Long covid symptoms are often overlooked in seniors

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Almost 18 months after contracting the coronavirus and spending weeks in hospital, Terry Bell is struggling to hang up his shirts and pants after doing laundry.

Lifting her clothes, raising her arms, putting things in her closet leaves Bell feeling out of breath and often triggers severe fatigue. He walks with a cane, and only for short distances. He weighs 50 pounds less than when he was struck down with covid-19, the disease caused by the coronavirus.

Bell, 70, is one of millions of older adults who have struggled with long covid – a population that has received little attention even though research suggests older people are more likely to develop the poorly understood disease than younger or middle-aged adults.

Long covid refers to ongoing or new health conditions that occur at least four weeks after a covid infection, according to the Centers for Disease Control and Prevention. Much of the condition is confusing: there is no diagnostic test to confirm it, no standard definition of the disease, and no way to predict who will be affected. Common symptoms, which can last for months or years, include fatigue, shortness of breath, high heart rate, muscle and joint pain, trouble sleeping, and problems with attention, concentration, speech, and speech. memory – a set of difficulties known as brain fog.

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

What is covid long? Current understanding of risks, symptoms and recovery.

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

The BMJ study looked at more than 87,000 adults age 65 and older who had covid infections in 2020, using claims data from UnitedHealth Group’s Medicare Advantage plans. It included symptoms that lasted 21 days or more after infection, a shorter period than the CDC uses in its long definition of covid. The data includes both seniors who have been hospitalized due to covid (27%) and those who have not (73%).

A study released last month by the CDC found that 1 in 4 older people who survived covid had at least 1 of 26 common symptoms associated with long covid, compared to 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 – characteristics that have led to a greater burden of serious illness, hospitalizations and death. deaths among the elderly throughout the pandemic.

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

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

But for many seniors, the long covid is hard 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 people. Or people may think, “It’s part of aging,” said Charles Thomas Alexander Semelka, 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 emergency room and follow-up home visits from nurses every few days. She soon began having problems with memory, attention and speech, as well as sleep problems and severe fatigue. Although she has improved somewhat, several cognitive problems and fatigue persist.

“What was frustrating was I was telling people my symptoms and they were like, ‘Oh, we’re like that too,’ like it’s about getting older,” she told me. “And I’m like, but it happened to me suddenly, almost overnight.”

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Bell, a singer-songwriter from Nashville, struggled to get adequate follow-up after spending two weeks in an intensive care unit and an additional five 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 over-the-counter medicine for your sinuses and things like that.” Bell said his real recovery began after being referred to specialists at Vanderbilt University Medical Center.

‘Significant differences’

James Jackson, director of long-term outcomes at Vanderbilt’s Critical Illness, Brain Dysfunction, and Survivorship Center, leads several long-running covid support groups that Morse and Bell attend and has worked with hundreds of similar patients. He said he estimates about a third of older people 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 replenishing themselves, and our younger patients seem able to regain cognitive functioning more quickly.”

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

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

Research by Sinvani and colleagues, published in March, found that 13% of covid patients who were 65 and older and hospitalized at Northwell Health in March 2020 or April 2020 showed signs of dementia a year later.

Thomas Gut, associate director of medicine at Staten Island University Hospital, which opened one of the first long-term clinics in the United States, observed that getting sick with covid can push older people with pre-existing conditions such as heart failure or lung disease edge’ to more severe impairment.

In older people in particular, he said, “it’s hard to attribute what is directly related to covid and what is the progression of the conditions they already have.”

That was not the case for Richard Gard, 67, who lives just outside of New Haven, Connecticut, a self-proclaimed “very healthy and fit” sailor, diver and music teacher at the Yale University who contracted covid in March 2020. He was the first covid patient treated at Yale New Haven Hospital, where he was critically ill for 2.5 weeks, including five days in intensive care and three days under fan.

Over the next two years, Gard spent more than two months in hospital, usually with symptoms that resemble a heart attack.

“If I tried to climb the stairs or 10 feet I would almost pass out from exhaustion and the symptoms would start – extreme chest pain radiating from my arm into my neck, difficulty breathing, sweating,” he said. -he declares.

Erica Spatz, director of the preventive cardiovascular health program at Yale, is one of the Gard doctors.

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

“A lot of times it’s been hard to keep going, but I tell myself that I just have to get up and try one more time,” he said. “Every day that I feel a little better, I tell myself that I add another day or another week to my life.”

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

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