On March 13th, 2020, The World Health Organization effectively established that Europe is the new the COVID-19 pandemic world epicenter, as cases in Italy and other European nations soared. The numbers in Italy have climbed with over 80,000 cases as of March 25th, 2020 and with over 8000 deaths, placing Italy now as the country with the highest mortality rate. Importantly, older adults are particularly vulnerable to get severe illness, complications, and to have a higher mortality rate than any other age group. The clinical presentation in older adults with severe illness, in the experience from geriatricians in Lombardy, is described as quite sudden; patients can develop severe hypoxemia with the need of ventilation support in few hours. Geriatric syndromes are not a common form of presentation for COVID-19 in severe illness. It is suggested that stratification by frailty level may help to detect the most vulnerable, and decisions about healthcare resource prioritization should not be taken based only on age itself or previous diagnosis, such as having dementia.