Prolonged covid symptoms are often overlooked in older people

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Nearly 18 months after contracting the coronavirus and spending weeks in the hospital, Terry Bell is having trouble hanging up his shirts and pants after doing laundry.

Picking up his clothes, raising his arms, arranging the items in his closet leaves Bell breathless and often leads to severe fatigue. She walks with a cane, and only short distances. He weighs 50 pounds less than when he was attacked by covid-19, the disease caused by the coronavirus.

Bell, 70, is among millions of older adults who have long dealt with Covid, a population that has received little attention despite research suggesting older people are more likely to develop the little-known condition. than younger or middle-aged adults.

Long-term COVID refers to new or ongoing 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 puzzling: there is no diagnostic test to confirm it, no standard definition of the ailment, and no way to predict who will be affected. Common symptoms, which can last for months or years, include fatigue, shortness of breath, elevated heart rate, muscle and joint pain, sleep disturbances, and problems with attention, concentration, language, and memory—a set of difficulties known as brain fog.

Ongoing inflammation or a dysfunctional immune response may be responsible, along with remaining reservoirs of the virus in the body, small blood clots, or residual damage to the heart, lungs, vascular system, brain, kidneys, or other organs .

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The impact on older adults is only now beginning to be documented. In a study published in the journal BMJ, researchers estimated that 32% of older adults in the United States who survived Covid infections had prolonged Covid symptoms up to four months after infection, more than double the rate 14% that an earlier study found in adults. from 18 to 64 years old. (Other studies suggest that symptoms can last much longer, a year or more.)

The BMJ study looked at more than 87,000 adults age 65 and older who had Covid infections in 2020, based on claims data from UnitedHealth Group’s Medicare Advantage plans. It included symptoms that lasted 21 days or more after an infection, a shorter period than the CDC uses in its long definition of covid. The data covers both older adults who were hospitalized for COVID (27 percent) and those who were not (73 percent).

A study published last month by the CDC found that 1 in 4 older adults who survived Covid experienced at least 1 of 26 common symptoms associated with prolonged Covid, compared with 1 in 5 people between the ages of 18 and 64.

The higher rate of post-Covid symptoms in older adults is likely due to a higher incidence of chronic disease and physical vulnerability in this population, traits that have led to a higher burden of serious illness, hospitalization, and death among older adults during the pandemic.

“On average, older adults are less resilient. They don’t have the same ability to recover from severe illness,” said Ken Cohen, study co-author and executive director of translational research at Optum Care. Optum Care is a network of physician offices owned by UnitedHealth Group.

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For older people affected by prolonged covid, the consequences can be devastating: development of disability, inability to work, reduced ability to carry out activities of daily living and a lower quality of life.

But in many older people, prolonged covid is difficult to recognize.

“The challenge is that nonspecific 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 aging,’” said Charles Thomas Alexander Semelka, a postdoctoral fellow in geriatric medicine at Wake Forest University.

Ann Morse, 72, of Nashville, was diagnosed with COVID in November 2020 and recovered at home after a trip to the ER and follow-up home visits from nurses every few days. She soon began having problems with memory, attention, and speech, as well as trouble sleeping and severe fatigue. Although she has improved somewhat, she still has several cognitive problems and fatigue.

“What was frustrating was that I would tell people my symptoms and they would say, ‘Oh, we’re like that too,’ as if it were getting old,” she told me. “And I’m like, but this happened to me out of the blue, almost overnight.”

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Bell, a Nashville singer-songwriter, struggled to get adequate follow-up care after spending two weeks in an ICU and five more weeks in a nursing home receiving rehabilitation therapy.

“I wasn’t getting answers from my regular doctors about my breathing and other issues,” he said. “They said to take some over-the-counter sinus medications and things like that.” Bell said his real recovery began after he was referred to specialists at Vanderbilt University Medical Center.

‘Significant differences’

James Jackson, director of long-term outcomes at the Vanderbilt Center for Critical Illness, Brain Dysfunction and Survivorship, runs several Covid support groups attended by Morse and Bell and has worked with hundreds of similar patients. He said that he estimates that around a third of older people have some degree of cognitive impairment.

“We know that there are significant differences between younger and older brains,” Jackson said. “Younger brains are more plastic and effective at reconstitution, and our younger patients seem able to recover their cognitive functioning more quickly.”

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In extreme cases, covid infections can lead to dementia. That may be because older adults who are seriously ill are at high risk of developing delirium, a sudden, acute change in mental status, which is associated with the later development of dementia, said Liron Sinvani, a geriatrician and assistant professor at the Northwell Health Feinstein Institutes for Medical Research in Manhasset, NY

The brains of older patients may also have been injured by lack of oxygen or inflammation. Or the disease processes underlying dementia may already have been underway, and a covid infection may serve as a tipping point, accelerating the onset of symptoms.

Research by Sinvani and colleagues, published in March, found that 13 percent of Covid patients who were age 65 or older and hospitalized at Northwell Health in March 2020 or April 2020 had evidence of dementia at one year. after.

Thomas Gut, associate chair of medicine at Staten Island University Hospital, which has long opened one of the first Covid clinics in the United States, noted that getting sick with Covid can push older adults with pre-existing conditions like heart failure “over the edge” heart or lung disease to more severe impairment.

Especially in older adults, he said, “it’s hard to attribute what’s directly related to Covid and what’s a progression of conditions they already have.”

That wasn’t true for Richard Gard, 67, who lives outside New Haven, Connecticut, a sailor, diver and music professor at Yale University who describes himself as “very healthy and fit.” and that he contracted covid in March 2020. He was the first covid patient treated at Yale New Haven Hospital, where he was critically ill for two and a half weeks, including five days in intensive care and three days on a ventilator.

In the two years since then, Gard has spent more than two months in the hospital, usually for symptoms that resemble a heart attack.

“If I tried to go up the stairs or 10 feet, I would almost pass out from exhaustion and the symptoms would start: extreme chest pain radiating up my arm to my neck, shortness of breath, sweating,” he said.

Erica Spatz, director of Yale’s preventive cardiovascular health program, is one of the Gard physicians.

“The more severe the Covid infection and the older you are, the more likely you are to have a cardiovascular complication afterwards,” he 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 never imagined. Unable to work, he takes 22 medications and can still walk only 10 minutes on level ground. Post-traumatic stress disorder is a frequent and unwelcome companion.

“Many times, it has been difficult to continue, but I tell myself that I have to get up and try one more time,” he said. “Every day that I get a little better, I tell myself that I am adding another day or week to my life.”

Judith Graham is a columnist for Kaiser Health News, which produces in-depth journalism on health. KHN is a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides health information to the nation.

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