Got a long cove? Medical expertise is vital, and seniors should be prepared to go

Older adult survivors of Covid-19 are more likely to have persistent symptoms such as fatigue, shortness of breath, muscle aches, heart palpitations, headaches, joint pain, and memory and concentration problems – problems associated with long Covid.

However, it may be difficult to distinguish the long-term effects of covid from the general condition of older adults, such as lung disease, heart disease, and mild cognitive impairment. There is no diagnostic test or recommended treatment for chronic covid and the biological processes involved in its effects are not well understood.

Dr. Nathan Erdman, an assistant professor of infectious diseases at the University of Alabama-Birmingham Medicine, said, “It is difficult to identify long covid in adults with other medical conditions. Failure to do so may mean that the elderly covid survivors may not receive adequate care.

What should adults do if they do not feel well after a few weeks of being infected with the virus? I sought the advice of a dozen experts. Here’s what they offer.

Seek treatment. “If an elderly person or their caregiver notices that one or two months have passed since Kovid and something is not right – they have lost a lot of weight or they are very weak or forgetful – it is worth going for an assessment. Dr. Liron Sinwani is the director of the Geriatric Hospitalist Services at Northwell Health, a large healthcare system in New York.

But beware in advance: many primary care physicians are at a loss as to how to identify and manage long covid. If you do not get much help from your doctor, consider referring to a specialist who sees a long covid patient or a long covid clinic. Also, be prepared to be patient: the wait for an appointment is long.

According to an industry publication Baker’s Hospital Review, at least 66 hospitals or health systems have created interdepartmental clinics. For those who are not close to one another, virtual advice is often available. For specialist referrals, ask if the physician has experience with patients with long covid.

Also, more than 80 medical centers in more than 30 states are enrolling patients for four years, a কো 1.15 billion study of Long Covid funded by the National Institutes of Health and known as RECOVER (Research Covid to Enhance Recovery). Adult adults who choose to participate will receive ongoing medical attention.

Follow extensive care. At the Covid Recovery Clinic at the University of Southern California, physicians began by making sure that elderly patients had any underlying medical condition – for example, heart failure or chronic obstructive pulmonary disease – well controlled. Also, they test for new conditions that may manifest after covid infection.

Dr. Caitlin Macaulay, one of the two physicians at the Cake School of Medicine clinic, said that if pre-existing and new conditions were handled properly and subsequent tests returned negative, “probably there is an element of long covid”.

At that point, Focus helps adults regain the ability to perform daily tasks such as bathing, dressing, walking around the house, and shopping. Typically, a few months of physical therapy, occupational therapy, or cognitive rehabilitation is prescribed.

Dr. Erica Spatz, an associate professor of cardiology at the Yale School of Medicine, looks for evidence of organ damage, such as changes in the heart muscle, in older patients. If it is detected, there is a well-established treatment that can be tried. “The older a person gets, the more likely we are to get an injury,” Spatz said.

Experts at Shirley Ryan Ability Lab, a rehabilitation hospital in Chicago, have discovered that a significant number of patients with respiratory problems have atrophy in the diaphragm, a muscle that is essential for breathing, says Dr. Colin Franz, a physician-scientist. Once the inflammation is under control, breathing exercises help patients build muscle, he said.

For older adults who are concerned about their knowledge after covid, Macaulay recommends a neuropsychological test. “A lot of older patients who have had covids seem to have dementia now. But when they test, all of their high-level cognitive functioning is intact, and it’s something like attention or cognitive fluency that is impaired, “he said. “It’s important to understand where the deficit is so that we can properly target therapy.”

Gradually become active. Elderly patients tend to lose energy and fitness after a serious illness – a phenomenon known as “decoding” – and their blood volume and heart muscle will begin to contract within a few weeks if they lie in bed or get little activity, Spatz said. It can cause dizziness or heart palpitations while standing.

In line with recent recommendations from the American College of Cardiology, those who develop these symptoms after Spatz Covid are advised to drink more fluids, eat more salt, and wear compression socks and abdominal binders.

“I often hear that walking is scary,” Spatz said. When returning to exercise, “Start with a five- to 10-minute blocked bike or rover and add a few minutes each week,” he advises. A month later, go to a semi-practiced position on a standard bike. Then, one more month later, try walking, first a short distance and then a long distance over time.

This “slow down” advice also applies to older adults with cognitive anxiety after covid. Franz said he often advises limiting time spent on activities that require knowledge as well as exercises for brain health and memory. At least early on, “people need less activity and more cognitive rest,” he noted.

Reset expectations. Older adults usually have a hard time recovering from serious illness, including colic. But even seniors who had a mild or moderate response to the virus may struggle on their own after weeks or months.

Elderly patients need to hear the most important message, “Give yourself time to recover,” said Dr. Greg Vanichkacharn, director of the Covid Activity Rehabilitation Program at the Mayo Clinic in Rochester, Minnesota. In general, older adults seem to take longer to recover from a long covid than younger or middle-aged adults, he noted.

It is important to learn how to prioritize and not rush. “In this patient population, we’ve seen patients gnashing their teeth and pushing themselves actually make them worse” – a phenomenon known as “post-labor illness”, says Vanichkacharn.

Instead, people need to learn how to move themselves.

Jamie Wilcox, an associate professor of clinical occupational therapy at the Cake School of Medicine, says, “Any significant health event forces people to re-examine their expectations and their priorities, and the long coward has really accelerated this.” “Everyone I see feels that it has accelerated their aging process.”

Consider the weakness. Older adults who suffer from covid and those who are poor, weak, physically or cognitively disabled and socially isolated are of considerable concern. This group is more likely to experience serious effects from Covid, and survivors may not have easy access to healthcare services.

“We all share concerns about marginalized elderly people with limited access to healthcare and poor overall health status,” said Erdman of UAB. “Sprinkle a dangerous new pathology that is not well understood above, and there is a recipe for greater inequality in your care.”

“She is OK [long covid] The patients we work with aren’t accustomed to asking for help, and they think it’s probably a little embarrassing to be in need, “said James Jackson, director of long-term results at the Center for Critical Illness, Brain Dysfunction and Survivorship. Vanderbilt University Medical Center in Nashville, Tennessee.

The effects are significant, not only for patients but also for healthcare providers, friends and family. Jackson said, “You really have to check in with people who are older and weaker and have covid and they tell you they shouldn’t be assumed to be okay.” “We need to be more proactive in getting them involved and finding out, really, how they are.”

We look forward to hearing from you readers who are interested in answering your questions, your problems with your care and the advice you need to deal with the healthcare system. Visit khn.org/columnists to submit your request or tips.

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