Vulnerable Adults

Vulnerable Adults

These 4 risk factors make older people more prone to Covid-19 complications

Shortly after a visit to New York in April, John Troy was diagnosed with Covid-19. Troy, 71, of Skokie, was hospitalized for 12 days due to the illness.

“Before they even got the results from my Covid-19 test, they hospitalized me,” he says. “I think because of my age and my other physical conditions, they were nervous.”

Although he’s still feeling some lingering effects of the illness, including loss of taste and smell and dizziness when he stands up, Troy expects to fully recover and is luckier than many older adults who’ve contracted Covid-19.

Covid-19 has killed people of all ages, but it’s clear that older adults and people with underlying medical conditions are more at risk of suffering severe complications and death from the illness.

Statistics from the Centers for Disease Control and Prevention (CDC) show exactly that. The agency reports that 8 in 10 Covid-19 deaths in the U.S. have been among adults 65 and older.

Here are four risk factors that make older people more vulnerable to Covid-19 complications.

1. A changing immune system

“From a broad perspective, seniors have different susceptibility to different diseases and conditions, even the cold and flu,” says Ali Khan, MD, executive medical director of Oak Street Health in Chicago, which provides primary care to older adults. “The same is true in dramatic fashion with the coronavirus.”

This happens because the immune system, which acts as the body’s defense system, tends to weaken with age.

“It’s called immunosenescence, which is really just a fancy word for an aging immune system,” says Victoria Braund, MD, director of the division of geriatrics at NorthShore University HealthSystem. “As you get older, the immune system dials down.”

Conversely, older people also are more prone to a systemic overreaction of the immune system called a cytokine storm. This occurs when the immune system overresponds to a threat with a sudden release of cytokine molecules, which are part of the body’s immune response. In a cytokine storm, these cytokines can overtake the body’s other systems, potentially leading to multisystem organ failure and death.

“It’s the immune system reacting too hard to something that’s going on in the body,” Khan says. “It’s hyperinflammation. It can affect your heart and blood pressure. It can get very tenuous.”

To stay healthy, keep your immune system as strong as possible. “It comes down to the basics,” Khan says. “In general, people should work on maintaining a good diet, getting exercise, and doing stress-reducing activities like talking with friends. It gives your body the right baseline to be able to stave off an infection.”

2. Weight

People who are obese aren’t more likely to contract Covid-19, but they are more likely to become severely ill from it, according to the CDC.

Weight plays an important role in immune response. Obesity is linked to chronic inflammation, which could make a person more vulnerable to Covid-19’s deadly consequences, according to a 2019 study in Metabolism Open.

“We know that even small reductions of 5 or 10 pounds over a year can have a huge impact on a person’s health,” Khan says.

Losing weight can help reduce the risk of Covid-19 complications. “I wish there was a silver bullet, but it’s about overall health, and a lot of that comes down to weight,” he says.

3. Underlying health conditions

Older people are more likely to have a range of underlying health conditions including type 2 diabetes, heart disease, kidney disease, cancer, and lung disease, making it harder for them to fight off an infectious disease.

“If you have those pre-existing conditions and you aren’t managing them well, you might be at higher risk of inflammation,” Khan says.

A person with asthma, for instance, may have reduced lung function and a greater susceptibility to lung inflammation. A person with cancer may be taking immune-suppressing drugs that weaken the immune system.

4. Isolation and depression

Isolation and depression can also lead to more severe consequences of Covid-19. Many seniors have had to stay at home to avoid coming into contact with the coronavirus. They’ve lost their social connections as well as the activities that kept them engaged.

Many older adults “have lost their formal and informal support systems,” Braund says. “They get weak and rundown. They tend not to eat as well or drink enough water, which makes them more susceptible to not being able to defend against an infection.”

Recent studies have shown a link between social isolation and increased inflammation in the body. One, published in 2019 in Brain, Behavior, and Immunity, showed that social engagement and cohabitation are linked to lower inflammation in the body.

How to help

Braund says that seniors who need to stay home should find ways to combat loneliness, stay engaged, and connect, even if it’s by a video platform. If they can’t leave the house, they can connect with their physicians by video, too.

“I have a 98-year-old patient who called me about a rash on her neck, and I taught her how to FaceTime,” Braund says. “Being able to reach out to family and friends is an advantage of technology.”

But sometimes, people just need the basics — literally. Oak Street Health periodically calls its patients to learn what their needs are and connect them to services. “We’ve had drivers deliver toilet paper to them,” Khan says.

If older adults have underlying health conditions, they should keep those conditions in check as best they can in order to manage their risk of Covid-19 complications.

With no vaccine for Covid-19 yet available, living a healthy lifestyle and practicing such preventive measures as wearing a mask, avoiding crowded places, and washing hands frequently with soap and water or 60% alcohol hand sanitizer are currently the best ways to avoid Covid-19.

And even though older people are more vulnerable, Braund says, “We’ve had 30- and 40-year-olds who’ve crashed and burned. Covid-19 doesn’t just happen to old people.”


Illustrations by Andrea Fowler. Originally published in the Fall 2020/Winter 2021 print issue.

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