“That’s just part of aging”: Covid’s long-term symptoms are often overlooked in the elderly

(Hannah Norman / KHN)

After receiving Covid-19 and spending weeks in the hospital for nearly 18 months, Terry Bell struggles to hang his shirt and pants after washing his clothes.

Lifting clothes, raising arms, arranging things in the closet leaves Bell breathless and often causes great fatigue. He walks with a cane, only for short stretches. It is 50 pounds lighter than when the virus struck.

Bell, 70, is among the millions of adults who have faced long-term covid – a population that has received little attention, although research suggests that older people are more likely to develop a misunderstood situation than young adults or middle-aged adults.

According to the Centers for Disease Control and Prevention, long-term covid reports of ongoing or new health problems that occur at least four weeks after a Covid infection. There is a lot of confusion about the situation: there is no diagnostic test to confirm it, there is no standard definition of the disease and there is no prediction of who will be affected. Common symptoms that can last for months or years include fatigue, shortness of breath, increased heart rate, muscle and joint pain, sleep disturbances and attention, concentration, language and memory problems – a set of difficulties called brain fog. .

It can be a constant inflammation or dysfunctional immune response, along with viral deposits left in the body, small blood clots, or damage to the heart, lungs, vascular system, brain, kidneys, or other organs.

Only now is it beginning to document its impact on older adults. In the most recent study of its kind published in the journal BMJ, the researchers estimated that 32% of US adults who survived covid infections had symptoms of Covid up to four months after infection, more than double the 14% infection rate. Earlier research found in adults aged 18 to 64 years. (Other research suggests that the symptoms may last much longer, lasting a year or more).

The BMJ study looked at more than 87,000 adults over the age of 65 who had covid infections in 2020, based on data from UnitedHealth Group’s Medicare Advantage claims. It included symptoms that lasted 21 days or more after an infection, a shorter duration than that used by the CDC in the long definition covid. The data includes elderly adults (27%) and non-elderly (73%) who were hospitalized for covida.

The higher rate of post-covid symptoms in older adults is likely to be due to the higher incidence of chronic illness and physical weakness in this population, a feature that has led to serious illnesses, hospitalizations, and deaths among the elderly during the pandemic.

“On average, adults are not so resilient. They don’t have the same ability to recover from a serious illness, ”said Dr. Ken Cohen, co-author of the research and executive director of translational research at Optum Care. Optum Care is a network of medical practices owned by UnitedHealth Group.

Applying the findings of the study to the latest data from the CDC suggests that 2.5 million adults may have long covids. For these people, the consequences can be devastating: inability to work, inability to work, reduced ability to perform activities of daily living, and a lower quality of life.

But for many seniors, long covid is hard to spot.

“The challenge is that non-specific symptoms such as fatigue, weakness, pain, confusion and increased vulnerability are things we often see in seriously ill adults. Or people may think, ‘That’s just part of aging,'” said Charles Thomas Alexander Semelka. Ph.D., a postdoctoral fellow in geriatrics at Wake Forest University.

Ann Morse, a 72-year-old Ann Morse covid from Nashville, Tennessee, was diagnosed in November 2020 and cured at home after an emergency trip and nursing home visits. He soon began to have problems with memory, attention, and speech, as well as sleep problems and severe fatigue. Although it has improved somewhat, many cognitive problems and fatigue remain to this day.

“What was amazing was that I would tell people my symptoms and they would say,‘ Oh, we’re like that too, ’as if this was about aging,” he told me. “And I am, but this happened to me all of a sudden, almost overnight.”

Terry Bell, who spent two weeks in intensive care and has been diagnosed with long-term covid, says he now walks with a cane for a short distance and is 50 pounds lighter than before he became ill.(Bob McReynolds)

Bell, the Nashville singer-songwriter, found it difficult to get proper follow-up care for two weeks in intensive care and another five weeks in a nursing home that received rehabilitation therapy.

“I didn’t get any answers from my regular doctors about my breathing and other problems. You need to take some over-the-counter medications for the sinus and things like that,” Bell said.

James Jackson, director of Vanderbilt’s Critical Illness, Brain Dysfunction, and Long-Term Outcomes Center, leads Morse and Bell’s long-running covid support team and has worked with hundreds of similar patients. One-third of seniors believe they have some form of cognitive impairment.

“We know there are big differences between young and old brains. Young brains are more plastic and more efficient at rebuilding, and our young patients seem to be able to recover their cognitive functioning faster, ”he said.

In extreme cases, covid infections can lead to dementia. Covid may be at high risk for the development of delirium in older adults who are seriously ill — an acute and sudden change in mental condition — associated with post-dementia development, said Dr. Liron Sinvani, a geriatrician and caregiver. Professor at the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York.

The brains of older patients may also have been injured due to lack of oxygen or inflammation. Or the dementia-based disease processes may be already underway, and a covid infection may serve as a turning point, accelerating the onset of symptoms.

A study published by Sinvani and colleagues in March found that 13% of patients hospitalized at Northwell Health were hospitalized at Northwell Health in March 2020 or April 2020, with evidence of dementia a year later.

Dr. Thomas Gut, a professor of medicine at Staten Island University Hospital, who opened one of the first long-term covid clinics in the U.S., found that covid disease can “further” promote older adults with heart failure or lung disease. edge ”with a more severe disability.

In older adults, in particular, he said, “it is difficult to attribute what is directly related to covida and the progression of existing conditions.”

That wasn’t true, Richard Gard, 67, who lives on the outskirts of New Haven, Connecticut, described as “very healthy and fit” a Yale University sailor, diver and music teacher who hired a covid in March 2020. The first covid patient treated at Yale New Haven Hospital, where he was seriously ill for 2 and a half weeks, including five days in intensive care and three days in a ventilator.

Richard Gard is seen smiling at a photograph, sitting in front of a harpsichord.
Richard Gard described himself as a “very healthy and fit” sailor, diver and music teacher at Yale University after taking a covid in March 2020 before being hospitalized in intensive care. He has since spent more than two months in hospital, often. for heart-like symptoms.(Richard Gard)

For the past two years, Garde has spent more than two months in the hospital suffering from symptoms that are usually heart-like. “If I tried to climb stairs or 10 feet, I would almost go through fatigue, and the symptoms would start: a severe chest pain radiated from arm to neck, breathing problems, sweating,” she said.

Dr. Erica Spatz, director of the Yale Cardiovascular Prevention Health Program, is one of Garde’s physicians. “The more severe the covid infection and the older it is, the more likely it is to have a cardiovascular complication afterwards,” he said. Complications include heart muscle weakness, blood clots, abnormal heart rhythms, damage to the vascular system, and high blood pressure.

Gard’s life has changed in a way he never imagined. Unable to work, he takes 22 medications and can only walk 10 minutes on the same ground. Post-traumatic stress is an unwanted friend.

“It’s often been hard to move forward, but I tell myself that I need to get up and try again,” he told me. “Every day I improve a little bit, I tell myself I’m adding another day or a week to my life.”

We look forward to answering any questions you may have from readers about your problems with your care and the advice you need to deal with your healthcare system. Visit khn.org/columnists to submit your requests or tips.

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