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Nearly 18 months after receiving coronavirus and spending weeks in hospital, Terry Bell struggled to hang his shirts and pants after washing.
Lifting his clothes, raising his arms, arranging things in his closet left Bell breathless and often caused severe fatigue. He walks with a cane and only for short distances. He is 50 pounds lighter than when he was struck by covid-19, a disease caused by the coronavirus.
Bell, 70, is among millions of older people who have struggled with covid for a long time, a population that has received little attention, although research shows that older people are more likely to develop a poorly understood condition than young or middle-aged adults. age.
Long covid refers to current or new health problems that appear 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.
What is a long covid? Ongoing understanding of risks, symptoms and recovery.
Only now is the effect on the elderly beginning to be documented. In a study published in the journal BMJ, researchers estimated that 32 percent of seniors in the United States who survived covid infections had symptoms of prolonged covid for up to four months after infection – more than twice as much as 14 percent of 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 claims data from UnitedHealth Group’s Medicare Advantage plans. It includes symptoms that last 21 days or more after infection, a shorter period than the CDC uses in its long definition of covid. The data cover both elderly people who were hospitalized for covid (27%) and those who were not (73%).
A study published last month by the CDC found that 1 in 4 adults who survived covid had at least 1 in 26 common symptoms associated with prolonged covid, compared with 1 in 5 people between the ages of 18 and 64. years.
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 a pandemic.
“Middle-aged people are less resilient. They do not have the same ability to recover from a serious illness, “said 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.
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For older people affected by prolonged covid, the consequences can be devastating: the onset of 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,” said Charles Thomas Alexander Semelka, a 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 subsequent home visits by nurses every few days. Soon she began to have problems with memory, attention and speech, as well as problems with sleep and extreme fatigue. Although it has improved somewhat, several cognitive problems and fatigue still persist.
“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, too, but it happened to me suddenly, almost overnight.”
Fifty percent of people who survive covid-19 experience prolonged symptoms, the study found
Bell, a singer and songwriter in Nashville, had difficulty gaining adequate follow-up after spending two weeks in the intensive care unit and an additional five weeks in a nursing home receiving rehabilitation therapy.
“I didn’t get answers from my regular doctors about breathing and other problems,” he said. “They told you to take over-the-counter medications for your sinuses and things like that.” Bell said his real recovery began after he was referred to specialists at Vanderbilt University Medical Center.
“Significant differences”
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 said 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,” Jackson said. “Younger brains are more plastic and efficient at recovery, and our younger patients seem to be able to regain their cognitive functioning faster.
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In extreme cases, covid infections can lead to dementia. This may be due to the fact that older people who are severely ill with it 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 Liron Sinwani. geriatrician and assistant 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 a lack of oxygen 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 Xinwani and colleagues, published in March, found that 13% of covid patients who were 65 years of age or older and were hospitalized at Northwell Health in March 2020 or April 2020 had evidence for dementia a year later.
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. over end ”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’s not 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 2½ 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-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 to my neck, difficulty breathing, sweating,” he said.
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 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 changed in ways he never imagined. Unable to work, he is taking 22 medications and can still walk for only 10 minutes on level ground. 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 said. “Every day when I get a little better, I tell myself I’m adding another day or week to my life.”
Judith Graham is a columnist for Kaiser Health News, which produces in-depth journalism on health. KHN is a program of the Kaiser Family Foundation, a non-profit organization that provides information about the nation’s health problems.
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