What older adults need to know about long COVID

What older adults need to know about long COVID thumbnail

This article originally appeared on Kaiser Health News .

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–problems linked to long covid.

But, it can be difficult to distinguish the lingering effects of covid from other conditions that are common in older adults, such as heart disease, lung disease, and mild cognitive impairment. Long covid is not a condition that can be diagnosed or treated. The biological mechanisms behind its effects are still poorly understood.

” It is difficult to identify long covid in older adults who have other medical conditions,” said Dr. Nathan Erdmann ,, an assistant professor of infectious disease at the University of Alabama-Birmingham. If this is not done, older covid survivors might not receive the appropriate care ..

What should older adults do if they feel ill for weeks? I sought advice from a dozen experts. Here are their suggestions.

Seek medical attention

“If an older person or their caregiver is noticing that it’s been a month or two since covid and something isn’t right–they’ve lost a lot of weight or they’re extremely weak or forgetful–it’s worth going in for an evaluation,” said Dr. Liron Sinvani, director of the geriatric hospitalist service at Northwell Health, a large health system in New York.

But be aware that many primary care physicians are unable to recognize and manage long covid. If your doctor is not able to help you, it may be worth referring you to a specialist who treats long covid patients. Be patient. Waiting times can be long.

At least 66 hospitals or health systems have created interdisciplinary clinics, according to Becker’s Hospital Review, an industry publication. Virtual consultations are available for those who don’t live in the vicinity of one of these hospitals. Ask your doctor if they have experience treating long-covid patients.

Also, more than 80 medical centers in more than 30 states 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). Participants over 60 years old will be provided with ongoing medical care.

Pursue comprehensive care

At the University of Southern California’s covid recovery clinic, physicians start by making sure that any underlying medical conditions that older patients have–for instance, heart failure or chronic obstructive pulmonary disease–are well controlled. They also check for any new conditions that may have developed after a covid infected.

If preexisting and new conditions are properly managed and further tests come back negative, “there is probably an element of long covid,” said Dr. Caitlin McAuley, one of two physicians at the Keck School of Medicine clinic.

At that point, the focus shifts to helping older adults manage daily tasks like dressing, showering, moving around the house, and grocery shopping. Typically, physical therapy, occupational therapy, and cognitive rehabilitation are prescribed.

Dr. Erica Spatz is an associate professor of cardiology in Yale School of Medicine. She examines older patients for signs of organ damage such as changes to the heart muscle. There are many proven treatments that can be used if this is detected. Spatz stated that organ injury is more common in older people.

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’s essential to breathing, said Dr. Colin Franz, a physician-scientist. He said that breathing exercises can be used to help patients rebuild the muscle once inflammation has been controlled.

McAuley recommends that older adults who are concerned about their cognition after having covid have a neuropsychological examination. Many older patients who have had covid feel they have dementia. However, the testing shows that their higher-level cognitive functioning is intact and it’s only things like attention and cognitive fluency that are impaired. “It’s important to understand where deficits are so we can target therapy appropriately.”

Become active gradually

Older patients tend to lose strength and fitness after severe illness–a phenomenon known as “deconditioning”–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. This can lead to dizziness and a racing heart when standing up.

In line with recent recommendations from the American College of Cardiology, Spatz advises patients who have developed these symptoms after covid to drink more fluids, consume more salt, and wear compression socks and abdominal binders.

” “I often hear that going on a walk feels terrible,” Spatz stated. When returning to exercise, “start with five to 10 minutes on a recumbent bicycle or a rower, and add a couple of minutes every week,” she suggested. After a month, you can move to semi-recumbent on a standard bicycle. After another month, you can start walking, initially for a short distance, and then gradually increasing your distances.

This “go slow” advice is also applicable to older adults who have cognitive problems after having had covid. Franz stated that he recommends limiting time spent on cognitively challenging tasks and exercising for brain health. He noted that people need to be less active and get more rest, at least in the beginning.

Reset expectations

Older adults often have a harder time recovering from serious illness, such as covid. Even seniors with mild or moderate reactions can still experience difficulties weeks or months later.

The most important message older patients need to hear is “give yourself time to recover,” said Dr. Greg Vanichkachorn, director of the Mayo Clinic’s Covid Activity Rehabilitation Program in Rochester, Minnesota. He noted that it seems that older adults take longer to recover from long-term covid than younger and middle-aged people.

It is important to learn how to prioritize and not do too many things at once. “In this patient population, we’ve found that having patients grit their teeth and push themselves will actually make them worse”–a phenomenon known as “post-exertional malaise,” Vanichkachorn said.

People need to learn how they can pace themselves.

“Any significant health event forces people to reexamine their expectations and their priorities, and long covid has really accelerated that,” said Jamie Wilcox, an associate professor of clinical occupational therapy at the Keck School of Medicine. “Everyone I meet feels it has accelerated their aging .”

Consider vulnerabilities

Older adults with covid who are poor, frail and physically or cognitively disabled and socially isolated are of great concern. These people are more likely to suffer severe side effects from covid. Those who survive may not be able to access health care services.

” We all share concern over seniors who are disadvantaged and have limited access to health care. “Sprinkle a dangerous, new pathology on top of that, you have the recipe for greater care .”

disparities

“A lot of older [long covid] patients we deal with aren’t accustomed to asking for help, and they think, perhaps, it’s a little shameful to be needy,” said James Jackson, 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 serious, not only for patients, but also for friends, family, and health care providers. Jackson stated that it is important to engage people who are older, vulnerable, and have had covid. It is not enough to assume they are fine because they tell you so. “We must be more proactive in engaging them .”

and finding out how they are.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.

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