An Ode to the Old- COVID-19 and More

by Dr Makini McGuire-Brown

Life events and COVID-19 got me thinking about the elderly and the lack of recognition and care given to them at times. According to the Centers for Disease Control and Prevention (CDC), in the US, 8 out of 10 deaths from COVID-19 have been in adults over 65 years old.  Unfortunately, it is a common occurrence for respiratory infections and infections overall to have a preference for annihilating the elderly. This is because the ability of your grandmother to create your favourite dish far exceeds her body’s ability to fight off infection, far exceeds her excess lung capacity and far exceeds her ejection fraction/her heart’s pumping power.

Once contracted, this novel corona virus invades the cells of the lung, disrupting function and causing symptoms such as fever and cough and can progress to pneumonia, acute respiratory distress syndrome and/or sepsis all of which can lead to death. A younger person without co-morbidities or in other words, other chronic illnesses, is better able to mobilise his or her immune system to prevent progression of the infection. Is better able to accommodate the extra metabolic work required for the fight. Has stronger heart muscle and is thus able to pump faster/harder as required into cleaner blood vessels enabling blood to circulate smoothly and rapidly. The young and healthy are able to lose more lung volume and still compensate to deliver sufficient oxygen into the body. Years of life and excellent work each day by the body births wear and tear as the years progress. The imperative therefore is to protect the elderly from contracting the virus in the first place.

In keeping with that thinking of focus and protection for the elderly I find it prudent to mention possibly the most important fact to keep in mind. Many times older people do not present with the typical symptoms of a particular disease. Infection may present as lethargy, fatigue and loss of appetite, without a fever, the tell-tale sign of infection, ever occurring. Heart attacks may present with sweating and shortness of breath without ever having chest pain (especially in the elderly that have diabetes). A keen eye and extra caution is therefore necessary. Thank you to all the geriatric physicians out there who deal with the masquerading symptoms of the elderly daily.

Finally, the elderly should always have a voice and be given appropriate care; not sidelined for the sole reason that they are of a certain age. They did not make it all this way in life to be disregarded or written off. There are those who are definitely better off with minimal intervention and left to live their limited days in peace. Then there are those who can undergo surgery, chemotherapy, rehabilitation and come out smiling, proud and content; ready to live 10 more years and try new things. Each case should be evaluated individually and the rights and wishes of the patient should be respected. There are geriatric physicians and palliative care physicians fully equipped for this job and their importance is being felt increasingly.

It is never easy to deal with a loved one being ill but just as you would fight and do what is most appropriate for a younger person  is the same way you should for the elderly. Age should not be the sole determinant of care.

Love to all the grandparents out there! Stay safe!