Fatores de risco para forma grave da COVID-19 em pessoas idosas institucionalizadas

Abstract

Introduction: COVID-19 is characterized by a respiratory syndrome with severity variations. However, this disease has disproportionately affected institutionalized elderly people, leading to a high mortality in this population. Objective: To analize the conditions considered at risk for severe form and death by COVID-19 in institutionalized elderly people and their association with nutritional status. Methods: Two analysis were performed: 1) descriptive study, crosssectional with quantitative approach, carried out in eight long-stay institution for the elderly in the Metropolitan region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between February and December 2018, which used as an instrument to collect sociodemographic data, health and risk factors the Elderly Health Handbook, and Pearson’s chi-square and Chance Ratio tests were performed to analyze the variables; 2) systematic review of the literature of observational epidemiological studies published between January 2020 and February 10, 2021, for which searches were conducted in the databases Virtual Health Library (BVS), PubMed, Scopus and Web of Science, using the Standard DeCS/MeSH (Descriptors in Health Sciences), and evaluated the risk of bias by instruments of the Joanna Briggs Institute. Results: 1) Of the 267 elderly people evaluated, the most prevalent risk conditions were cognitive impairment (57.5%), hypertension (55.6%) and diabetes (27.5%), with a higher frequency of low birth weight in elderly with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) diabetics (12.9%). Body mass index (BMI) was associated with the age group over 80 years (p=0.013), hypertension (p<0.001), and diabetes (p=0.001). Hypertensive elderly people are more likely to have low weight when compared to non-hypertensive people (CR=3.6; IC95% 1.5-8.6). 2) 171 publications were identified, nine of which met the eligibility criteria. The complementary search in the list of references of these studies resulted in two articles. With this, it included 11 articles in the review. It identified different risk factors grouped into sociodemographic factors—male gender, age over 80 years and institutionalization itself; clinical manifestations—presence of symptoms, loss of appetite, fever, diarrhea, altered mental status, lethargy, respiratory symptoms, and shorthand; and health conditions - cardiovascular diseases, diabetes, kidney disease, functional and cognitive decline, Parkinson’s disease, frailty, depression, and chronic obstructive pulmonary disease. Final considerations: Institutionalized elderly people present health conditions that make them more vulnerable to develop to a severe form of COVID-19 if infected, which requires the adoption of protective measures and protocols to provide opportunities to treat these individuals and prevention of injuries for those at higher risk for severe form of the disease.