Despite evidence of their effectiveness in reducing hospitalization and mortality rates, many older individuals remain untreated, with recent studies highlighting significant disparities in treatment access and adherence.
A recent report from MMWR Morb Mortal Wkly Rep highlights how older adults, 65 and older, are at high risk for severe COVID-19 outcomes with risk escalating with age. Outpatient antiviral treatments have been shown to reduce these risks, yet there is limited information on how their usage varies among older adults by age group. Antiviral therapy for COVID-19 is underutilized among this age demographic, especially in the oldest age group, underscoring the need for increased use of these medications to mitigate COVID-19–related morbidity and mortality.
Among 393,390 adults aged 65 and older, 45.9% received outpatient COVID-19 antivirals, with usage rates of 48.4% for ages 65–75, 43.5% for ages 76–89, and 35.2% for those 90 and older. The adjusted odds of being untreated were significantly higher for patients aged 75–89 (1.17 times) and those 90 and older (1.54 times) compared to those aged 65–74. Among patients with severe outcomes, only 21.1% had received antiviral treatment, compared to 46.7% of those without severe outcomes.1
Another recent MMWR Morb Mortal Wkly Rep examined nonhospitalized patients aged 65 and older with COVID-19 from the National Patient-Centered Clinical Research Network between April 2022 and September 2023. Researchers assessed antiviral treatment usage among the same three age groups (65–74, 75–89, and 90+), using multivariable logistic regression to analyze the association between age and the likelihood of not receiving antiviral treatment.2
In these findings, hospitalization rates for adults aged 75 and older approached one COVID-19 hospitalization for every 100 individuals. Among hospitalized adults, 88.1% had not received the 2023–2024 COVID-19 vaccine prior to admission, while 80% had multiple underlying medical conditions. Additionally, 16.6% of these patients were residents of long-term care facilities (LTCFs).2
COVID-19 hospitalization rates among adults are notably increasing with age, particularly for those 65 and older, who represented 70% of all adult COVID-19 hospitalizations during the October 2023–April 2024 surveillance period. This data, sourced from the COVID-19–Associated Hospitalization Surveillance Network, highlights a concerning trend, even as overall cumulative hospitalization rates were the lowest for all adult age groups since the 2020-2021 season.2
Further research by JAMA utilized modeling from 2021-2022 data, indicating that achieving an 80% treatment uptake could reduce hospitalizations by 42% and deaths by 51%. Although, a 2024 survey of 2,858 high-risk older adults revealed that only 16.5% had received COVID-19 treatment, and just 23.3% would accept an antiviral if prescribed.3
Despite evidence supporting outpatient treatment efficacy in preventing severe outcomes, many older adults remain untreated. Concerns about drug interactions and side effects contribute to clinicians' reluctance to prescribe these treatments. Additionally, inequities in vaccine access and healthcare may hinder antiviral use.3
Experts emphasize the need for continued guidance focused on high-risk populations. For older adults and LTCF residents, strategies should prioritize measures to minimize COVID-19 exposure, advocate for up-to-date vaccinations, and encourage prompt access to outpatient antiviral treatments following a positive SARS-CoV-2 test. These steps mitigate severe outcomes and enhance patient care in this vulnerable demographic.
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