Rahman Sayeeda, Singh Keerti, Dhingra Sameer, Charan Jaykaran, Sharma Paras, Islam Salequl, Jahan Dilshad, Iskandar Katia, Samad Nandeeta, Haque Mainul
School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados.
Faculty of Medical Science, The University of the West Indies, Cave Hill Campus, Wanstead, Barbados.
Ther Clin Risk Manag. 2020 Oct 20;16:1007-1022. doi: 10.2147/TCRM.S272908. eCollection 2020.
COVID-19 pandemic is inducing acute respiratory distress syndrome, multi-organ failure, and eventual death. Respiratory failure is the leading cause of mortality in the elderly population with pre-existing medical conditions. This group is particularly vulnerable to infections due to a declined immune system, comorbidities, geriatric syndrome, and potentially inappropriate polypharmacy. These conditions make the elderly population more susceptible to the harmful effects of medications and the deleterious consequences of infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2. Chronic diseases among elderlies, including respiratory diseases, hypertension, diabetes, and coronary heart diseases, present a significant challenge for healthcare professionals. To comply with the clinical guidelines, the practitioner may prescribe a complex medication regimen that adds up to the burden of pre-existing treatment, potentially inducing adverse drug reactions and leading to harmful side-effects. Consequently, the geriatric population is at increased risk of falls, frailty, and dependence that enhances their susceptibility to morbidity and mortality due to SARS-CoV-2 respiratory syndrome, particularly interstitial pneumonia. The major challenge resides in the detection of infection that may present as atypical manifestations in this age group. Healthy aging can be possible with adequate preventive measures and appropriate medication regimen and follow-up. Adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection. Better training programs are needed to enhance the skill of health care professionals and patient's caregivers. This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing co-morbidities during the COVID-19 pandemic.
新型冠状病毒肺炎大流行正在引发急性呼吸窘迫综合征、多器官功能衰竭，并最终导致死亡。呼吸衰竭是患有基础疾病的老年人群死亡的主要原因。由于免疫系统衰退、合并症、老年综合征以及可能不适当的多种药物联合使用，这一群体特别容易受到感染。这些情况使老年人群更容易受到药物的有害影响以及感染的有害后果，包括中东呼吸综合征冠状病毒、严重急性呼吸综合征冠状病毒和严重急性呼吸综合征冠状病毒2。老年人中的慢性病，包括呼吸系统疾病、高血压、糖尿病和冠心病，给医疗保健专业人员带来了重大挑战。为了遵循临床指南，从业者可能会开出复杂的药物治疗方案，这增加了现有治疗的负担，可能会引发药物不良反应并导致有害的副作用。因此，老年人群跌倒、虚弱和依赖的风险增加，这增加了他们因严重急性呼吸综合征冠状病毒2呼吸道综合征，特别是间质性肺炎而发病和死亡的易感性。主要挑战在于检测可能在该年龄组中表现为非典型症状的感染。通过适当的预防措施、合适的药物治疗方案和随访，可以实现健康老龄化。遵守世界卫生组织、美国疾病控制与预防中心以及其他国家/地区/国际机构的指南和建议可以降低感染严重急性呼吸综合征冠状病毒2的风险。需要更好的培训项目来提高医疗保健专业人员和患者护理人员的技能。这篇综述解释了在新型冠状病毒肺炎大流行期间，多种药物联合使用对患有基础合并症的老年人群的公共卫生影响。
