Coronavirus, nursing homes, and elderly: the age at which you're considered 'at risk'

With each decade added after 50 years of age, the mortality rate for coronavirus increases

The Life Care Center of Kirkland in Washington State has emerged as ground zero for one of the largest clusters of COVID-19 in the United States. This particular outbreak has revealed a vulnerable patient population in America’s efforts to against COVID-19: the elderly.

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It has been a sobering reminder of how vulnerable high-risk populations, including the elderly and people with pre-existing conditions such as heart disease, lung disease, and diabetes, are for developing serious COVID-19 illness. While one may say, “age is just a number” – in the context of COVID-19, with each decade added after 50 years of age, the mortality rate increases, too. The highest mortality rate of 14.8 percent is being seen in those 80 and over.

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The identification of this vulnerable patient population has several implications for not only the elderly but also long-term care facilities, where patients are more likely to have chronic health conditions or be of advanced age.

The Centers for Disease Control and Prevention (CDC) refers to nursing homes, skilled nursing facilities, and assisted living facilities collectively as long-term care facilities (LTCFs).

The CDC estimates that over 4 million Americans are admitted to LTCF each year. With a growing focus on infection prevention due to the vulnerability of these patients, it is estimated that 1-3 million serious infections occur each year in these facilities.

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The infection control strategies for long term care facilities to prevent the spread of other respiratory viruses is the same for COVID-19: adherence to basic infection control precautions for all patient-care activities, implementing environmental, engineering and source control measures and effectively managing health care staff who become ill.

Besides preventing the spread of the virus within the facility, it is critical to take proactive steps to mitigate the impact of COVID-19.

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These efforts include monitoring residents and employees for influenza-like illness and strict adherence to respiratory and cough hygiene by staff, residents and visitors.

It is also important to prevent the spread of COVID-19 between facilities. To do this there needs to be proper notification and the relay of pertinent health information, including any information about respiratory illness, prior to transferring a resident from one place to another.

What happened at the Seattle-area nursing home could happen in any long-term care facility in this country. Every individual plays a key role in outbreak preparedness and response. By helping yourself, you can help others, including those in the high-risk category just by following public health advice. These are the everyday respiratory measures that all public health officials have been emphasizing:

  • Avoid close contact with sick people
  • Avoid touching your eyes, nose, and mouth
  • Stay home when you’re sick
  • Cover coughs or sneezes with a tissue, and then throw the tissue in the trash or cough in your elbow if tissue is not available then wash your hands
  • Washing your hands often with soap for at least 20 seconds
  • Clean and disinfect frequently touched items and surfaces with EPA-registered disinfectants effective against COVID-19 (meaning they fall under the EPA’s Emerging Viral Pathogen Claim)

In addition to these everyday preventative actions, social distancing strategies should also be adhered to depending on the local response. These efforts include avoiding unnecessary social gatherings, limiting use of health care for worried well/mildly ill, working from home, etc.

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Beyond these efforts though, an understanding of the risk for severe disease in older people is a vital piece to prevention efforts.

The World Health Organization (W.H.O.) has collectively referred to older persons as those 60+ years of age. Based off the epidemiology of those cases in the Seattle-area LTCF and the progression of the COVID-19 outbreak in the United States, the CDC is urging older adults to engage in those prevention efforts like avoiding crowds, cruise travel and non-essential air travel.

For those patients at risk for more severe illness (older adults and those with serious chronic medical conditions like heart disease, diabetes, and lung disease), the CDC also recommends that when out in public they limit close contact with people, practice frequent hand hygiene and avoid sick people. Moreover, the CDC recommends that if there is a COVID-19 outbreak in the community, those people who fall into the higher risk category should stay home as much as possible to avoid risk for exposure.

Since COVID-19 is a rapidly evolving virus with new information being learned about it daily, it is very important to stay informed.

Because every incident of coronavirus, and the response to it, starts at the local level, you should also check your local health department website for updates including national resources like the Centers for Disease Control and Prevention.

Syra Madad, D.,H.Sc., M.S.c, MCP, is the Senior Director for the System-wide Special Pathogens Program for New York City Health + Hospitals. 

Saskia Popescu, PhD, MPH, MA, CIC is a Senior Infection Prevention Epidemiologist for HonorHealth.

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