Ask the Pharmacist

Q) I’m worried about my mother who is a senior and how she will fare with COVID-19. Is there anything I should be aware of that is different for seniors versus the rest of the population?

A) There are a number of special considerations when it comes to our elderly and the threats imposed by this pandemic. Much but not all of these differences relates to their immune system. It is a well known consequence of the aging process that there is a gradual and progressive decline in immune function.

This is not to say that our elderly are immunodeficient in the same way as someone who has had a transplant or is undergoing chemotherapy is. But, the ability of their body to respond to new infections, such as COVID-19, is drastically reduced. Researchers believe this is due to changes at multiple levels of the immune system that include a reduced production of B and T cells (these are highly specialised defender cells that recognize invaders and attack them) in the bone marrow and the thymus and diminished activity from our mature lymphocytes.

All of this leads to two negative consequences for our seniors. One is that they are more likely to catch an infection such as the coronavirus and fare less well in fighting it off. This makes sense given what we have been discussing and the numbers bear it out. Of the 1,121 deaths in Ontario (as of early May 1st), 291 of the deceased were between the ages of 60 and 79 and 774 were over the age of 80. Clearly this infection is having an exaggerated impact upon this demographic when compared to younger generations.

The second negative consequence of this impairment of their immune system is that it is often more difficult to recognize infections in the elderly leading to less timely medical interventions and therefore poorer outcomes. Seniors tend to have a “blunted” response to infection.

For example, the ability of their body to regulate its temperature in response to a virus is frequently altered meaning that they are less likely to be able to produce the most easily detectable sign of an infection, a fever.

On top of this there are several other factors that make recognizing an infection in seniors more challenging. Seniors more often have other chronic illnesses which can mask or interfere with signs of infection. For example, patients who have suffered a previous stroke may not be able to produce a cough. Cognitive impairment also plays a role in all of this as these seniors may not be able to communicate their symptoms to their caregivers.

There have been a number of articles in the press reflecting upon this as they discuss the multitude of seniors who are refused testing and are later hospitalized for severe symptoms. Many doctors now say that we have to get better at recognizing what they term the atypical symptoms that are frequently the only signs a senior may exhibit if they have this infection. So rather than strictly focussing on the big 3 (fever, cough and shortness of breath) we need to expand our scope and look for more subtle signs.

One doctor termed that if your parent or spouse seems a little “off” you would do well to keep a close eye upon them. This may manifest itself as sleeping more than usual or a decrease in appetite. Or they may just seem more apathetic (i.e. a lack of interest) about life in general. Some seem to be more confused than normal, losing orientation to their surroundings which may cause them to take time to ponder where their bathroom is. Dizzy spells with subsequent falls also seem to be another potential symptom in seniors as is a decreased tendency to speak.

Other signs that make the list as being more prevalent in seniors include fatigue/ lethargy, low blood pressure, painful swallowing, GI symptoms (nausea, vomiting, abdominal pain and diarrhea) and the loss of smell and taste.

There is also a hidden threat to our seniors when it comes to our response to this pandemic. Many of their routines and activities have either been altered or stopped altogether putting them at risk of becoming weaker physically and/ or declining cognitively. This all stems from the necessity of having to be isolated within their homes (or rooms in the case of a senior’s facility) and the resultant lack of interaction with others which is critical in maintaining brain function.

Loved ones must step up and do their best to engage their relatives/ neighbours on a regular basis in order to prevent the apathy and depression that isolation can make anybody susceptible to. As well, some seniors will need help with meeting their nutritional needs now that getting to a grocery store is both more challenging and dangerous for them as well as regular medical issues such as managing all of their medications or other existing medical conditions such as diabetes.

Now, perhaps more than ever, our seniors need our support. So let’s all agree to be a little extra vigilant with respect to our elderly without taking it to extremes. Everyone is entitled to have a “bad” day or two when the memory isn’t working quite as well as we’re used to or the energy levels sag. But, if they are definitely not themselves for a couple of days, please reach out to their family doctor even if they do not appear to be sick.

For more information about this or any other health related questions, contact your pharmacist.