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Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications

Covid-19 infection is a multisystem disease more frequent in older individuals, especially in those with multiple chronic diseases. This multimorbid and frail population requires attention and a personalized comprehensive assessment in order to avoid the occurrence of adverse outcomes. As other dise...

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Autores principales: Lauretani, Fulvio, Ravazzoni, Giulia, Roberti, Maria Federica, Longobucco, Yari, Adorni, Elisa, Grossi, Margherita, De Iorio, Aurelio, La Porta, Umberto, Fazio, Chiara, Gallini, Elena, Federici, Raffaele, Salvi, Marco, Ciarrocchi, Erika, Rossi, Francesca, Bergamin, Marina, Bussolati, Giacomo, Grieco, Ilaria, Broccoli, Federica, Zucchini, Irene, Ielo, Giuseppe, Morganti, Simonetta, Artoni, Andrea, Arisi, Arianna, Tagliaferri, Sara, Maggio, Marcello
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mattioli 1885 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569659/
https://www.ncbi.nlm.nih.gov/pubmed/32420939
http://dx.doi.org/10.23750/abm.v91i2.9629
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author Lauretani, Fulvio
Ravazzoni, Giulia
Roberti, Maria Federica
Longobucco, Yari
Adorni, Elisa
Grossi, Margherita
De Iorio, Aurelio
La Porta, Umberto
Fazio, Chiara
Gallini, Elena
Federici, Raffaele
Salvi, Marco
Ciarrocchi, Erika
Rossi, Francesca
Bergamin, Marina
Bussolati, Giacomo
Grieco, Ilaria
Broccoli, Federica
Zucchini, Irene
Ielo, Giuseppe
Morganti, Simonetta
Artoni, Andrea
Arisi, Arianna
Tagliaferri, Sara
Maggio, Marcello
author_facet Lauretani, Fulvio
Ravazzoni, Giulia
Roberti, Maria Federica
Longobucco, Yari
Adorni, Elisa
Grossi, Margherita
De Iorio, Aurelio
La Porta, Umberto
Fazio, Chiara
Gallini, Elena
Federici, Raffaele
Salvi, Marco
Ciarrocchi, Erika
Rossi, Francesca
Bergamin, Marina
Bussolati, Giacomo
Grieco, Ilaria
Broccoli, Federica
Zucchini, Irene
Ielo, Giuseppe
Morganti, Simonetta
Artoni, Andrea
Arisi, Arianna
Tagliaferri, Sara
Maggio, Marcello
author_sort Lauretani, Fulvio
collection PubMed
description Covid-19 infection is a multisystem disease more frequent in older individuals, especially in those with multiple chronic diseases. This multimorbid and frail population requires attention and a personalized comprehensive assessment in order to avoid the occurrence of adverse outcomes. As other diseases, the COVID-19 presentation in older patients is often atypical with less severe and unspecific symptoms. These subjects both at home and during hospitalization suffer isolation and the lack of support of caregivers. The geriatric care in COVID-19 wards is often missing. The application of additional instruments would be necessary to facilitate and personalize the clinical approach, not only based on diseases but also on functional status. This narrative review starts from diagnostic evaluation, continues with adapted pharmacologic treatment and ends with the recovery phase targeting the nutrition and physical exercise. We developed a check-list of respiratory, gastro-intestinal and other less-specific symptoms, summarized in a table and easily to be filled-up by patients, nurses and general practitioners. As second step, we reported the clinical phases of this disease. Far to be considered just viral infective and respiratory, this disease is also an inflammatory and thrombotic condition with frequent bacterial over-infection. We finally considered timing and selection of treatment, which depend on the disease phase, co-administration of other drugs and require the monitoring of renal, liver and cardiac function. This underlines the role of age not just as a limitation, but also an opportunity to increase the quality and the appropriateness of multidisciplinary and multidimensional intervention in this population. (www.actabiomedica.it)
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spelling pubmed-75696592020-10-21 Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications Lauretani, Fulvio Ravazzoni, Giulia Roberti, Maria Federica Longobucco, Yari Adorni, Elisa Grossi, Margherita De Iorio, Aurelio La Porta, Umberto Fazio, Chiara Gallini, Elena Federici, Raffaele Salvi, Marco Ciarrocchi, Erika Rossi, Francesca Bergamin, Marina Bussolati, Giacomo Grieco, Ilaria Broccoli, Federica Zucchini, Irene Ielo, Giuseppe Morganti, Simonetta Artoni, Andrea Arisi, Arianna Tagliaferri, Sara Maggio, Marcello Acta Biomed Reviews/Focus on Covid-19 infection is a multisystem disease more frequent in older individuals, especially in those with multiple chronic diseases. This multimorbid and frail population requires attention and a personalized comprehensive assessment in order to avoid the occurrence of adverse outcomes. As other diseases, the COVID-19 presentation in older patients is often atypical with less severe and unspecific symptoms. These subjects both at home and during hospitalization suffer isolation and the lack of support of caregivers. The geriatric care in COVID-19 wards is often missing. The application of additional instruments would be necessary to facilitate and personalize the clinical approach, not only based on diseases but also on functional status. This narrative review starts from diagnostic evaluation, continues with adapted pharmacologic treatment and ends with the recovery phase targeting the nutrition and physical exercise. We developed a check-list of respiratory, gastro-intestinal and other less-specific symptoms, summarized in a table and easily to be filled-up by patients, nurses and general practitioners. As second step, we reported the clinical phases of this disease. Far to be considered just viral infective and respiratory, this disease is also an inflammatory and thrombotic condition with frequent bacterial over-infection. We finally considered timing and selection of treatment, which depend on the disease phase, co-administration of other drugs and require the monitoring of renal, liver and cardiac function. This underlines the role of age not just as a limitation, but also an opportunity to increase the quality and the appropriateness of multidisciplinary and multidimensional intervention in this population. (www.actabiomedica.it) Mattioli 1885 2020 2020-05-11 /pmc/articles/PMC7569659/ /pubmed/32420939 http://dx.doi.org/10.23750/abm.v91i2.9629 Text en Copyright: © 2020 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA http://creativecommons.org/licenses/by-nc-sa/4.0 This work is licensed under a Creative Commons Attribution 4.0 International License
spellingShingle Reviews/Focus on
Lauretani, Fulvio
Ravazzoni, Giulia
Roberti, Maria Federica
Longobucco, Yari
Adorni, Elisa
Grossi, Margherita
De Iorio, Aurelio
La Porta, Umberto
Fazio, Chiara
Gallini, Elena
Federici, Raffaele
Salvi, Marco
Ciarrocchi, Erika
Rossi, Francesca
Bergamin, Marina
Bussolati, Giacomo
Grieco, Ilaria
Broccoli, Federica
Zucchini, Irene
Ielo, Giuseppe
Morganti, Simonetta
Artoni, Andrea
Arisi, Arianna
Tagliaferri, Sara
Maggio, Marcello
Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title_full Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title_fullStr Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title_full_unstemmed Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title_short Assessment and treatment of older individuals with COVID-19 multi-system disease: clinical and ethical implications
title_sort assessment and treatment of older individuals with covid-19 multi-system disease: clinical and ethical implications
topic Reviews/Focus on
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569659/
https://www.ncbi.nlm.nih.gov/pubmed/32420939
http://dx.doi.org/10.23750/abm.v91i2.9629
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