay; cancer by LAFS, RU; Blood Pressure Cuff by Shiva, IN; Diabetes by Daniel Grohotolski, DE; macrophage by Léa Lortal; natural killer cell by Léa Lortal; neutrophil by Léa Lortal; grandmother by Marie Van den Broeck, BE; Nurse by Llisole; Food by Guilherme Furtado, BR; Vaccine by parkjisun; medicine by UNiCORN; medicine by alvianwijaya, ID; lungs by Saeful Muslim, ID health by StringLabs, ID; home care by Bestdesignmarket, IN; Hospital Bed by Linseed Studio, US; Pneumonia by Gan Khoon Lay; cost by monkik; Hospital by Nociconist, ID; virus transmission by mim studio, ID; Money by Icon Lauk, ID; Hospital Bed by LAFS, RU.