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Bell, 70, is among millions of older adults who have been grappling with long-Covid – a demographic that has received little attention, although research suggests seniors are more likely to develop the poorly understood condition than younger or middle-aged groups.
Long Covid refers to ongoing or new health problems that appear at least four weeks after a Covid infection, according to the Centers for Disease Control and Prevention. Much about the disease is intriguing: 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, an increased heart rate, muscle and joint pain, trouble sleeping, and problems with attention, concentration, speech, and memory — a series of difficulties known as brain fog.
Persistent inflammation or an impaired immune response can be responsible, as can virus reservoirs remaining in the body, small blood clots or residual damage to the heart, lungs, vascular system, brain, kidneys or other organs.
It is only now that the effects on older adults are beginning to be documented. In a study published in the journal BMJ, researchers estimated that 32 percent of older adults in the United States who survived Covid infections had symptoms of a long Covid up to four months after infection — more than double the 14- Percent rate found in a previous study in adults aged 18 to 64 years. (Other studies suggest that symptoms can last much longer, a year or more.)
The BMJ study looked at more than 87,000 adults ages 65 and older who had Covid infections in 2020 and drew on claim 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 Covid definition. The data includes both older adults who were hospitalized for Covid (27 percent) and those who were not (73 percent).
A study published by the CDC last month found that 1 in 4 older adults who survived Covid had at least 1 in 26 common symptoms associated with long Covid, compared with 1 in 5 people aged 18 to 64.
The higher rate of post-Covid symptoms among older adults is likely due to a higher incidence of chronic disease and physical vulnerability in this demographic — traits that have led to a greater burden of serious illness, hospitalizations and deaths among the elderly during the pandemic.
“On average, older adults are less resilient. They don’t have the same ability to recover from a serious illness,” said Ken Cohen, study co-author and executive director of translational research at Optum Care. Optum Care is a network of physician practices owned by UnitedHealth Group.
For older people affected by a prolonged Covid-19 pandemic, the consequences can be devastating: onset of disability, incapacity to work, reduced ability to perform activities of daily living and reduced quality of life.
But in many seniors, a long covid is hard to spot.
“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 might think, ‘That’s just part of aging,'” said Charles Thomas Alexander Semelka, a postdoctoral fellow in geriatrics at Wake Forest University.
Ann Morse, 72, of Nashville, was diagnosed with Covid in November 2020 and recovered at home after a visit to the emergency room and subsequent home visits by nurses every few days. She soon developed problems with her memory, attention and speech, as well as trouble sleeping and severe fatigue. Although she has improved somewhat, some cognitive issues and fatigue remain.
“What was frustrating is when I told people my symptoms and they were like, ‘Oh, we’re like that too,’ like it’s about getting older,” she told me. “And I think, but this happened to me all of a sudden, almost overnight.”
Bell, a singer-songwriter in Nashville, had a hard time getting proper follow-up care after spending two weeks in an intensive care unit, another five weeks in a nursing home, and receiving rehabilitation therapy.
“I didn’t get any answers from my GPs about my breathing and other issues,” he said. “They said take some over-the-counter meds for your sinuses and things like that.” Bell said his real recovery began after being referred to specialists at Vanderbilt University Medical Center.
‘Clear Differences’
James Jackson, director of long-term outcomes at Vanderbilt’s Critical Illness, Brain Dysfunction, and Survivorship Center, runs several long-running Covid support groups that Morse and Bell participate in and has worked with hundreds of similar patients. He said he estimates about a third of the elderly 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 recovery, and our younger patients appear to be able to regain their cognitive function more quickly.”
In extreme cases, Covid infections can lead to dementia. That may be because older adults who are severely ill with it are at high risk of developing delirium — an acute and sudden change in mental status — that is linked to the subsequent development of dementia, said Liron Sinvani, a geriatrician and Assistant Professor at Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, NY
The brains of elderly patients may also have been damaged by lack of oxygen or inflammation. Or disease processes underlying dementia could already be underway, and Covid infection can serve as a tipping point and accelerate the onset of symptoms.
Research by Sinvani and colleagues, published in March, found that 13 percent of Covid patients aged 65 and older who were hospitalized at Northwell Health in March 2020 or April 2020 had signs of dementia a year later .
Thomas Gut, associate professor of medicine at Staten Island University Hospital, which opened one of the first long-running Covid clinics in the United States, noted that contracting Covid “throws older adults with pre-existing conditions such as heart failure or lung disease can edge” to a more severe impairment.
Especially in older adults, he said, “it’s hard to pinpoint what’s directly related to Covid and what’s a progression of the conditions they already have.”
That wasn’t the case for Richard Gard, 67, who lives just outside New Haven, Connecticut, a self-described “very healthy and fit” yachtsman, diver and music teacher at Yale University, who contracted Covid in March 2020. He was 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, usually with symptoms resembling 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 start — extreme chest pain radiating up my arm to my neck, difficulty breathing, sweating,” he said.
Erica Spatz, director of Yale’s preventive cardiovascular health program, is one of Gard’s physicians.
“The more severe the Covid infection and the older you are, the more likely you are to have a cardiovascular complication afterwards,” 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. He is disabled, on 22 medications and can only walk 10 minutes on level ground. Post-Traumatic Stress Disorder is a common, unwanted companion.
“Often times it was difficult to keep going, but I tell myself I just have to get up and try again,” he said. “Every day that I feel a little better, I tell myself I’ll add another day or week to my life.”
Judith Graham is a columnist for Kaiser Health News, which produces informed journalism about health. KHN is a program of the Kaiser Family Foundation, a non-profit foundation that provides information on health issues to the nation.
