Current guidance on coronavirus ‘largely ignores’ those most at risk, according to an international group of global health experts.
Researchers have called for an age perspective on the implication for public health and clinical responses to be included explicitly in national and global planning on COVID-19, as well as the urgent formation of an expert group on older people to support with guidance and response to the virus.
In their editorial, Professor Peter Lloyd-Sherlock of the University of East Anglia and others note that the largest number of deaths will occur among older people in low and middle-income countries (LMICs). These countries contain 69 per cent of the global population aged 60 and over.
Prof. Lloyd-Sherlock said: “The global response to coronavirus must be directed towards those groups that will face the most devastating consequences. So far, this has not happened. We are facing an unprecedented and enormous wave of mortality among older people in these countries.”
In these situations the risk of infection for older people will be high because living arrangements are often cramped and overcrowded. Increasing numbers of older people in these countries live in nursing homes or similar facilities, where conditions are often poor and regulation weak.
Social distancing policies must consider the already precarious existence of many older people, researchers say, particularly those living alone or dependent on others for care and support. These people may face barriers to obtaining food and other essential supplies if quarantine conditions become more widespread.
As in high-income countries, the risk of dying from COVID-19 in low to middle income increases sharply with age and the vast majority of deaths observed are in people over 60, especially those with chronic conditions such as cardiovascular disease.
The researchers add: “It will not be easy to deal with these problems, especially in settings where there is often weak public health infrastructure, a lack of gerontological expertise at all levels of the health system, and limited trust in government.
“However, a first step would be to recognise that these problems exist. A global expert group on older people should be formed to support with guidance and response to the virus in both residential facilities and home settings.
“As new knowledge emerges, this group can identify and evaluate cost effective therapies and interventions that respond to the particular needs of older people in LMICs living in challenging settings, where formal health service infrastructure is limited.
“Previously, some of the authors have argued that global health priority setting is institutionally ageist. Covid-19 offers an opportunity to prove us wrong.”
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