Nearly 18 months after contracting COVID-19 and weeks in the hospital, Terry Bell is struggling to hang up his shirts and pants after doing the laundry.
Lifting his clothes, raising his arms, organizing things in his closet makes Bell short of breath and often causes severe fatigue. He walks with a cane, only short distances. He is 50 pounds lighter than when the virus struck.
Bell, 70, is one of millions of older adults who have long struggled with COVID — a population that has received little attention, although research suggests seniors are more likely to develop the poorly understood condition than younger or middle-aged adults.
Long COVID refers to ongoing or new health problems that occur at least four weeks after a COVID infection, according to the Centers for Disease Control and Prevention. Much of the condition is mind boggling: there is no diagnostic test to confirm it, no standard definition of the condition, and no way to predict who will be affected. Common symptoms, which can last for months or years, include fatigue, shortness of breath, an increased heart rate, muscle and joint pain, sleep disturbances and problems with attention, concentration, language and memory – a series of problems known as brain fog.
Persistent inflammation or a dysfunctional immune response may be responsible, along with reservoirs of the virus remaining in the body, small blood clots, or residual damage to the heart, lungs, vascular system, brain, kidneys, or other organs.
Only now is the impact on older adults being documented. In the largest study of its kind, published recently in the journal BMJ, researchers estimated that 32% of older adults in the U.S. who survived COVID infections had symptoms of prolonged COVID for up to four months after infection — more than double the rate. 14% percent previous study found in adults ages 18 to 64. (Other studies suggest that symptoms can last much longer, a year or more.)
The BMJ study examined more than 87,000 adults ages 65 and older who had COVID infections in 2020, based on claim data from UnitedHealth Group’s Medicare Advantage plans. It included symptoms lasting 21 days or more after infection, a shorter period of time than the CDC uses in its long COVID definition. The data included both older adults who were hospitalized because of COVID (27%) and those who were not (73%).
The higher rate of post-COVID symptoms in older adults is likely due to a higher incidence of chronic illness and physical frailty in this population – traits that have led to a greater burden of serious illness, hospitalization and death among seniors during the pandemic.
“On average, older adults are less resilient. They don’t have the same ability to recover from serious illness,” says Dr. Ken Cohen, a study co-author and executive director of translational research for Optum Care. Optum Care is a network of physician practices owned by UnitedHealth Group.
Applying the study’s findings to the latest data from the CDC suggests that up to 2.5 million older adults may have been affected by long-term COVID. For those individuals, the consequences can be devastating: the onset of disability, the inability to work, reduced ability to perform activities of daily living and a lower quality of life.
But for many seniors, long-term COVID is difficult to recognize.
“The challenge is that non-specific symptoms such as fatigue, weakness, pain, confusion and increased frailty are things we often see in critically ill older adults. Or people may think, ‘That’s just part of getting older,'” said Dr. . Charles Thomas Alexander Semelka, a postdoctoral researcher in geriatric medicine at Wake Forest University.
Ann Morse, 72, of Nashville, Tennessee, was diagnosed with COVID in November 2020 and recovered at home after a trip to the emergency room and follow-up nurses’ home visits every few days. She soon developed problems with her memory, attention and speech, as well as sleeping problems and severe fatigue. Although she has improved somewhat, several cognitive problems and fatigue persist to this day.
“What was frustrating was that I would tell people my symptoms and they would say, ‘Oh, that’s how we are,’ like this was about aging,” she told me. “And I’m like, but this happened to me suddenly, almost overnight.”
Bell, a singer-songwriter in Nashville, struggled to get enough follow-up attention after two weeks in the intensive care unit and another five weeks in a nursing home with rehabilitation therapy.
“I didn’t get answers from my regular doctors about my breathing and other problems. They said you should take some over-the-counter medicine for your sinus and things like that,” he said. Bell said his real recovery began after he was recommended to specialists at Vanderbilt University Medical Center.
James Jackson, director of long-term outcomes at Vanderbilt’s Critical Illness, Brain Dysfunction and Survivorship Center, leads several long-term COVID support groups that Morse and Bell attend and has worked with hundreds of similar patients. He estimates that about a third of older adults have some degree of cognitive impairment.
“We know that there are significant differences between younger and older brains. Younger brains are more plastic and more effective at recovering, and our younger patients seem to be able to regain cognitive function more quickly,” he said.
In extreme cases, COVID infections can lead to dementia. That may be because older adults who are critically ill with COVID are at high risk of developing delirium — an acute and sudden change in mental status — that is associated with the subsequent development of dementia, said Dr. Liron Sinvani, a geriatrician and assistant professor at Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, New York.
The brains of elderly patients may also be injured from lack of oxygen or inflammation. Or disease processes underlying dementia may already be underway and a COVID infection could serve as a tipping point, hastening the emergence of symptoms.
Research by Sinvani and colleagues, published in March, found that 13% of COVID patients aged 65 and over admitted to the Northwell Health hospital in March 2020 or April 2020 showed signs of dementia one year later.
dr. Thomas Gut, an associate professor of medicine at Staten Island University Hospital, which opened one of the first long-term COVID clinics in the US, noted that getting sick with COVID can exaggerate older adults with pre-existing conditions such as heart failure or lung disease” to a more serious disorder.
Particularly in older adults, he said, “it’s difficult to attribute what is directly related to COVID and what is a progression of conditions they already have.”
Not so Richard Gard, 67, who lives just outside New Haven, Connecticut, a self-proclaimed “very healthy and fit” sailor, diver and music teacher at Yale University who contracted COVID in March 2020. the first COVID patient to be treated at Yale New Haven Hospital, where he was critically ill for 2½ weeks, including five days in intensive care and three days on a ventilator.
In the two years since, Gard has spent more than two months in the hospital, mostly for symptoms that resemble a heart attack. “If I tried to walk up the stairs or 10 feet, I would almost pass out from exhaustion, and the symptoms would set in — extreme chest pain radiating to my arm at the back of my neck, trouble breathing, sweating,” he said .
dr. Erica Spatz, director of the preventive cardiovascular health program at Yale, is one of Gard’s physicians. “The more severe the COVID infection and the older you are, the more likely you are to develop a cardiovascular complication afterward,” she said. Complications include weakening of the heart muscle, blood clots, abnormal heart rhythms, damage to the vascular system and high blood pressure.
Gard’s life has changed in ways he could never have imagined. He can’t work, takes 22 meds and can only walk for 10 minutes on level ground. Post-traumatic stress disorder is a common, unwanted companion.
“A lot of times it was hard to keep going, but I tell myself to just get up and try again,” he told me. “Every day that I get a little better, I tell myself I’m adding another day or week to my life.”
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