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Scientific knowledge about infections by the new coronavirus in older adults: a scoping review

Conocimiento científico sobre las infecciones por el nuevo coronavirus en los ancianos: scoping review

ABSTRACT

Objective:

to map the scientific knowledge about COVID-19 in older adults.

Method:

this is a scoping review literature review. A search was performed in the PubMed, CINAHL, Web of Science and LILACS databases. Original articles that answered the guiding question were included: what scientific knowledge is available in the world about COVID-19 in older adults?

Results:

thirty-one articles were included, most of them carried out in China (n=23) and with a retrospective design (n=13) and case studies/case series (n=13). Based on the findings, six thematic categories emerged: clinical signs and symptoms (n=12), other information (n=9), adverse outcomes/complications resulting from COVID-19 (n=8), age relationship and greater severity of COVID-19 (n=8), variables related to death by COVID-19 (n=8), and diagnostic findings (n=8).

Conclusion:

the findings reinforce older adults’ greater vulnerability to the worsening of COVID-19, as well as to complications resulting from the disease, including the greater occurrence of death.

Descriptors:
Aged; Coronavirus; Severe Acute Respiratory Syndrome; Coronavirus Infections; Geriatric Nursing

RESUMEN

Objetivo:

mapear el conocimiento científico sobre COVID-19 en ancianos.

Método:

revisión de la literatura del tipo scoping review. Se realizó una búsqueda en las bases de datos PubMed, CINAHL, Web of Science y LILACS. Se incluyeron artículos originales que respondieron a la pregunta orientadora: ¿qué conocimiento científico está disponible en el mundo sobre el COVID-19 en los ancianos?

Resultados:

se incluyeron 31 artículos, la mayoría realizados en China (n=23) y con un diseño retrospectivo (n=13) y estudios de casos/series de casos (n=13). A partir de los hallazgos, surgieron seis categorías temáticas: signos y síntomas clínicos (n=12); otra información (n=9); resultados/complicaciones adversos resultantes de COVID-19 (n=8); relación de edad y mayor gravedad de COVID-19 (n=8); variables relacionadas con la muerte por COVID-19 (n=8); hallazgos diagnósticos (n=8).

Conclusión:

los hallazgos refuerzan la mayor vulnerabilidad de los ancianos al agravamiento del COVID-19, así como las complicaciones derivadas de la enfermedad, incluida la mayor ocurrencia de muerte.

Descriptores:
Anciano; Coronavirus; Síndrome Respiratorio Agudo Grave; Infecciones por Coronavírus; Enfermería Geriátrica

RESUMO

Objetivo:

mapear o conhecimento científico sobre a COVID-19 no idoso.

Método:

revisão da literatura do tipo scoping review. Realizou-se uma busca nas bases de dados PubMed, CINAHL, Web of Science e LILACS. Incluíram-se os artigos originais que responderam à questão norteadora: quais os conhecimentos científicos disponíveis no mundo sobre a COVID-19 no idoso?

Resultados:

foram incluídos 31 artigos, a maioria realizada na China (n=23) e de delineamento retrospectivo (n=13) e estudos de casos/série de casos (n=13). Com base nos achados, emergiram seis categorias temáticas: sinais e sintomas clínicos (n=12); outras informações (n=9); desfechos adversos/complicações decorrentes da COVID-19 (n=8); relação da idade e maior gravidade da COVID-19 (n=8); variáveis relacionadas ao óbito pela COVID-19 (n=8); achados diagnósticos (n=8).

Conclusão:

os achados reforçam a maior vulnerabilidade do idoso ao agravamento da COVID-19, bem como as complicações decorrentes da doença, incluindo a maior ocorrência de óbito.

Descritores:
Idoso; Coronavírus; Síndrome Respiratória Aguda Grave; Infecções por Coronavírus; Enfermagem Geriátrica

Descriptores:
Anciano; Coronavirus; Síndrome Respiratorio Agudo Grave; Infecciones por Coronavírus; Enfermería Geriátrica

RESUMEN

Objetivo:

mapear el conocimiento científico sobre COVID-19 en ancianos.

Método:

revisión de la literatura del tipo scoping review. Se realizó una búsqueda en las bases de datos PubMed, CINAHL, Web of Science y LILACS. Se incluyeron artículos originales que respondieron a la pregunta orientadora: ¿qué conocimiento científico está disponible en el mundo sobre el COVID-19 en los ancianos?

Resultados:

se incluyeron 31 artículos, la mayoría realizados en China (n=23) y con un diseño retrospectivo (n=13) y estudios de casos/series de casos (n=13). A partir de los hallazgos, surgieron seis categorías temáticas: signos y síntomas clínicos (n=12); otra información (n=9); resultados/complicaciones adversos resultantes de COVID-19 (n=8); relación de edad y mayor gravedad de COVID-19 (n=8); variables relacionadas con la muerte por COVID-19 (n=8); hallazgos diagnósticos (n=8).

Conclusión:

los hallazgos refuerzan la mayor vulnerabilidad de los ancianos al agravamiento del COVID-19, así como las complicaciones derivadas de la enfermedad, incluida la mayor ocurrencia de muerte.

INTRODUCTION

COVID-19 is an acute respiratory disease caused by the new coronavirus (SARS-CoV-2)(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
), which was declared a Public Health Emergency of International Concern and characterized as a pandemic on March 11, 2020(22 Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ. 2020;368:m1036. https://doi.org/10.1136/bmj.m1036
https://doi.org/10.1136/bmj.m1036...
). The clinical picture of COVID-19, in most cases, has been reported as similar to other respiratory infections, with fever (≥37.8ºC), coryza, cough, usually dry and tired(33 Strabelli TMV, Uip DE. COVID-19 and the Heart. Arq Bras Cardiol. 2020;114(4):598-600. https://doi.org/10.36660/abc.20200209
https://doi.org/10.36660/abc.20200209...
). The reverse-transcriptase polymerase chain reaction (RT-PCR, polymerase chain reaction with reverse transcription) by nasopharyngeal swab was the reference standard for definitive diagnosis of infection with the new coronavirus(33 Strabelli TMV, Uip DE. COVID-19 and the Heart. Arq Bras Cardiol. 2020;114(4):598-600. https://doi.org/10.36660/abc.20200209
https://doi.org/10.36660/abc.20200209...
). However, it is estimated that 5% of those infected develop the most severe form of the disease, with symptoms of dyspnea and/or signs of pulmonary bleeding, severe lymphopenia, and kidney failure(33 Strabelli TMV, Uip DE. COVID-19 and the Heart. Arq Bras Cardiol. 2020;114(4):598-600. https://doi.org/10.36660/abc.20200209
https://doi.org/10.36660/abc.20200209...
).

Due to the physiological changes that occur with the human aging process and compromise the immune system, and the greater number of complications resulting from chronic diseases, older adults have been the most vulnerable to severe forms of COVID-19 and for evolution to death(44 D'Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-term Care: the ABCDs of COVID-19. J Am Geriatr Soc. 2020;68(5):1-6. https://doi.org/10.1111/jgs.16445
https://doi.org/10.1111/jgs.16445...
). In an epidemiological cohort study conducted in China, most cases of COVID-19 and the worst prognosis for this disease were among older adults(55 Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23. https://doi.org/10.1001/jama.2020.6130
https://doi.org/10.1001/jama.2020.6130...
). Supporting these findings, data demonstrated that the occurrence of death by COVID-19 increased exponentially from 3 to 5% among people aged 65├75 years, from 4 to 11% among people aged 75├85 years and from 10 to 27% among people aged 85 years and over. Moreover, people aged 65 and over represented 45% more hospital admissions, 53% of occupations in Intensive Care Units and 80% of deaths(66 Centers for Disease Control and Prevention. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12 - March 16, 2020. Morbidity and Mortality Weekly Report (MMWR)[Internet]. 2020 [cited 2020 May 05];69(12):343-6. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
https://www.cdc.gov/mmwr/volumes/69/wr/m...
). This leads to the belief that more comprehensive measures are needed to protect older adults.

In this regard, studies are needed to subsidize the care of health professionals to older adults with COVID-19 and, likewise, to give direction to sectoral and intersectoral actions under an integrating look among all instances involved in facing this pandemic situation. This scientific basis can support health teams’ work, in order to develop interventions that can favor older adults’ management and health care.

Given the above, the scoping review is considered a useful tool to identify and synthesize scientific knowledge(77 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual, JBI. [Internet]. 2020 [cited 2020 May 05]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
), especially in the COVID-19 pandemic, enabling planning care actions for older adults, which are foundations in evidence-based practice. Furthermore, assessment of studies may target priority areas that need to advance knowledge on this emerging topic.

OBJECTIVE

To map the scientific knowledge about COVID-19 in older adults.

METHODS

This is scoping review literature developed according to the Joanna Briggs Institute protocol(77 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual, JBI. [Internet]. 2020 [cited 2020 May 05]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
).

To develop the research question, Population, Concept and Context (PCC)(77 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual, JBI. [Internet]. 2020 [cited 2020 May 05]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
) was used, being: P - older adults; C - COVID-19; C - scientific knowledge. Thus, the guiding question was established: what scientific knowledge is available in the world about COVID-19 in older adults? Older adults were defined as persons aged 60 and over(88 Presidência da República (BR). Lei nº 10.741, de 1º de outubro de 2003. Dispõe sobre o Estatuto do Idoso e dá outras providências [Internet]. Brasília (DF): Diário Oficial da União; 2003 [cited 18 Aug 2020]. Available from: http://www.planalto.gov.br/ccivil_03/leis/2003/L10.741.htm
http://www.planalto.gov.br/ccivil_03/lei...
); COVID-19 was considered to be the disease caused by the new coronavirus (2019 novel coronavirus, acronym 2019-nCoV)(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
).

As an eligibility criterion, original articles, case reports and case series were all considered, all about COVID-19 and with data referring to older adults, from December 2019, when the first study on said disease(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
). Letters to the editor, opinion articles, and reflection articles were excluded.

Search strategy

In the first stage, a search was carried out in the National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, in which titles, abstracts and descriptors found were analyzed. In the second stage, all keywords and descriptors were used to identify the articles in other databases: Web of Science and Latin American and Caribbean Literature in Health Sciences (LILACS). In the third stage, the studies published on the PubCovid-19 platform (http://pubcovid19.pt/index.php), which covers articles published on COVID-19, divided into several themes, were analyzed as an additional source. Studies on the theme “older adults” were considered.

Search for primary studies was carried out on April 17, 2020. To that end, controlled and uncontrolled descriptors were delimited according to the databases using advanced search tools, i.e., the selected descriptors were crossed and combined using the Boolean operators “AND” and “OR”. The controlled descriptors (MESH) adopted in search strategy for primary studies were “Coronavirus, Coronavirus Infections”, “Severe Acute Respiratory Syndrome”, “SARS Virus” and “aged”, “aged, 80 and over”.

Considering that there are no specific descriptors available for the new coronavirus and that the first case of the disease was reported in December 2019(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
), the time frame was used to search the databases for primary studies (December 2019 until the data collection time).

Study selection and data extraction

The articles found were imported into the program on the Web Endnote - Clarivate Analytics (https://access.clarivate.com/login?app=endnote) for identification and exclusion of duplicates. Subsequently, the Rayyan QCRI - Qatar Computing Research Institute (https://rayyan.qcri.org/welcome) program was used to manage the selection process of the final sample.

For data extraction, a script was elaborated containing information related to authorship, year and place of publication, type of study, participants, study period, and results. Article assessment and data extraction were conducted by two independent reviewers (NGNO and MADR), with disagreements sorted out by a third reviewer (AFB).

Analysis of evidence

Data synthesis was performed descriptively considering the construction of thematic categories, which addressed the results of original studies on COVID-19 in older adults worldwide.

RESULTS

The Preferred Reporting Items for Systematic Review and Meta-Analys for Scoping Reviews (PRISMA) diagram(99 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Loannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100
https://doi.org/10.1371/journal.pmed.100...
) was used to present the article selection steps (Figure 1).

Figure 1
Flow diagram of study selection in the databases according to Preferred Reporting Items for Systematic Review and Meta-Analyzes for Scoping Reviews (PRISMA)(99 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Loannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100
https://doi.org/10.1371/journal.pmed.100...
)

In the first stage, 440 articles were found in the databases and 79 identified in the PubCovid-19 Platform, 103 of which were excluded by duplicate. After reading all titles and abstracts, 92 articles were included for reading in full, in order to answer the research question. Studies that did not meet the inclusion criteria (n=61) were excluded due to different population (n=19), study design (n=37), and others (n=5). Therefore, 31 articles made up the final sample of this scoping review (Figure 1).

Of the 31 articles analyzed, all were published in 2020 and the majority in China (n=23). Case report (n=13) and retrospective (n=13) studies figured prominently, which aimed mainly to investigate the epidemiological, clinical and diagnostic characteristics of COVID-19.

With regard to case studies/case series (n=13), a large part (n=6) occurred in January 2020 aiming to report, by and large, the clinical characteristics, the diagnostic findings and the prospects for treatment of the first confirmed cases for COVID-19. Other information was highlighted in these reports, such as: improvement of serial laboratory parameters and oxygenation with the infusion of plasma in treatment of two older adults hospitalized with COVID-19(1010 Ahn JY, Sohn Y, Lee SH, Cho Y, Hyun JH, Baek YJ, et al. Use of convalescent plasma therapy in two COVID-19 patients with acute respiratory distress syndrome in Korea. J Korean Med Sci. 2020;35(14):e149. https://doi.org/10.3346/jkms.2020.35.e149
https://doi.org/10.3346/jkms.2020.35.e14...
); the best clinical evolution of a female older adult immunocompromised in relation to her immunocompetent spouse(1111 Spezzani V, Piunno A, Iselin HU. Benign COVID-19 in an immune compromised cancer patient - the case of a married couple. Swiss Med Wkly. 2020;150:w20246. https://doi.org/10.4414/smw.2020.20246
https://doi.org/10.4414/smw.2020.20246...
); syncope(1212 Tapé C, Byrd KM, Aung S, Lonks JR, Flanigan TP, Rybak NR. COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray. R I Med J[Internet]. 2020 [cited 18 Aug 2020];103(3):50-1. Available from: http://rimed.org/rimedicaljournal/2020/04/2020-04-50-case-tape.pdf
http://rimed.org/rimedicaljournal/2020/0...
), malnutrition(1313 Yuan Y, Wang N, Ou X. Caution should be exercised for the detection of SARS-CoV-2, especially in the elderly. J Med Virol. 2020;92:1641-8. https://doi.org/10.1002/jmv.25796
https://doi.org/10.1002/jmv.25796...
) and rhabdomyolysis(1414 Suwanwongse K, Shabarek N. Rhabdomyolysis as a Presentation of 2019 Novel Coronavirus Disease. Cureus. 2020;12(4):e7561. https://doi.org/10.7759/cureus.7561
https://doi.org/10.7759/cureus.7561...
) in cases of older adults with COVID-19; and diagnostic findings by computed tomography(1515 Chen X, Liu S, Zhang C, Pu G, Sun J, Shen J, et al. Dynamic chest CT evaluation in three cases of 2019 novel coronavirus pneumonia. Arch Iran Med. 2020;23(4):277-80. https://doi.org/10.34172/aim.2020.11
https://doi.org/10.34172/aim.2020.11...

16 Moreira BL, Brotto MPD'A, Marchiori E. Chest radiography and computed tomography findings from a Brazilian patient with COVID-19 pneumonia. Rev Soc Bras Med Trop. 2020;53:e20200134. https://doi.org/10.1590/0037-8682-0134-2020
https://doi.org/10.1590/0037-8682-0134-2...
-1717 Quin C, Liu F, Yen TC, Lan X. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47(5):1281-6. https://doi.org/10.1007/s00259-020-04734-w
https://doi.org/10.1007/s00259-020-04734...
) (Chart 1).

Chart 1
Characteristics of case reports or case series on COVID-19 in older adults according to authorship, year of publication, country, type of study, study participants, period, and main results

The synthesis of scientific knowledge was distributed in two groups according to study design, the first being case reports/case series (n=13) (Chart 1); and the second according to other scientific results (n=18) about COVID-19 in older adults (Chart 2).

Chart 2
Characteristics of scientific knowledge about COVID-19 in older adults according to authorship, year of publication, country, type of study, study participants, period, and main results

As for other designs of the studies (n=18) (Chart 2), it was found that two were carried out only with older adults, in the others (n=16), participants were constituted by the general population, which presented results on COVID-19 stratified according to age group, which included older adults. The number of study participants ranged from 17(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
) to 13,909(2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
) older adults, with heterogeneous selection criteria, being: confirmed diagnoses of COVID-19(66 Centers for Disease Control and Prevention. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12 - March 16, 2020. Morbidity and Mortality Weekly Report (MMWR)[Internet]. 2020 [cited 2020 May 05];69(12):343-6. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
https://www.cdc.gov/mmwr/volumes/69/wr/m...
.2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...

25 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...

26 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...

27 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...

28 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...

29 Chen Z, Fan H, Cai J, Li J, Wu B, Hou Y, et al. High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. Eur J Radiol. 2020;126(108972):1-6. https://doi.org/10.1016/j.ejrad.2020.108972
https://doi.org/10.1016/j.ejrad.2020.108...

30 Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020;95(1):421-8. https://doi.org/10.1016/j.ijid.2020.03.070
https://doi.org/10.1016/j.ijid.2020.03.0...
-3131 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...
); pneumonia by COVID-19(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
.3131 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...

32 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
-3333 Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/https://doi.org/10.1016/...
); adults with one or more morbidities(3434 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239...
); deaths associated with COVID-19(2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
.3535 Kirigia JM, Muthuri RNDK. The fiscal value of human lives lost from coronavirus disease (COVID-19) in China. BMC Res Notes. 2020;13(1):198-202. https://doi.org/10.1186/s13104-020-05044-y
https://doi.org/10.1186/s13104-020-05044...
); suspected cases(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and confirmed symptomatic of the disease(3636 Zhu N, Zhang D, Wang W, Xingwang L, Yang B, Song J, et al. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017
https://doi.org/10.1056/NEJMoa2001017...
). The sample data, from most surveys, were related to the period of January and/or February (n=13). The consecutive and non-probabilistic sample was used in 17 studies (Chart 2).

Based on the findings of the studies included in this scoping review (n=31), six thematic categories of the main results of studies on COVID-19 in older adults were listed, as shown in Chart 3.

Chart 3
Thematic categories of the main results on COVID-19 in older adults

As for outcomes/complications resulting from COVID-19 (n=8), there was a higher proportion of hospitalizations in older adults in Intensive Care Units(2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
), severe pneumonia(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and a lower proportion of discharge in these units in relation to the younger groups(2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
). Descriptively, higher percentages of other complications resulting from the disease were identified in older adults, such as mortality(2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
,2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
,3535 Kirigia JM, Muthuri RNDK. The fiscal value of human lives lost from coronavirus disease (COVID-19) in China. BMC Res Notes. 2020;13(1):198-202. https://doi.org/10.1186/s13104-020-05044-y
https://doi.org/10.1186/s13104-020-05044...
), severe acute respiratory syndrome(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3737 Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta. 2020;505:172-175. https://doi.org/10.1016/j.cca.2020.03.009
https://doi.org/10.1016/j.cca.2020.03.00...
), cardiac injuries(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), hepatic injuries(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
.3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and acute renal injuries(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), secondary infection(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), shock, acute respiratory distress syndrome(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), multiple organ failure(1818 Lescure FX , Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697-706. https://doi.org/10.1016/S1473-3099(20)30200-0
https://doi.org/10.1016/S1473-3099(20)30...
), pneumonia(3131 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...
), and use of mechanical ventilation(2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...

26 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...

27 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...

28 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...

29 Chen Z, Fan H, Cai J, Li J, Wu B, Hou Y, et al. High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. Eur J Radiol. 2020;126(108972):1-6. https://doi.org/10.1016/j.ejrad.2020.108972
https://doi.org/10.1016/j.ejrad.2020.108...

30 Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020;95(1):421-8. https://doi.org/10.1016/j.ijid.2020.03.070
https://doi.org/10.1016/j.ijid.2020.03.0...

31 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...

32 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...

33 Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/https://doi.org/10.1016/...
-3434 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239...
) (Chart 3).

Those with advanced age had a higher severity of COVID-19(55 Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23. https://doi.org/10.1001/jama.2020.6130
https://doi.org/10.1001/jama.2020.6130...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
-2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
-2828 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...
,3030 Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020;95(1):421-8. https://doi.org/10.1016/j.ijid.2020.03.070
https://doi.org/10.1016/j.ijid.2020.03.0...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
,.3434 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239...
) (n=8). Likewise, advanced age was related to the occurrence of death by COVID-19(1717 Quin C, Liu F, Yen TC, Lan X. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47(5):1281-6. https://doi.org/10.1007/s00259-020-04734-w
https://doi.org/10.1007/s00259-020-04734...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
,2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
) (n=4). Also related to death: occurrence of acute respiratory distress syndrome and obstructive pulmonary disease, presence of comorbidities and symptoms of dyspnea(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), and greater development of serious charts(55 Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23. https://doi.org/10.1001/jama.2020.6130
https://doi.org/10.1001/jama.2020.6130...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
,2828 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) (Chart 3).

Also, the high cost resulting from deaths from the disease stands out(3535 Kirigia JM, Muthuri RNDK. The fiscal value of human lives lost from coronavirus disease (COVID-19) in China. BMC Res Notes. 2020;13(1):198-202. https://doi.org/10.1186/s13104-020-05044-y
https://doi.org/10.1186/s13104-020-05044...
); high prevalence of comorbidities among infected older adults, especially hypertension, diabetes mellitus and cardiovascular diseases(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
); higher occurrence of COVID-19 infection in older adults(3737 Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta. 2020;505:172-175. https://doi.org/10.1016/j.cca.2020.03.009
https://doi.org/10.1016/j.cca.2020.03.00...
); treatment of COVID-19 with plasma infusion(1010 Ahn JY, Sohn Y, Lee SH, Cho Y, Hyun JH, Baek YJ, et al. Use of convalescent plasma therapy in two COVID-19 patients with acute respiratory distress syndrome in Korea. J Korean Med Sci. 2020;35(14):e149. https://doi.org/10.3346/jkms.2020.35.e149
https://doi.org/10.3346/jkms.2020.35.e14...
); andclinical analysis of COVID-19 in an immunocompromised patient(1111 Spezzani V, Piunno A, Iselin HU. Benign COVID-19 in an immune compromised cancer patient - the case of a married couple. Swiss Med Wkly. 2020;150:w20246. https://doi.org/10.4414/smw.2020.20246
https://doi.org/10.4414/smw.2020.20246...
) andgenomic characteristics of the virus(1919 Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020. Euro Surveill. 2020;25(8):1-5. https://doi.org/10.2807/1560-7917.ES.2020.25.8.2000097
https://doi.org/10.2807/1560-7917.ES.202...
) (n=9) (Chart 3).

With regard to studies that addressed the clinical signs of the disease in older adults (n=12), the results identified dyspnea(2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), dry cough(1717 Quin C, Liu F, Yen TC, Lan X. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47(5):1281-6. https://doi.org/10.1007/s00259-020-04734-w
https://doi.org/10.1007/s00259-020-04734...
,2020 Wang Z, Chen X, Li Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020;14(1):64-8. https://doi.org/10.5582/bst.2020.01030
https://doi.org/10.5582/bst.2020.0103...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), fever(1212 Tapé C, Byrd KM, Aung S, Lonks JR, Flanigan TP, Rybak NR. COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray. R I Med J[Internet]. 2020 [cited 18 Aug 2020];103(3):50-1. Available from: http://rimed.org/rimedicaljournal/2020/04/2020-04-50-case-tape.pdf
http://rimed.org/rimedicaljournal/2020/0...
.2020 Wang Z, Chen X, Li Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020;14(1):64-8. https://doi.org/10.5582/bst.2020.01030
https://doi.org/10.5582/bst.2020.0103...
,2222 Chan JFW, Yuan S, Kok KH, To KKW, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23. https://doi.org/10.1016/S0140-6736(20)30154-9
https://doi.org/10.1016/S0140-6736(20)30...

23 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
-2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), and fatigue(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), in addition to lower oxygen saturation rates(2121 Zang W. Imaging changes in severe COVID-19 pneumonia. Intensive Care Med. 2020;46:583-5. https://doi.org/10.1007/s00134-020-05976-w
https://doi.org/10.1007/s00134-020-05976...
,3838 Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-77. https://doi.org/10.1093/cid/ciaa272
https://doi.org/10.1093/cid/ciaa272...
). Symptoms of vdizziness, constipation(2020 Wang Z, Chen X, Li Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020;14(1):64-8. https://doi.org/10.5582/bst.2020.01030
https://doi.org/10.5582/bst.2020.0103...
), syncope(1212 Tapé C, Byrd KM, Aung S, Lonks JR, Flanigan TP, Rybak NR. COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray. R I Med J[Internet]. 2020 [cited 18 Aug 2020];103(3):50-1. Available from: http://rimed.org/rimedicaljournal/2020/04/2020-04-50-case-tape.pdf
http://rimed.org/rimedicaljournal/2020/0...
), malnutrition(1313 Yuan Y, Wang N, Ou X. Caution should be exercised for the detection of SARS-CoV-2, especially in the elderly. J Med Virol. 2020;92:1641-8. https://doi.org/10.1002/jmv.25796
https://doi.org/10.1002/jmv.25796...
) and rhabdomyolysis(1414 Suwanwongse K, Shabarek N. Rhabdomyolysis as a Presentation of 2019 Novel Coronavirus Disease. Cureus. 2020;12(4):e7561. https://doi.org/10.7759/cureus.7561
https://doi.org/10.7759/cureus.7561...
) (Chart 3) were also reported.

The diagnostic findings by computed tomography (n=8) identified changes in the lungs, in particular, the involvement of the pulmonary lobes(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
,3636 Zhu N, Zhang D, Wang W, Xingwang L, Yang B, Song J, et al. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017
https://doi.org/10.1056/NEJMoa2001017...
). They also found a lower proportion of lymphocytes in older adults compared to young people(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and the occurrence of lymphocytopenia(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
) (Chart 3).

DISCUSSION

The current study is one of the first to map scientific knowledge about infection with the new coronavirus in older adults. Mapping the literature, which deals with aspects related to COVID-19 in this population, allowed to outline the different contexts of investigations with this theme, with regard to adverse outcomes/complications, the relationship of age and greater severity of the disease, deaths, clinical signs, diagnostic findings, and other information.

Most of studies in this review concentrated in China, because the outbreak started in this country(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
), and presented a descriptive design, with non-probabilistic and consecutive samples. The option for the design, possibly, was due to the emergency nature of building knowledge about the COVID-19 pandemic. However, the set of findings shows that there are still few studies in the world, which were carried out specifically with older adults, highlighting the need to expand scientific knowledge on this topic. Thus, it is necessary to increasingly qualify scientific productions according to the evolution of the pandemic and, therefore, to advance in knowledge about the dynamics of the disease and its impact on society, on older adults, and their families.

The greater likelihood that older adults will develop complications from infection with the new coronavirus compared to the general population was identified in this review. The analysis of information on adverse outcomes related to COVID-19 in older adults, such as progression of disease severity and hospital discharge, can provide information to guide the most effective treatment of the disease(3939 Lithander FE, Neumann S, Tenison E, Lloyd K, Welsh TJ, Rodrigues JCL, et al. COVID-19 in older people: a rapid clinical review. Age Ageing. 2020;49(4):501-15. https://doi.org/10.1093/ageing/afaa093
https://doi.org/10.1093/ageing/afaa093...
) in managing care and health service resources.

It also favors organization of work in primary care, which, in addition to maintaining continuity of care for chronic diseases, should also undertake health surveillance actions. In this perspective, nurses, based on the situational health diagnosis, will be able to identify the most vulnerable older adults and promote health education. The approach to older adults’ social support network provides the capillarity of effective information on preventive measures and care related to COVID-19, postponing its adverse effects.

It is noteworthy that the mortality in the SARS-CoV-2 pandemic in older adults has also been observed in some studies(1818 Lescure FX , Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697-706. https://doi.org/10.1016/S1473-3099(20)30200-0
https://doi.org/10.1016/S1473-3099(20)30...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
,2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
,3333 Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/https://doi.org/10.1016/...
), with advanced age related to this outcome(55 Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23. https://doi.org/10.1001/jama.2020.6130
https://doi.org/10.1001/jama.2020.6130...
,1818 Lescure FX , Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697-706. https://doi.org/10.1016/S1473-3099(20)30200-0
https://doi.org/10.1016/S1473-3099(20)30...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...

24 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
-2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
-2828 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...
,3030 Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020;95(1):421-8. https://doi.org/10.1016/j.ijid.2020.03.070
https://doi.org/10.1016/j.ijid.2020.03.0...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
,3434 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239...
). The highest proportion of severe pneumonia(3131 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...
-3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), associated with severe acute respiratory syndrome(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3737 Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta. 2020;505:172-175. https://doi.org/10.1016/j.cca.2020.03.009
https://doi.org/10.1016/j.cca.2020.03.00...
), acute cardiac(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), liver(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and acute kidney(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) injuries, secondary infection(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), shock(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
), acute respiratory distress syndrome(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), multiple organ failure(1818 Lescure FX , Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697-706. https://doi.org/10.1016/S1473-3099(20)30200-0
https://doi.org/10.1016/S1473-3099(20)30...
) and use of mechanical ventilation(2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...

26 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...

27 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...

28 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...

29 Chen Z, Fan H, Cai J, Li J, Wu B, Hou Y, et al. High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. Eur J Radiol. 2020;126(108972):1-6. https://doi.org/10.1016/j.ejrad.2020.108972
https://doi.org/10.1016/j.ejrad.2020.108...

30 Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020;95(1):421-8. https://doi.org/10.1016/j.ijid.2020.03.070
https://doi.org/10.1016/j.ijid.2020.03.0...

31 Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207. https://doi.org/10.1056/NEJMoa2001316
https://doi.org/10.1056/NEJMoa2001316...
-3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) are the main outcomes related to the severity of the cases with worst prognosis. As a consequence, the use of mechanical ventilation(2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and hospitalization in Intensive Care Units(11 Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Resp Res. 2020;21(1):74. https://doi.org/10.1186/s12931-020-01338-8
https://doi.org/10.1186/s12931-020-01338...
,2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
) is high as well as the lower proportion of discharge in these hospital units.

Likewise, acute respiratory distress syndrome and chronic obstructive pulmonary disease(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), old age(1818 Lescure FX , Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697-706. https://doi.org/10.1016/S1473-3099(20)30200-0
https://doi.org/10.1016/S1473-3099(20)30...
,2323 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
,2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), presence of comorbidities and dyspnea symptoms(2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), and the greater development of serious charts(55 Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-23. https://doi.org/10.1001/jama.2020.6130
https://doi.org/10.1001/jama.2020.6130...
,2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
,2828 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...
,3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) are responsible for the high death rate by COVID-19 in older adults. This relationship may be linked to physiological changes in the immune system resulting from the aging process as well as the greater number and complications of chronic diseases in older adults(44 D'Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-term Care: the ABCDs of COVID-19. J Am Geriatr Soc. 2020;68(5):1-6. https://doi.org/10.1111/jgs.16445
https://doi.org/10.1111/jgs.16445...
). The variables related to higher probability of death in older adults, verified in this review, contribute to outline the characteristics of older adults who are at higher risk for this outcome.

Therefore, attention is needed to the particularities of the development of the clinical picture in older adults. Dyspnea(2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), fever(1212 Tapé C, Byrd KM, Aung S, Lonks JR, Flanigan TP, Rybak NR. COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray. R I Med J[Internet]. 2020 [cited 18 Aug 2020];103(3):50-1. Available from: http://rimed.org/rimedicaljournal/2020/04/2020-04-50-case-tape.pdf
http://rimed.org/rimedicaljournal/2020/0...
,2020 Wang Z, Chen X, Li Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020;14(1):64-8. https://doi.org/10.5582/bst.2020.01030
https://doi.org/10.5582/bst.2020.0103...
,2222 Chan JFW, Yuan S, Kok KH, To KKW, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23. https://doi.org/10.1016/S0140-6736(20)30154-9
https://doi.org/10.1016/S0140-6736(20)30...

23 Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30...
-2424 Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
https://doi.org/10.1093/cid/ciaa242...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), cough(1919 Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020. Euro Surveill. 2020;25(8):1-5. https://doi.org/10.2807/1560-7917.ES.2020.25.8.2000097
https://doi.org/10.2807/1560-7917.ES.202...
-2020 Wang Z, Chen X, Li Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020;14(1):64-8. https://doi.org/10.5582/bst.2020.01030
https://doi.org/10.5582/bst.2020.0103...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
-2727 Chen TL, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020;glaa0089. https://doi.org/10.1093/gerona/glaa089
https://doi.org/10.1093/gerona/glaa089...
), fatigue(2828 Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020;288(1):128-38. https://doi.org/10.1111/joim.13063
https://doi.org/10.1111/joim.13063...
), and lower oxygen saturation rates (<90%)(2121 Zang W. Imaging changes in severe COVID-19 pneumonia. Intensive Care Med. 2020;46:583-5. https://doi.org/10.1007/s00134-020-05976-w
https://doi.org/10.1007/s00134-020-05976...
,3838 Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-77. https://doi.org/10.1093/cid/ciaa272
https://doi.org/10.1093/cid/ciaa272...
) are the main clinical findings that can guide the diagnosis of COVID -19. In a cohort study, older adults with mild and/or moderate infection with the new coronavirus were found to have fever as the most frequent symptom (82-87%), followed by coughing (36-66%)(4040 Michelen M, Jones N, Stavropoulou C. In patients of COVID-19, what are the symptoms and clinical features of mild and moderate cases? [Internet]. 2020 [cited 2020 May 05]. Available from: https://www.cebm.net/covid-19/in-patients-of-covid-19-what-are-the-symptoms-and-clinical-features-of-mild-and-moderate-case/
https://www.cebm.net/covid-19/in-patient...
). It should be noted that fever may not be present in older adults, referring to the need to investigate other symptoms, such as tiredness and cough(4040 Michelen M, Jones N, Stavropoulou C. In patients of COVID-19, what are the symptoms and clinical features of mild and moderate cases? [Internet]. 2020 [cited 2020 May 05]. Available from: https://www.cebm.net/covid-19/in-patients-of-covid-19-what-are-the-symptoms-and-clinical-features-of-mild-and-moderate-case/
https://www.cebm.net/covid-19/in-patient...
). Additionally, most of these studies reported the signs and symptoms of COVID-19 in patients with infection diagnosed in hospitals(2121 Zang W. Imaging changes in severe COVID-19 pneumonia. Intensive Care Med. 2020;46:583-5. https://doi.org/10.1007/s00134-020-05976-w
https://doi.org/10.1007/s00134-020-05976...
,2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
,3838 Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-77. https://doi.org/10.1093/cid/ciaa272
https://doi.org/10.1093/cid/ciaa272...
,4040 Michelen M, Jones N, Stavropoulou C. In patients of COVID-19, what are the symptoms and clinical features of mild and moderate cases? [Internet]. 2020 [cited 2020 May 05]. Available from: https://www.cebm.net/covid-19/in-patients-of-covid-19-what-are-the-symptoms-and-clinical-features-of-mild-and-moderate-case/
https://www.cebm.net/covid-19/in-patient...
), which assumes the relevance of advancing knowledge about the dynamics of the disease in older adults in representative population samples and before arriving at the hospital, seeking to prevent hospitalizations and worsening cases.

Considering the severity of the disease and its worst prognosis, the need to disseminate preventive measures for COVID-19 is reinforced in all areas of care, aiming at promoting older adults’ rights to life and health. In this regard, COVID-19 prevention among older adults with advanced age should be preferred, requiring interventions that can contain the worsening of the disease, in positive cases, minimizing the occurrence of these outcomes. Teams experienced in geriatrics and gerontology need to be agile in making the most appropriate decision in the context of older adults with advanced age.

Regarding diagnostic findings, computed tomography scans showed greater involvement of the pulmonary lobes(3636 Zhu N, Zhang D, Wang W, Xingwang L, Yang B, Song J, et al. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017
https://doi.org/10.1056/NEJMoa2001017...
-3737 Liu R, Han H, Liu F, Lv Z, Wu K, Liu Y, et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta. 2020;505:172-175. https://doi.org/10.1016/j.cca.2020.03.009
https://doi.org/10.1016/j.cca.2020.03.00...
) and proportion of subpleural line and pleural thickening(3636 Zhu N, Zhang D, Wang W, Xingwang L, Yang B, Song J, et al. A novel Coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017
https://doi.org/10.1056/NEJMoa2001017...
); in relation to young people, lower proportion of lymphocytes(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and lymphocytopenia(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
). These radiological changes may be absent at the beginning of the disease and be minimal in the mild form(2525 Grasselli G, Zangrillo A, Zanella A, Antonell M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUS of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394
https://doi.org/10.1001/jama.2020.5394...
). Therefore, other findings can be considered in the clinical assessment of older adults, such as the lowest proportion of lymphocytes(3232 Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. https://doi.org/10.1016/j.jinf.2020.03.005
https://doi.org/10.1016/j.jinf.2020.03.0...
) and lymphocytopenia(2626 Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45. https://doi.org/10.1016/j.jinf.2020.03.019
https://doi.org/10.1016/j.jinf.2020.03.0...
), as verified in this scoping review.

Thus, clinical signs and imaging tests can guide the diagnosis of COVID-19 and provide early isolation and treatment for older adults. However, no studies were found that offered specific information about the treatment of this disease, showing the relevance of investments in research.

Considering the higher risk of complications and death by COVID-19 among older adults, its protection has been considered a priority action in Brazil(4141 Oliveira KW, Duarte E, França GVA, Garcia LP. How Brazil can hold back COVID-19. Epidemiol Serv Saúde. 2020;29(2):e2020044. https://doi.org/10.5123/s1679-49742020000200023
https://doi.org/10.5123/s1679-4974202000...
). In this perspective, in addition to individual clinical focus, it is necessary, in this phase of the pandemic, to advance in reflections and research on the broad geriatric and gerontological approach in caring for older adults, namely: what are the impacts of social isolation for older adults? How to deal with the various situations that disadvantage social mitigation measures in older adults, such as those who live in a context of high social vulnerability and live alone? What is the relationship between frailty and geriatric syndromes with the occurrence of COVID-19?

Such reflections and investigations are urgent, as they may support health professionals’ role in caring for older adults and their families before this pandemic context. Experts from the American Society of Geriatrics stressed the importance of expanding knowledge in gerontology and geriatrics to health professionals to understand the health peculiarities of older adults and their impact on coping with COVID-19(4242 Trucil DE, Medina-Walpole A. In COVID-19 Response to Congress & Administration, AGS Calls for Access to Medical Supplies, Telehealth, Among Other Needs. Geriatr Nurs. 2020;41(3):347-8. https://doi.org/10.1016/j.gerinurse.2020.04.013
https://doi.org/10.1016/j.gerinurse.2020...
). The Brazilian Society of Geriatrics and Gerontology (SBGG - Sociedade Brasileira de Geriatria e Gerontologia), aware of the severity of the disease in older adults with comorbidities, recommends the adoption of measures to restrict social contact, avoiding crowds or trips during the COVID-19 pandemic. Moreover, it encourages that older adults should preferably be cared for at home, avoiding collective exposure in health services and that, in the event of being assisted by caregivers or health professionals, they should be screened for flu-like syndromes. Furthermore, special attention should be given to older adults who live in nursing homes (NHs), as they tend to be more frail(4343 Sociedade Brasileira de Geriatria e Gerontologia. Posicionamento sobre COVID-19 - Atualização 15/03/2020. [Internet]. 2020 [cited 2020 Oct 27]. Available from: https://sbgg.org.br/posicionamento-sobre-covid-19-sociedade-brasileira-de-geriatria-e-gerontologia-sbgg-atualizacao-15-03-2020/
https://sbgg.org.br/posicionamento-sobre...
).

In particular, nursing has a decisive role in facing the pandemic of COVID-19, considering that it corresponds to the largest health workforce and, in Brazil, they operate in all health care networks(4444 Silva MCND, Machado MH. Health and work system: challenges for the nursing in Brazil. Cienc Saúde Colet. 2020;25(1):7-13. https://doi.org/10.1590/1413-81232020251.27572019
https://doi.org/10.1590/1413-81232020251...
).

Study limitations

The types of studies available in scientific literature, at the beginning of the pandemic, were mostly descriptive and few carried out experimental investigations, testing the main interventions. On the other hand, the studies included in this review were not analyzed for methodological limitations or risk of bias, as proposed for scoping review. These two aspects may have brought together investigations with a low level of evidence; however, they met the proposed objective of presenting an overview of scientific knowledge available worldwide about COVID-19 in older adults.

Contributions to nursing

In this scoping review, no studies were identified that addressed nursing care directed to older adults affected with COVID-19. It is worth mentioning that the year 2020 was chosen to honor the bicentenary of Florence Nightingale, a precursor to modern nursing. Florence worked in the Crimean War(4545 The Lancet Editorial. 2020: unleashing the full potential of nursing. Lancet. 2019;394(10212):1879. https://doi.org/10.1016/S0140-6736(19)32794
https://doi.org/10.1016/S0140-6736(19)32...
) and, from her legacy, nurses have played an essential role in the prevention and control of infections, as well as in social mitigation measures(4646 Smith GD, Ng F, Li HCW. COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity. J Clin Nurs. 2020;29:1425-8. https://doi.org/10.1111/jocn.15231
https://doi.org/10.1111/jocn.15231...
). Such theoretical bases need to be rescued to support nursing professionals’ work in coping with COVID-19. The pandemic moment of COVID-19 reinforces the need for nurses to provide qualified and safe gerontological care, through fundamental professional training, and it is essential to develop care actions for older adults, considering, both in present and future scenarios, the particularities and specificities of this population.

CONCLUSION

Most of the research was carried out in China with a retrospective and case study type or case series design. With regard to case reports or case series, most aimed to report the clinical characteristics, diagnostic findings and treatment perspectives of the first confirmed cases of the disease. As for the other studies, participants ranged from 17 to 13,909 older adults, with heterogeneous selection criteria. Six thematic categories were identified: adverse outcomes/complications resulting from COVID-19, age relationship and greater severity of COVID-19, variables related to death by COVID-19, clinical signs and symptoms, diagnostic findings, and other information.

In general, scientific knowledge about COVID-19 in older adults is still incipient. However, they already indicate high vulnerability of older adults to the worsening of COVID-19 and to complications resulting from the disease, which includes a higher proportion of hospitalizations in Intensive Care Units and severe pneumonia and a lower proportion of hospital discharge compared to younger people. They also demonstrate that advanced age was related to the occurrence of death. There was also a major episode of COVID-19 infection in older adults, high cost due to deaths from the disease and high occurrence of comorbidities in this population group, when infected. In this context, it is suggested to carry out national surveys with representative samples of older adults in different Brazilian states, in order to contribute to improving health care for older adults before the COVID-19 pandemic.

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Edited by

EDITOR IN CHIEF: Dulce Barbosa
ASSOCIATE EDITOR: Mitzy Reichembach

Publication Dates

  • Publication in this collection
    14 Apr 2021
  • Date of issue
    2021

History

  • Received
    15 May 2020
  • Accepted
    06 Dec 2020
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