Rhinovirus in the Elderly: The Commonest of Colds

JANUARY 09, 2015
Jeannette Y. Wick, RPh, MBA
Rhinovirus infection tends to aggravate other conditions in the elderly.
Globally, acute respiratory tract infections are the most common of all illnesses; they are generally caused by rhinovirus, adenovirus, coronavirus, and (of course) influenza.1 Influenza is associated with the most severe respiratory viral illness (RVI), but rhinoviruses—which manifest as the common cold—cause the greatest number of RVIs. Rhinovirus usually causes a milder clinical syndrome (Table 12-5) than influenza does,2 but rhinovirus may progress to acute sinusitis and often exacerbates other pulmonary conditions.3 Having a rhinovirus infection does not preclude having another viral or bacterial infection, and patients with concurrent infections are at increased risk for severe illness.2,6 In elderly patients, rhinovirus infection can lead to serious trouble.

Among individuals older than 65 years, increased susceptibility to infection occurs in those who have lower humoral and cellular immunity, impaired physiologic function, impaired mobility, or immunosuppression. Pharmacists need to acknowledge the varied presentation of rhinovirus infection among the elderly, in whom atypical clinical presentations and discordant disease severity are common. Seniors may have signs and symptoms that are milder—or more severe—than expected. Clinicians need to adjust their therapeutic approach, taking comorbidities (especially chronic lung disease), organ failure associated with senescence, and polypharmacy or polymedicine into consideration.3,7,8

Seniors who contract rhinovirus may be afebrile or feverish and often have no cough or headache. They may, however, experience changes in cognition, myalgia, or pleural pain.7 Elders infected with rhinovirus are significantly more likely than their younger counterparts to be forced to restrict their activities or require consultation with a medical professional. Rhinoviruses cause more lower respiratory illnesses in the elderly, increasing the likelihood that these patients will need to see a physician and restrict physical activity.8 The greatest concern about rhinovirus infection in the elderly is its propensity to aggravate other conditions, setting the stage for increased morbidity and mortality.