Nearly 18 months after receiving covid-19 and spending weeks in hospital, Terry Bell struggled to hang up his shirts and pants after washing.
Lifting his clothes, raising his arms, arranging things in his closet leaves Bell panting and often causes severe fatigue. Walk with a cane, only short distances. It is 50 pounds lighter than when the virus struck.
Bell, 70, is among millions of older people who have struggled for a long time with covid, a population that has received little attention, although research shows that older people are more likely to develop a misunderstood condition than young adults. middle-aged.
Long covid refers to current or new health problems that occur at least four weeks after covid infection, according to the Centers for Disease Control and Prevention. Many of the conditions are confusing: there is no diagnostic test to confirm it, there is no standard definition of the disease, and there is no way to predict 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 problems with attention, concentration, language and memory – a set of difficulties known as brain fog.
Continued inflammation or a dysfunctional immune response may be responsible, along with reservoirs of the virus that remain 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 effect on the elderly is beginning to be documented. In the largest study of its kind, published recently in the journal BMJ, researchers estimated that 32% of older adults in the United States who survived covid infections had symptoms of prolonged covid for up to four months after infection – more than twice as many of the 14% percentage of an earlier study found in adults aged 18 to 64 years. (Other studies show that symptoms can last much longer, a year or more.)
The BMJ study examined more than 87,000 adults aged 65 and over who had covid infections in 2020, based on data from claims from UnitedHealth Group’s Medicare Advantage plans. It includes symptoms that last 21 days or more after infection, a shorter period than that used by the CDC in its long definition of covid. The data cover both elderly people who were hospitalized for covid (27%) and those who were not (73%).
The higher rate of post-covid symptoms in older people is probably due to the higher incidence of chronic diseases and physical vulnerability in this population – traits that have led to a higher burden of serious illness, hospitalization and death. among the elderly during the pandemic.
“On average, older people are less resilient. They do not have the same ability to recover from a serious illness, “said Dr. Ken Cohen, co-author of the study and executive director of translational research for Optum Care. Optum Care is a network of medical practices owned by the UnitedHealth Group.
Applying the findings of the study to the latest CDC data suggests that up to 2.5 million older people may have been affected by long-term covid. For these people, the consequences can be devastating: disability, inability to work, reduced ability to perform daily activities and a lower quality of life.
But in many older people it is difficult to recognize the long covid.
“The challenge is that non-specific symptoms such as fatigue, weakness, pain, confusion and increased weakness are things we often see in seriously ill elderly people. Or people may think, “It’s just part of aging,” says Dr. Charles Thomas Alexander Semelka, a doctoral student in geriatric medicine at Wake Forest University.
Ann Morse, 72, of Nashville, Tennessee, was diagnosed with covid in November 2020 and recovered at home after a trip to the emergency room and subsequent home visits by nurses every few days. She soon began to have problems with memory, attention and speech, as well as sleep problems and severe fatigue. Although it has improved somewhat, several cognitive problems and fatigue persist to this day.
“What was disappointing was that I told people my symptoms and they said, ‘Oh, we are, too,’ as if it were aging,” she told me. “I’m like that too, but it happened to me suddenly, almost overnight.”
Bell, a singer and songwriter in Nashville, had difficulty gaining adequate follow-up after spending two weeks in intensive care and an additional five weeks in a nursing home receiving rehabilitation therapy.
“I did not receive answers from my regular doctors about breathing and other problems. “They told you to take over-the-counter medications for your sinuses and things like that,” he said. Bell said his real recovery began after he was recommended to specialists at Vanderbilt University Medical Center.
James Jackson, director of long-term outcomes at the Vanderbilt Center for Critical Illness, Brain Dysfunction and Survival, leads several long covid support groups that visit Morse and Bell, 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 there are significant differences between younger and older brains. Younger brains are more flexible and efficient at recovery, and our younger patients seem to be able to regain their cognitive function faster, ”he said.
In extreme cases, covid infections can lead to dementia. This may be due to the fact that elderly people who are severely ill with covid are at high risk of developing delirium – an acute and sudden change in mental state – which is associated with the subsequent development of dementia, said Dr. Liron Sinvani, geriatrician and assistant professor at the Feinstein Institute for Medical Research at Northwell Health in Manhattan, New York.
The brains of older patients may also have been injured by oxygen deficiency or inflammation. Or the disease processes that underlie dementia may already be underway and covid infection may serve as a turning point, accelerating the onset of symptoms.
A study conducted by Sinvani and colleagues, published in March, found that 13% of covid patients aged 65 and over who were hospitalized at Northwell Health in March 2020 or April 2020 had evidence for dementia a year later.
Dr. Thomas Guth, associate president of medicine at Staten Island University Hospital, which opened one of the first long-term covid clinics in the United States, noted that covid disease can displace older people with pre-existing conditions such as heart failure or lung disease. disease. edge ”to more severe damage.
Especially in the elderly, he said, “it is difficult to attribute what is directly related to covid and what is the progression of the conditions they already have.”
That wasn’t true of Richard Gard, 67, who lives just outside New Haven, Connecticut, who describes himself as a “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 2 weeks, including five days in intensive care and three days in a ventilator.
Gard has spent more than two months in hospital over the past two years, usually for heart attack-like symptoms. “If I tried to climb the stairs or 10 feet, I would almost faint from exhaustion and the symptoms would begin – severe chest pain, radiating my arm to my neck, difficulty breathing, sweating,” he said.
Dr. Erika Spatz, director of the Yale Cardiovascular Prevention Program, is one of Gard’s doctors. “The more severe the covid infection and the older you are, the more likely you are to have a cardiovascular complication,” 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 changed in ways he never imagined. Unable to work, he is taking 22 medications and can still walk for only 10 minutes on a flat surface. Post-traumatic stress disorder is a common, unwanted companion.
“Many times it was difficult for me to continue, but I tell myself that I just have to get up and try again,” he told me. “Every day when I get a little better, I tell myself I’m adding another day or week to my life.”
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