About 18 months after getting the Covid-19 and spending a few weeks in the hospital, Terry Bell struggles to keep his shirt and pants hanging after laundry.
Picking up his clothes, raising his arms, arranging things in the cupboard, Bell suffers from shortness of breath and often severe fatigue. He walked with a cane, only a short distance. He is 50 pounds lighter than the virus hit.
Bell, 70, is one of the millions of older adults who have jumped on the long cove – a population that has received very little attention, although studies have shown that adults are more likely to develop impaired comprehension than younger or middle-aged adults.
Chronic covid refers to an ongoing or new health problem that occurs at least four weeks after covid infection, according to the Centers for Disease Control and Prevention. Much is surprising about the condition: there are no diagnostic tests to confirm it, no standard definition of illness, and no way to predict who will be infected. Common symptoms, which can last for months or years, include fatigue, shortness of breath, high heart rate, muscle and joint pain, sleep disturbances and attention, concentration, language and memory problems – a set of problems known as brain fog.
Ongoing inflammation or a dysfunctional immune response may be responsible, along with the presence of a virus in the body, small blood clots, or residual damage to the heart, lungs, vascular system, brain, kidneys, or other organs.
Only now 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 adults in the United States who survived covid infection had symptoms of covid for up to four months after infection – more than double the rate of 14% among 18- to 64-year-old adults. Gone. (Other studies have shown that symptoms can last for a year or more.)
The BMJ study examined 87,000 adults 65 years of age or older with covid infection in 2020, based on data from the United Health Group’s Medicare Advantage Plan claims. This includes symptoms that lasted 21 days or more after infection, a shorter time than the CDC used in its long covid definition. The data included older adults who were hospitalized due to covid (27%) and those who were not (73%).
The high rate of post-covid symptoms in older adults is probably due to the high incidence of chronic disease and physical weakness in this population – a trait that has led to a greater understanding of serious illness, hospitalization and death in adults throughout the epidemic.
“On average, older adults are less resilient. They do not have the capacity to recover from serious illness,” said Dr. Ken Cohen, co-author of the study and executive director of translation research at Optam Care.
The results of the study, applied to recent data from the CDC, suggest that up to 2.5 million adults may be affected by chronic covid. For these individuals, the consequences can be devastating: the onset of disability, inability to work, loss of ability to manage the activities of daily life, and poor quality of life.
But in the case of many seniors it is difficult to recognize the long covid.
“The challenge is that indeterminate symptoms such as fatigue, weakness, pain, confusion and increased weakness we often see in seriously ill adults. Or people may think, ‘It’s just part of aging,'” said Dr. Charles Thomas Postdoctoral Fellow.
Ann Morse, 72, of Nashville, Tennessee, contracted covid disease in November 2020 and recovered at home after a visit to the emergency room and a follow-up home visit from the nurses every few days. He soon began to have problems with his memory, attention and speech, as well as sleep problems and severe fatigue. Although he has improved somewhat, some cognitive problems and fatigue still persist.
“What was frustrating was I would tell people my symptoms and they would say, ‘Oh, we’re like that too,’ as if it’s about getting older,” she told me. “And I’m like that, but it happened to me all of a sudden overnight.”
Bell, a singer-songwriter from Nashville, had a hard time getting enough follow-up attention after spending two weeks in intensive care and an additional five weeks receiving rehabilitation therapy in a nursing home.
“I did not get any answers from my regular doctors about my breathing and other problems. They told me to take some over-the-counter medications for your sinuses and things like that, “he said.
James Jackson, director of long-term outcomes at Vanderbilt’s Critical Illness, Brain Dysfunction and Survival Center, runs several long-coveted support groups where Morse and Bell have been present and worked with hundreds of similar patients. He estimates that about one-third of the elderly have some degree of cognitive impairment.
“We know there are significant differences between the young and the old brain. Younger brains are more plastic and more efficient in reconstructing, and our younger patients seem to be able to recover their cognitive function more quickly, ”he said.
In extreme cases, covid infection can lead to dementia. This may be because older adults who are seriously ill with Covid have a higher risk of developing delirium – an acute and sudden change in mood – which is associated with the subsequent development of dementia, says Dr. Liron Sinvani, an aging specialist and an assistant. Professor at the Feinstein Institute for Medical Research at Northwell Health in Manhattan, New York.
Elderly patients may also have brain damage from oxygen deprivation or inflammation. Or the disease processes associated with dementia are already underway, and a covid infection can act as a tipping point, accelerating the onset of symptoms.
A study conducted in March by Sinwani and colleagues found that 13% of Kovid patients aged 65 and over and were hospitalized at Northwell Health in March 2020 or April 2020 found evidence of dementia one year later.
Dr. Thomas Gutt, associate chair of medicine at Staten Island University Hospital, which opened one of the first long covid clinics in the United States, observed that adults with covid could push adults with pre-existing conditions such as heart failure or lung disease. Edge “is a more serious obstacle.
In the case of older adults in particular, he said, “it is difficult to relate to what is directly related to Covid and to blame for the progress they have already made.”
Richard Gard, 67, who lives just outside of New Haven, Connecticut, was not a true self-described “very healthy and fit” sailor, scuba diver and Yale University music teacher who was attacked by Covid in March 2020. The first covid patient was treated at Yale New Haven Hospital, where he was seriously ill for 28 weeks, including five days of intensive care and three days of ventilator.
In the two years since then, Gard has spent more than two months in hospital, usually for symptoms such as a heart attack. “If I tried to climb the stairs or walk 10 feet, I would almost come out exhausted, and the symptoms would start – severe chest pain would spread to my neck, I would have trouble breathing, I would sweat,” he said.
Dr. Erica Spatz, director of Yale’s Preventive Cardiovascular Health Program, is a physician at the Guard. “The more severe the covid infection and the older you are, the more likely you are to have cardiovascular complications later,” he said. Complications include weakening of the heart muscle, blood clots, abnormal heart rhythms, damage to the vascular system, and high blood pressure.
The guard’s life has changed in a way he never imagined. Unable to work, he takes 22 pills and can still walk only 10 minutes on flat ground. Post-traumatic stress disorder is a frequent, unwanted companion.
“A lot of times it was hard to keep going, but I tell myself I just have to get up and try one more time,” he told me. “Every day that I get a little better, I tell myself I’m adding another day or week to my life.”
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