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.
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%).
“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.
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.
“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.
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.
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.
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.