By Tamsin Zandstra
As more research becomes available on COVID-19 and Long COVID it is evident that there is a gap in understanding on the implications for the older adult population, defined by Medicare as individuals over the age of 65.
This article is informed by academic research and a discussion with Dr. Elizabeth White, APRN, PhD, an Assistant Professor of Health Services, Policy, and Practice at the Brown University School of Public Health.
Evidence shows that older adult populations are at a higher risk of contracting COVID-19 and subsequently developing Long COVID as they belong to a more medically complex population with higher risk of chronic conditions and multimorbidity. However, knowing the true implications of Long COVID on their health can be difficult as common symptoms including cough, fatigue, shortness of breath, chest pain, brain fog, difficulty sleeping and a change in smell and/or taste are often nonspecific and can be dismissed as “signs of aging.”
Some unique Post-COVID symptoms are manifesting in older adults which include heart failure or lung disease, as the virus weakens the immune system prematurely. Research from Denmark is also showing that there is an increased correlation between COVID-19 in older patients and the acceleration of developing Alzheimer’s (and subsequently dementia), Parkinson’s disease and ischemic stroke. In addition, a study by the Mayo Clinic has found that among people over the age of 65, one in four have at least one medical condition caused by COVID-19 including Long COVID. Organ damage and inflammation of the immune system can lead to persistent COVID-19 symptoms or the development of new conditions.
Nursing home populations and those in long-term care facilities have been particularly devastated by COVID-19, accounting for around 40% of deaths prior to the existence of the COVID vaccine. Baseline factors such as the prior need of such individuals to already require constant care, being in close living quarters and depending on staff for everyday activities such as getting dressed and eating, made social distancing impossible thus putting this population at greater risk of contracting COVID-19 and subsequently developing Long COVID.
Mental health in older patients has also been a struggle throughout the pandemic with social isolation leading to feelings of loneliness and increased levels of depression and anxiety. At the start of the pandemic this was the best way known to try and prevent the spread of the virus however, for those in full time care this led to little or no visitation time, and for older adult populations living at home it signified the end of community activities, adult day programs and senior centers operating due to a fear of the virus. Furthermore, older adult populations are vulnerable to mental health challenges as a result of Long COVID, sometimes becoming entirely reliant on others to care for them, feeling lonely and isolated and facing much uncertainty and change as relates to their health, familial and financial circumstances. Many people have been forced to make difficult decisions about retiring early, applying for disability benefits or taking on long term care because of their ongoing symptoms.
There are several challenges facing researchers in trying to understand how older adult populations are impacted by COVID-19 and subsequent Long COVID. Despite the Medicare definition of who is classified as an older adult patient the reality is that people have different chronological and functional ages at different stages so understanding the impact of COVID in adults is a challenge based on each individual’s circumstances. Furthermore gathering data by monitoring patients from their initial COVID infection to see how it impacts their body, if they develop Long COVID and other symptoms and conditions is extremely challenging and in addition you need a control group to monitor throughout this period.
The Long COVID Initiative would like to thank Dr. Elizabeth White for her time and insight into this topic.