Older adults who have survived covid-19 are more likely than younger patients to have persistent symptoms such as fatigue, breathlessness, muscle aches, heart palpitations, headaches, joint pain, and difficulty with memory and concentration 鈥 problems linked to .
But it can be hard to distinguish lingering aftereffects of covid from conditions common in older adults such as lung disease, heart disease, and mild cognitive impairment. There are no diagnostic tests or recommended treatments for long covid, and the biological mechanisms that underlie its effects remain poorly understood.
鈥淚dentifying long covid in older adults with other medical conditions is tricky,鈥 said , an assistant professor of infectious diseases at the University of Alabama-Birmingham鈥檚 school of medicine. Failing to do so means older covid survivors might not receive appropriate care.
What should older adults do if they don鈥檛 feel well weeks after becoming ill with the virus? I asked a dozen experts for advice. Here鈥檚 what they suggested.
Seek medical attention. 鈥淚f an older person or their caregiver is noticing that it鈥檚 been a month or two since covid and something isn鈥檛 right 鈥 they鈥檝e lost a lot of weight or they鈥檙e extremely weak or forgetful 鈥 it鈥檚 worth going in for an evaluation,鈥 said , director of the geriatric hospitalist service at Northwell Health, a large health system in New York.
But be forewarned: Many primary care physicians are at a loss as to how to identify and manage long covid. If you鈥檙e not getting much help from your doctor, consider getting a referral to a specialist who sees long covid patients or a long covid clinic. Also, be prepared to be patient: Waits for appointments are lengthy.
At least 66 hospitals or health systems have created , according to Becker鈥檚 Hospital Review, an industry publication. For people who don鈥檛 live near one of those, virtual consultations are often available. For specialist referrals, ask whether the physician has experience with long covid patients.
Also, are enrolling patients in a four-year, $1.15 billion study of long covid that is being funded by the National Institutes of Health and is known as RECOVER (Researching COVID to Enhance Recovery). Older adults who choose to participate will receive ongoing medical attention.
Pursue comprehensive care. At the University of Southern California鈥檚 , physicians start by making sure that any underlying medical conditions that older patients have 鈥 for instance, heart failure or chronic obstructive pulmonary disease 鈥 are well controlled. Also, they check for new conditions that may have surfaced after a covid infection.
If preexisting and new conditions are properly managed and further tests come back negative, 鈥渢here is probably an element of long covid,鈥 said , one of two physicians at the Keck School of Medicine clinic.
At that point, the focus becomes helping older adults regain the ability to manage daily tasks such as showering, dressing, moving around the house, and shopping. Typically, several months of physical therapy, occupational therapy, or cognitive rehabilitation are 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 that鈥檚 detected, there are well-established treatments that can be tried. 鈥淭he older a person is, the more likely we are to find organ injury,鈥 Spatz said.
At the Shirley Ryan AbilityLab in Chicago, a rehabilitation hospital, experts have discovered that a significant number of patients with breathing problems have atrophy in the diaphragm, a muscle that鈥檚 essential to breathing, said , a physician-scientist. Once inflammation is under control, breathing exercises help patients build back the muscle, he said.
For older adults concerned about their cognition after covid, McAuley recommends a neuropsychological exam. 鈥淧lenty of older patients who鈥檝e had covid feel like they now have dementia. But when they do the testing, all their higher-level cognitive functioning is intact, and it鈥檚 things like attention or cognitive fluency that are impaired,鈥 she said. 鈥淚t鈥檚 important to understand where deficits are so we can target therapy appropriately.鈥
Become active gradually. Older patients tend to lose strength and fitness after severe illness 鈥 a phenomenon known as 鈥渄econditioning鈥 鈥 and their blood volume and heart muscles will start shrinking in a few weeks if they lie in bed or get little activity, Spatz said. That can cause dizziness or a racing heart upon standing up.
In line with recent , Spatz advises patients who have developed these symptoms after covid to drink more fluids, consume more salt, and wear compression socks and abdominal binders.
鈥淚 often hear that going for a walk feels awful,鈥 Spatz said. When returning to exercise, 鈥渟tart with five to 10 minutes on a recumbent bicycle or a rower, and add a couple of minutes every week,鈥 she suggested. After a month, move to a semi-recumbent position on a standard bike. Then, after another month, try walking, a short distance at first and then longer distances over time.
This 鈥済o slow鈥 advice also applies to older adults with cognitive concerns after covid. Franz said he often recommends restricting time spent on cognitively demanding tasks, along with exercises, for brain health and memory. At least early on, 鈥減eople need less activity and more cognitive rest,鈥 he noted.
Reset expectations. Older adults typically have a harder time bouncing back from serious illness, including covid. But even seniors who had mild or moderate reactions to the virus can find themselves struggling weeks or months later.
The most important message older patients need to hear is 鈥済ive yourself time to recover,鈥 said , director of the Mayo Clinic鈥檚 Covid Activity Rehabilitation Program in Rochester, Minnesota. Generally, older adults appear to be taking longer to recover from long covid than younger or middle-aged adults, he noted.
Learning how to set priorities and not do too much too quickly is essential. 鈥淚n this patient population, we鈥檝e found that having patients grit their teeth and push themselves will actually make them worse鈥 鈥 a phenomenon known as 鈥,鈥 Vanichkachorn said.
Instead, people need to learn how to pace themselves.
鈥淎ny significant health event forces people to reexamine their expectations and their priorities, and long covid has really accelerated that,鈥 said , an associate professor of clinical occupational therapy at the Keck School of Medicine. 鈥淓veryone I see feels that it鈥檚 accelerated their aging process.鈥
Consider vulnerabilities. Older adults who have had covid and who are poor, frail, physically or cognitively disabled, and socially isolated are of considerable concern. This group has been more likely to experience severe effects from covid, and those who survived may not readily access health care services.
鈥淲e all share concern about marginalized seniors with limited health care access and poorer overall health status,鈥 said Erdmann, of UAB. 鈥淪prinkle a dangerous new pathology that鈥檚 not well understood on top of that, and you have a recipe for greater disparities in care.鈥
鈥淎 lot of older [long covid] patients we deal with aren鈥檛 accustomed to asking for help, and they think, perhaps, it鈥檚 a little shameful to be needy,鈥 said , director of long-term outcomes at the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt University Medical Center in Nashville, Tennessee.
The implications are significant, not only for the patients but also for health care providers, friends, and family. 鈥淵ou really have to check in with people who are older and vulnerable and who have had covid and not just make assumptions that they鈥檙e fine just because they tell you they are,鈥 Jackson said. 鈥淲e need to be more proactive in engaging them and finding out, really, how they are.鈥
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.
