Long Covid symptoms in older Americans are often hard to spot, experts say

Lifting his clothes, raising his arms, organizing items in his closet makes Bell short of breath and often results in severe exhaustion. He walks with a stick, only short distances. He’s 50 pounds lighter than when the virus struck.

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 US 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 may be responsible, along with residual virus reservoirs 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 the largest study of its kind, recently published in the journal BMJ, researchers estimated that 32% of older adults in the US who have survived Covid infections had symptoms of a long covid up to four months after infection more than double the 14% rate in the previous study in adults aged 18 to 64. (Other studies suggest that symptoms can last much longer, a year or more.)

Her virus symptoms were minor. Then they had long Covid.

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%) and those who were not (73%).

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 Dr. 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.

Applying the study’s findings to the CDC’s most recent data suggests as many as 2.5 million older adults may have been affected by long-term Covid. For these people, the consequences can be devastating: onset of disability, inability 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 commonly see in critically ill older adults. Or people might think, ‘That’s just part of aging,'” said Dr. Charles Thomas Alexander Semelka, postdoctoral fellow in geriatrics at Wake Forest University.

Ann Morse, 72, of Nashville, Tennessee, 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 problems and fatigue persist to this day.

“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 the ICU, another five weeks in a nursing home, and receiving rehabilitation therapy.

Terry Bell, who spent two weeks in intensive care and was long diagnosed with Covid, says he now only walks short distances with a cane and is 50 pounds lighter than before his illness. He finds that hanging up his shirts and pants after doing the laundry makes him short of breath and often induces severe fatigue.

“I’ve had no answers from my regular doctors about my breathing and other problems. They said to take some over-the-counter sinus medication and stuff like that,” he said. Bell said his real recovery began after being referred to specialists at Vanderbilt University Medical Center.

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 estimates that about a third of older people have some degree of cognitive impairment.

“We know that there are significant differences between younger and older brains. Younger brains are more plastic and effective at recovery, and our younger patients appear to be able to regain their cognitive function faster,” he said.

In extreme cases, Covid infections can lead to dementia. That could be because older adults who are severely ill with Covid are at high risk of developing delirium — an acute and sudden change in mental status — which is linked to the subsequent development of dementia, said Dr. Liron Sinvani, geriatrician and assistant professor at Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, New York.

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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.

A study conducted by Sinvani and colleagues and published in March found that 13% of Covid patients aged 65 or older who were hospitalized at Northwell Health in March 2020 or April 2020 showed signs of dementia a year later.

dr Thomas Gut, associate chair of medicine at Staten Island University Hospital, which opened one of the first long-term Covid clinics in the US, observed that contracting Covid can “overtake” older adults with pre-existing conditions such as heart failure or lung disease to “take the edge off.” to greater impairment.

Especially with 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” sailor, 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.

dr Erica Spatz, director of the preventive cardiovascular health program at Yale, 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.

“It was often difficult to keep going, but I tell myself, I just have to get up and try again,” he told me. “Every day that I feel a little better, I tell myself I’ll add another day or week to my life.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation.