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Old Age is Not One Thing in COVID-19

Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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Senior couple sitting in the garden with their baby grandson

Daily, if not multiple times a day, we hear about the serious consequences of COVID-19 for older adults and the need to stay at home. Undoubtedly, older adults carry a disproportionate risk from COVID-19. In the U.S., 80% of deaths from COVID-19 have occurred in adults age 65 and older.

But here is the important part: The case fatality rate (i.e., the number of deaths among people who contract COVID-19) varies greatly across age groups in late life. Everyone over age 65 is not in the same context of the COVID-19 pandemic. People who are 65 years old have rates of death — and likelihood of recovery — vastly different from patients who are 85 years old.

We need to stop lumping all older adults into one category and making decisions based on this blunt criterion. Doing so misses important differences across age.

It is difficult to estimate the case fatality rate because we do not know how many people of all ages contract the disease. But the Journal of the American Medical Association reported that in Italy, the rate of death for 60- to 69-year-olds was 3% to 4%, while estimates of the fatality rate among patients older than 80 who contract the disease is more than three times as high at 13%.

These differences play out in the diverse lives of older adults. Some older adults are disappointed that they had to cancel a trip to climb mountains in Nepal, and other older adults may be medical personnel contributing in vital ways to dealing with the health care crisis. Still other older adults are sick, frail and living alone, in multigeneration households, or in nursing homes. Efforts to divvy up the young and productive from the old and frail create a false dichotomy and are a disservice to older and younger adults alike. This approach fails to recognize the diversity across older adults.

Researchers who study aging distinguish between biological and chronological age. Chronological age is the number of years since birth, what people think of as “age.” Biological age reflects the physiology of a person and how well that person is functioning.

People the same chronological age may not be the same biological age later in life. Late life is often marked by increased health risk and declines in several physical dimensions, including the immune system. But biological age and the presence of severe illness and chronic conditions raise the risk of developing serious COVID-19 illness, not chronological age, per se.

For example, take two individuals who are the same chronological age. One is a tall, muscular man who loves swimming and traveling. He views 73 as the same as 40 but with more wrinkles. Another might be a petite 73-year-old woman who was diagnosed with colon cancer and recently underwent chemotherapy. Her immune system is weakened. Her cancer surgery led to complications, and she is in a rehabilitation center to recover her strength and ability to walk.

Different people, same age.

Vulnerable older adults also face a number of ongoing health problems. Many depend on weekly physical therapies, and their health will decline due to withdrawal of everyday treatments during the COVID outbreak. A third of adults over age 80 report at least one disability in self-care, walking or hearing. In the absence of regular services, therapies and health care, they may experience dramatic declines.

Grouping all older adults together sets us up to misunderstand the disease process and may lead to misappropriation of resources. Though we do not know for sure, adults age 60 to 70 may benefit from medical treatment and recover from the disease. We do need to focus on older adults who have multiple chronic diseases, are frail, or have known immune deficiencies, and safely protect those individuals from potential infection.

By understanding that age, or at least chronological age, is just a number and one of many factors to consider with COVID-19, we will be better prepared to fight this disease.

Karen L. Fingerman is a professor and director of the Texas Aging & Longevity Center at The University of Texas at Austin.

Kelly Trevino is an assistant attending psychologist at the Memorial Sloan Kettering Cancer Center.

A version of this op-ed appeared in USA Today.

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