Seniors who survived Covid-19 are more likely than younger patients to have persistent symptoms such as fatigue, shortness of breath, muscle aches, palpitations, headaches, joint pain, and memory and concentration difficulties. All these symptoms are related to long Covid.
But it can be difficult to distinguish later, persistent symptoms of Covid-19 from other conditions common in older people, such as lung disease, heart disease and mild cognitive impairment.
There are no diagnostic tests or recommended treatments for long-term Covid, and the biological mechanisms behind its effects remain poorly understood.
“Identifying long-term covid in older adults with other medical conditions is tricky,” said Nathan Erdmann, assistant professor of Infectious Diseases at the University of Alabama’s Heersink School of Medicine.
Failure to identify could mean that the elderly who survived Covid may not receive adequate care.
What should seniors do if they don’t feel well for weeks after infection? Here’s what the experts suggest:
Seek medical attention
“If an older person or their caregiver notices that it’s been a month or more since Covid and that something isn’t right, like a lot of weight loss or extreme weakness or forgetfulness, it’s worth getting an assessment,” commented Liron Sinvani, director of the Geriatrics Service at Northwell Health, a large health care system in New York.
But beware: many primary care physicians, such as those in emergency rooms, still do not know how to identify and manage long-term Covid. If you don’t have much help from your doctor, seek a referral to a clinic specializing in long-term Covid, or a specialist who sees these patients.
In the United States, at least 66 hospitals or healthcare systems have created interdisciplinary clinics, according to Becker’s Hospital Review, an industry publication.
In addition, more than 80 medical centers in more than 30 states are enrolling patients in a long, four-year, $1.15 billion study on Covid-19. by the US National Institutes of Health and known as Recover (Covid Research for Improved Recovery). Seniors who choose to participate will receive ongoing medical care.
Seek comprehensive care
At the University of Southern California’s Covid Recovery Clinic, doctors start by checking that any medical conditions older patients have, such as heart failure or chronic obstructive pulmonary disease, are well controlled.
In addition, they check for new diseases that may have emerged after Covid.
If pre-existing and new conditions are properly managed and new tests are negative, “there is likely an element of long Covid,” commented Caitlin McAuley, from the Keck School of Medicine clinic.
At this point, the focus shifts to helping the elderly regain their ability to perform daily tasks, such as bathing, dressing, moving around the house, or shopping.
Typically, the prescription is for several months of physical therapy, occupational therapy, or cognitive rehabilitation.
Erica Spatz, an associate professor of cardiology at the Yale School of Medicine, looks for evidence of organ damage, such as changes in heart muscle, in older patients.
If this is detected, there are well-established treatments that can be tested. “The older the person, the more likely we are to find organ damage,” said Spatz.
At the Shirley Ryan Ability Lab rehab hospital in Chicago, experts found that a significant number of patients with respiratory problems have atrophy in the diaphragm, an essential muscle for breathing, commented Colin Franz, medical scientist.
Once the inflammation is under control, breathing exercises help patients recover muscle.
For seniors concerned about their post-Covid cognition, McAuley recommends getting a neuropsychological exam.
“Many older patients who had Covid feel that they now have dementia. However, when they do the exams, all the high-level cognitive functioning is intact, and it’s things like attention or cognitive fluency that are impaired,” she explained. “It’s important to understand where the deficits are so we can target appropriate treatment.”
Get active gradually
Older patients tend to lose strength and physical condition after severe illness — a phenomenon known as “deconditioning” — and their blood volume and heart muscles begin to shrink within a few weeks if they are bedridden or do little activity, explained Dr. teacher Spatz.
The condition can cause dizziness or a racing heart when standing up.
In line with recent recommendations from the American College of Cardiology, Spatz advises patients who developed such symptoms after Covid to drink more fluids, consume more salt, and wear compression stockings and abdominal straps.
“I’ve heard a lot of people say they feel terrible going out for a walk,” she said. When returning to exercise, “start with five to ten minutes on a recumbent bike or rowing simulator, and add a few minutes each week,” she suggested.
After a month, move to a semi-recumbent position on a regular bike. Then, after another month, try walking, a short distance at first and then greater distances over time.
The advice to “take it slow” also applies to older adults with cognitive concerns after illness.
Franz often recommends restricting time spent on demanding cognition tasks, along with exercise, for brain health and memory. At least initially, “people need less activity and more cognitive rest,” he noted.
rethink expectations
Older adults in general have a harder time after experiencing a serious illness, including Covid.
However, even seniors who have had mild or moderate cases of coronavirus infection may experience difficulties weeks or months later.
The most important message older patients need to hear is “give yourself time to recover,” said Greg Vanichkachon, director of the Covid Activity Rehabilitation Program at the Mayo Clinic in Rochester, Minnesota.
Generally, older adults seem to take longer to recover from long-term Covid than younger or middle-aged adults.
It is essential to learn to set priorities and not do anything in a hurry. “In this patient population, we found that those who grind their teeth and try to force themselves to do everything do the worst” — a phenomenon known as “post-exertion malaise,” Vanichkachorn explained.
Instead, everyone needs to learn to deal with their own rhythm.
“Any significant health event forces people to re-examine their expectations and their priorities, and the long-term Covid has really accelerated that,” added Jamie Wilcox, associate professor of clinical occupational therapy at the Keck School of Medicine.
“Everyone who goes through this says that aging has accelerated.”
Consider your vulnerabilities
Older adults who have had Covid and who are poor, frail, physically or cognitively disabled and socially isolated are of great concern.
The group has been more likely to suffer serious effects from the disease. Those who survived may not have immediate access to health services.
“Our concern is for marginalized elderly people with limited access to health care and worse general health status,” said Erdmann of the UAB.
“When a dangerous new pathology arrives that is not well understood, we have a picture of greater disparities in care.”
“Many of the older patients with long-term Covid that we treat are not used to asking for help, and even find it embarrassing to do so,” said James Jackson, director of long-term outcomes at the Vanderbilt Center for Critical Illness, Brain Dysfunction and Survival. Medical Center in Nashville.
The implications are significant, not just for patients, but also for healthcare professionals, friends and family.
“You need to check up on older, more vulnerable people who have Covid and not just make assumptions that they’re okay just because they say they are,” Jackson advised.
“We need to be more proactive in engaging them to really find out how they are doing.”
*Judith Graham of Kaiser Health News. THE KHN (Kaiser Health News) is a US vehicle that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). The KFF is a non-profit, grant-aided organization that provides information on health issues.
Source: CNN Brasil
