Nearly 18 months after receiving COVID-19 and spending weeks in the hospital, Terry Bell is still struggling to hang up his shirts and pants after washing.
Lifting his clothes, lifting his arms, arranging things in his closet, Bell leaves short of breath and often triggers severe fatigue. He walks with a cane, only short distances. He is 50 pounds lighter than when the virus struck.
Bell, 70, is among millions of older adults who have struggled with long-term COVID-19 – a population that has received little attention, although research suggests seniors are more likely to develop the misunderstood condition than younger or middle-aged adults.
Long COVID-19 refers to ongoing or new health problems that occur at the very least four weeks after a coronavirus infection, according to the Centers for Disease Control and Prevention. Much about the condition is confusing: there is no diagnostic test to confirm it, no standard definition of the disorder and no way to predict who will be affected. Common symptomswhich can last months or years, include fatigue, shortness of breath, an increased heart rate, muscle and joint pain, sleep disorders 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 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 beginning to be documented.
In it largest study of its kindrecently published in the journal BMJ, researchers estimated that 32% of older adults in the United States who survived COVID-19 had long-distance symptoms up to four months after infection – more than double that of 14% rate a previous study found in adults aged 18 to 64. (Other studies suggest that symptoms may last much longer, for a year or more.)
The BMJ study examined more than 87,000 adults 65 and older who had COVID-19 by 2020, drawing on 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 COVID-19 definition. The data include both older adults who were admitted due to COVID-19 (27%) and those who were not (73%).
The higher incidence of long-distance symptoms in older adults is probably due to a higher incidence of chronic disease and physical vulnerability in this population – traits that have led to a greater burden in case of serious illnesshospitalization and death among seniors throughout the pandemic.
“On average, older adults are less resilient,” said Dr. Ken Cohen, co-author of the study and CEO of translational research for Optum Care, a network of medical practices owned by UnitedHealth Group. “They do not have the same ability to recover from serious illness.”
Application of the results of the study to latest data from the CDC suggests that up to 2.5 million older adults may have been affected by prolonged COVID-19. For these individuals, the consequences can be devastating: the onset of disability, inability to work, impaired ability to perform daily activities, and lower quality of life.
But in many seniors, long COVID-19 is hard to recognize.
“The challenge is that nonspecific symptoms such as fatigue, weakness, pain, confusion and increased fragility are things we often see in seriously ill older adults,” said Dr. Charles Thomas Alexander Semelka, a postdoc in geriatric medicine at Wake Forest University. “Or people might be thinking, ‘it’s just part of aging’.”
Ann Morse, 72, of Nashville, Tennessee, was diagnosed with COVID-19 in November 2020 and returned home after a trip to the emergency room and follow-up home visits from nurses every few days.
She quickly began to have problems with her memory, attention and speech, and she also had sleep problems and severe fatigue. Although she has improved a bit, several cognitive problems and fatigue continue to this day.
“The frustrating thing was that I wanted to tell people about my symptoms, and they said, ‘Oh, so are we,’ as if this was about getting older,” she said. “And I’m like, but this happened to me all of a sudden, almost from one day to the next.”
Bell, a singer-songwriter in Nashville, struggled to get adequate follow-up attention after spending two weeks in intensive care and another five weeks in a nursing home where she received rehabilitation therapy.
“I did not get answers from my GPs about my breathing and other problems,” Bell said. “They said you were taking some over-the-counter medicine for your sinus and stuff like that.”
His real recovery, Bell said, began after he was recommended to specialists at Vanderbilt University Medical Center.
James Jackson, director of long-term results at Vanderbilt’s Critical Illness, Brain Dysfunction, and Survivorship Center, runs several long-running COVID-19 support groups in which Morse and Bell participate and has worked with hundreds of similar patients.
He estimated that about a third of those who are older have some degree of cognitive impairment.
“We know there are significant differences between younger and older brains,” Jackson said. “Younger brains are more plastic and efficient at reconstituting, and our younger patients seem to be able to regain their cognitive function faster.”
In extreme cases, COVID-19 can lead to dementia.
This may be because older adults who are seriously ill with COVID-19 are at high risk develop delirium An acute and sudden change in mental status – which is associated with the subsequent development of dementiasaid Dr. Liron Sinvania geriatrician and an assistant professor at Northwell Health’s Feinstein Institutes of Medical Research in Manhasset, New York.
Elderly patients’ brains may also have been damaged by lack of oxygen or inflammation. Or disease processes underlying dementia may have already been underway and COVID-19 may serve as a turning point and accelerate the onset of symptoms.
Research conducted by Sinvani and colleagues, published in March, found that 13% of COVID-19 patients who were at least 65 and admitted to Northwell Health in March or April 2020 had signs of dementia a year later.
Dr. Thomas Gut, associate physician at Staten Island University Hospital, which opened one of the first long-distance clinics in the United States, observed that getting sick with COVID-19 can put older adults with pre-existing conditions, such as heart failure or lung disease, “over edge “to a more severe disability.
Especially in older adults, Gut said, “it’s hard to attribute what’s directly related to COVID and what’s a progression of conditions they already have.”
That was not true for Richard Gard.
Gard, 67, who lives just outside New Haven, Connecticut, is a self-described “very healthy” sailor, diver and music teacher at Yale University. He contracted COVID-19 in March 2020. He was the first COVID-19 patient to be treated at Yale New Haven Hospital, where he was critically ill for 2 1/2 weeks, including five days in intensive care and three days in respirator.
In the two years since, Gard has spent more than two months in the hospital, usually for symptoms resembling a heart attack.
“If I tried to walk up the stairs or 10 feet, I would almost faint from exhaustion and the symptoms would begin,” he said, “extreme chest pain radiating up from my arm in my neck, difficulty breathing, sweating. . “
Dr. Erica SpatzDirector of the Preventive Cardiovascular Health Program at Yale, is one of Gard’s physicians.
“The more severe the COVID infection is, and the older you are,” she said, “the more likely you are to have a cardiovascular complication after.”
Complications include weakening of the heart muscle, blood clots, abnormal heart rhythm, damage to the vascular system and high blood pressure.
Gard’s life has changed in ways he had never imagined.
He is unable to work, takes 22 medications – and can still only walk for 10 minutes on level ground. Post-traumatic stress disorder is a frequent, unwanted companion.
“Many times it has been hard to keep going, but I tell myself I just have to get up and try again,” Gard said. “Every day, I get a little bit better, I tell myself I’m adding another day or week to my life.”
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