Grandparents with persistent COVID? This is what they should do

Older adults who have 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 difficulty with memory and concentration , long-term covid-related issues.

But it can be difficult to distinguish the lingering sequelae 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 prolonged covid, and the biological mechanisms underlying its effects remain a mystery.

“Identifying persistent COVID in older adults with other illnesses is complicated,” said Dr. Nathan Erdmann, professor of infectious diseases at the University of Alabama-Birmingham (UAB) School of Medicine. Failing to do so means older covid survivors may not receive adequate care.

What should older adults do if they don’t feel well weeks after contracting the virus? Experts suggest:

seek medical care

“If an older person or their caregiver notices that it’s been a month or two after covid and something isn’t right — excessive weight loss, extreme weakness, or memory problems — it’s worth going for an evaluation,” Dr. Liron said. Sinvani, director of geriatric inpatient service at Northwell Health, a health system in New York.

But keep in mind that many primary care doctors don’t know how to identify and treat persistent covid. If your doctor can’t help you, consider a referral to a specialist who cares for long-term covid patients. Also, be patient: waiting times for appointments are long.

At least 66 hospitals or health systems have created interdisciplinary clinics, according to Becker’s Hospital Review, an industry publication. For people who don’t live near one of them, there are often virtual visits. When you are referred to a specialist, ask if the doctor has experience with patients with persistent or prolonged covid.

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In addition, more than 80 medical centers in more than 30 states are enrolling patients in a four-year, $1.15 billion study of persistent covid, funded by the National Institutes of Health (NIH) and known as RECOVER (Researching Covid to Enhance Recovery). -Investigate Covid to Enhance Recovery). Older adults who agree to participate will receive ongoing medical care.

seek comprehensive care

At the University of Southern California’s Covid Recovery Clinic, doctors start by making sure any underlying medical conditions older patients have — heart failure or chronic obstructive pulmonary disease, for example — are well controlled. In addition, they check if there are new conditions that may have arisen after a covid infection.

If pre-existing and new conditions are properly controlled and subsequent tests come back negative, “it’s likely to be prolonged Covid,” said Dr. Caitlin McAuley of the Keck School of Medicine clinic.

At that time, the focus is on helping older adults regain the ability to perform everyday tasks such as showering, dressing, getting around the house, and shopping. Typically, several months of physical therapy, occupational therapy, or cognitive rehabilitation are prescribed.

Dr. Erica Spatz, a professor of cardiology at Yale School of Medicine, looks for signs of organ damage, such as changes in the heart muscle, in older patients. If detected, there are well-established treatments that can be tried. “The older a person is, the more likely we are to find organ damage,” she added.

At Chicago’s Shirley Ryan AbilityLab, a rehabilitation hospital, experts have found that a significant number of patients with respiratory problems have atrophy in the diaphragm, a muscle essential for breathing, said Dr. Colin Franz. Once inflammation is controlled, breathing exercises help patients recover muscle, he added.

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For older adults concerned about their cognitive abilities after Covid, McAuley recommends a neuropsychological exam. “Many older patients who have had covid feel as if they have dementia. But when you do the tests, all of their cognitive functioning is intact, and it’s things like attention or cognitive fluency that are impaired,” she explained. “It is important to understand where the deficits are in order to establish therapy appropriately.”

Be active again little by little

Older patients tend to lose strength and fitness after severe illness, and their blood volume and heart muscles will start to shrink within a few weeks if they stay in bed or do little activity, Spatz said. This can cause dizziness or a racing heart when standing up.

Following recent recommendations from the American College of Cardiology, Spatz advises patients who have developed these symptoms after Covid to drink more fluids, eat more salt, and wear compression socks and abdominal binders.

They have to go little by little. Move around the house, then you can walk, a short distance at first, then longer distances over time.

manage expectations

Older adults often have a harder time recovering 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 is “give yourself time to recover,” said Dr. Greg Vanichkachorn, director of the Activity Rehabilitation Covid Program at the Mayo Clinic in Rochester, Minnesota. In general, older adults seem to take longer to recover from persistent Covid than younger or middle-aged adults, he noted.

Learning to prioritize and not doing too much too fast is essential. “In this patient population, we’ve found that making patients strain will actually make them worse,” Vanichkachorn added.

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Consider vulnerabilities

Older adults who have suffered from covid and who are poor, frail, physically or cognitively disabled and live in social isolation are of great concern. This group is more likely to suffer from the severe effects of covid, and those who have survived may not have easy access to health care services.

“We all share the concern for the elderly marginalized, with limited access to health care and a worse state of health in general,” said Erdmann, from the UAB. “Add to this a dangerous new pathology that is not well understood, and you have a recipe for widening disparities in care.”

“A lot of the older patients we treat are not used to asking for help, and they think maybe it’s a little embarrassing to need it,” said James Jackson, director of long-term outcomes at the Center for Critical Illness, Brain Dysfunction. and Survivorship from Vanderbilt University Medical Center in Nashville, Tennessee.

The implications are important, not only for patients, but also for health care providers, friends, and family. “You have to treat the elderly and vulnerable people who have had covid and not assume that they are fine just because they tell you they are,” Jackson said. “We have to be more proactive about engaging them and really finding out how they are doing.”

KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.

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