LAUSR

Background Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the amount of published studies, several unmet needs about the care for older adults exist. Objectives To discuss unmet needs of COVID-19 in this special population. Sources A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide the literature search. The search was conducted in the MEDLINE database combining specific search terms. Two reviewers independently conducted the search and selected the studies according to the pre-specified clinical questions. Content Elderly patients with COVID-19 have peculiar characteristics. They may have atypical clinical presentation, with no fever and delirium or neurological manifestations as the most common signs, with potential delayed diagnosis and increased risk of death. The reported fatality rates among elderly patients with COVID-19 are extremely high. Several factors, including comorbidities, atypical presentation, and exclusion from ICU care contribute to this excess of mortality. Age alone is frequently used as key factor to exclude elderly from intensive care, but there is evidence that frailty instead of age better predicts the risk of poor outcome in this category. Durability of vaccine efficacy in the elderly remains debated and need for the third booster dose is becoming more and more evident. Finally, efforts to care for elderly who survived after acute COVID-19 should be implemented, considering the high rates of long COVID sequelae and the risk of longitudinal functional and cognitive decline. Implications We hereby highlighted peculiar aspects of COVID-19 in elderly patients and factors contributing to high risk of poor outcome in this category. We also illuminated gaps in current evidence suggesting future research directions and underlining the need of further studies about the optimal management of elderly patients with COVID-19.