I have been active in a European research project the VIP= Very old Intensive care Patients and since the start of the pandemic we have had a prospective study running in elderly COVID-19 patients in the ICU. We constantly have been surprised by the lack of good evidence for core issues in intensive care for the elderly, and suggested a research agenda back in 2017 (https://doi.org/10.1007/s00134-017-4718-z). Our task has first and foremost been concentrated on various outcomes and explanatory variables. We have recently also started to find peculiar trends in the treatment of the elderly Covid-19 patients. Our data suggested that they had en excess mortality during the second surge, and also that it seems that systemic steroids given to this group may result in increased mortality, on contrast to the less old COVID-19 patients. It would be good to start a discussion about this, and feel free to comment and suggest other issues related to this topic.
You can also have a look at our web-page if you are interested in contribute (https://vipstudy.org/)
Hans Flaatten
Revered Professor Dr.Hans Flaatten,
Of course, this is mandatory for the elderly people who needs special ICU facilities during COVID 19 pandemic period because they might have inherited diseases in the body decline the immune power.
It is to considered for the aged people need to have a specialized facilities in the hospital.
Very few old people have good health might have affected due to COVID 19 but they should have to go under treatment with ICU including serious medical attention for them.
My answer may be general but it supports the medical care and treatment for aged ones should have to assist for everyone.
There would be an increasing number of publications in this area with respect to the gut microbiota and bacterial ecosystem living in the guts. Some species of those bacteria are producing essential nutrients, fats, vitamins, deliver minerals, modulate the immune system, a list goes on.
It would be interesting to observe effects of short-chain fatty acids on healing gut junctions and hence leaking gut, training immunity by bacteria, and improved mitochondrial functions due to normalizing gut microbiota.
In a cute case, it would be interesting to use supplements that are replacing metabolites of normal bacterial ecosystem living in the human gut. Supplements based on outsourcing of production of those substances in a bioavailable form. It is basically all fermented food: fish weggies, cheese, yeasts, etc. When the immune system is weak, it is possible to inactivate those bacteria by heat and simultaneously to do not destroy their metabolic products.
Non biomedical factors, such as nursing home residents, memtal health of elderly before ICU admission could be explored
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256767
Geriatric patients are fundamentally compromised in two ways:
1. decreased metabolic rate. This undermines their ability to replenish CO2 tissue reserves when they are mechanically hyperventilated. CO2 depletion undermines respiratory drive, cardiac output, cardiac efficiency, tissue perfusion, tissue oxygenation, and organ protection. Hypercarbia is always preferable to hyperventilation.
2. capillary senescence, which is a normal effect of aging that undermines tissue perfusion and tissue oxygenation. This makes elderly patients more vulnerable to all forms of stress.
I have recently published a book that describes the discovery of the mammalian stress mechanism and explains its implications for medical care and biological theory. It is called “50 Years Lost in Medical Advance” and can be purchased via Amazon.
In trauma…. We envision our patients saying, “Don’t give up on me because I’m old.” I find it remarkable, how well our elderly trauma patients do. Their will to survive sometimes exceeds that of patients half their age.
I should have added that tissue repair is slower in geriatric patients, and they are more vulnerable to injury
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