Older people with long Covid should prepare to slow down



KHN

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, heart palpitations, headaches, joint pain, and difficulty with memory and concentration – problems related to the long Covid.

But it can be difficult to distinguish the lingering sequelae of Covid from 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 Covid, and the biological mechanisms underlying its effects remain poorly understood.

“Identifying long Covid in older adults with other medical conditions is tricky,” said Dr. Nathan Erdmann, assistant professor of infectious diseases at the University of Alabama at the Heersink School of Medicine in Birmingham. Failure to do so means older Covid survivors may not receive proper care.

What should older people do if they don’t feel well weeks after falling ill with the virus? I sought advice from a dozen experts. Here’s what they suggested.

See a doctor. ‘If an older person or their carer notices that it’s been a month or two since Covid and something is wrong – they’ve lost a lot of weight or are extremely weak or forgetful – it’s worth going for an assessment said Dr. Liron Sinvani, director of the geriatric inpatient service at Northwell Health, a large health care system in New York.

But be warned: Many primary care doctors don’t know how to identify and manage long Covid. If you don’t get much help from your doctor, consider getting referred to a long Covid clinic or a specialist who sees long Covid patients. Also, be prepared to be patient: waiting times for appointments are long.

At least 66 hospitals or health systems have established interdisciplinary clinics, according to Becker’s Hospital Review, an industry publication. For people who don’t live near one, virtual consultations are often available. For specialist referrals, ask if the doctor has experience with long Covid patients.

Additionally, more than 80 medical centers in more than 30 states are enrolling patients in a four-year, $1.15 billion study funded by the National Institutes of Health known as RECOVER (Researching COVID to Enhance Recovery ). Seniors who choose to participate will receive ongoing medical care.

Continue comprehensive care. At the University of Southern California’s Covid Recovery Clinic, doctors begin by ensuring that any underlying medical conditions that elderly patients have – for example, heart failure or chronic obstructive pulmonary disease – are well controlled. Also, they check for new conditions that may have surfaced post-Covid.

If pre-existing and new conditions are properly managed and further tests come back negative, “there is likely an element of long Covid,” said Dr Caitlin McAuley, one of two doctors at the Keck School clinic. of Medicine.

At this point, the goal is to help older people regain the ability to manage daily tasks such as showering, dressing, moving around the house, and running errands. 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 heart muscle changes, in elderly 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,” Spatz said.

At the Shirley Ryan AbilityLab in Chicago, a rehabilitation hospital, experts have found that a significant number of patients with respiratory problems have atrophy of the diaphragm, a muscle essential for breathing, said physician-scientist Dr Colin Franz. . Once inflammation is under control, breathing exercises help patients rebuild muscle, he said.

For older people concerned about their cognition after Covid, McAuley recommends a neuropsychological examination. “Many elderly patients who have had Covid now feel like they have dementia. But when they do the tests, all of their higher-level cognitive functioning is intact, and it’s things like attention or cognitive fluency that are impaired,” she said. “It’s important to understand where the deficits are so that we can target therapy appropriately.”

Become active gradually. Older patients tend to lose strength and fitness after serious illness – a phenomenon known as ‘deconditioning’ – and their blood volume and heart muscle will begin to decline within weeks if they remain in bed or if they do little activity, Spatz said. This can cause dizziness or a racing heartbeat when standing up.

In line with recent recommendations from the American College of Cardiology, Spatz advises patients who developed these symptoms post-Covid to drink more fluids, consume more salt, and wear compression socks and abdominal belts.

“I often hear that walking around is awful,” Spatz said. When returning to exercise, “start with five to 10 minutes on a recumbent bike or rowing machine, and add a few minutes each week,” she suggested. After a month, move to a semi-recumbent position on a standard bicycle. Then, after another month, try walking, first a short distance, then longer distances over time.

This ‘go slow’ advice also applies to older people with cognitive issues after Covid. Franz said he often recommends limiting time spent on cognitively demanding tasks, as well as exercises, for brain health and memory. At least initially, “people need less activity and more cognitive rest,” he noted.

Reset expectations. Older people generally have a harder time recovering from serious illness, including Covid. But even older people who have had mild or moderate reactions to the virus can find themselves struggling weeks or months later.

The most important message elderly patients need to hear is “give yourself time to recover,” said Dr. Greg Vanichkachorn, director of the Covid Activity Rehabilitation Program at Mayo Clinic in Rochester, Minnesota. In general, older adults seem to take longer to recover from long Covid than younger or middle-aged adults, he noted.

Learning to set priorities and not to do too much too quickly is essential. “In this patient population, we found that having patients clench their teeth and push themselves will actually make them worse” — a phenomenon known as “post-exercise sickness,” Vanichkachorn said.

Instead, people need to learn to pace themselves.

“Any significant health event forces people to re-examine their expectations and priorities, and for a long time Covid has really accelerated that,” said Jamie Wilcox, associate professor of clinical occupational therapy at Keck School of Medicine. “Everyone I see feels like it has accelerated their aging process.”

Consider vulnerabilities. Elderly people who have had Covid and who are poor, frail, physically or cognitively disabled and socially isolated are of great concern. This group was more likely to suffer severe effects from Covid, and those who survived may not have easy access to healthcare services.

“We all share concerns about marginalized older adults with limited access to health care and poorer overall health,” said UAB’s Erdmann. “Sprinkle a dangerous new pathology that is not well understood on top of that, and you have a recipe for greater disparities in care.”

“A lot of the elderly (long Covid) patients we deal with aren’t used to asking for help, and they think, maybe, it’s a bit shameful to be in need,” said James Jackson, director of long-term outcomes at the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt University Medical Center in Nashville.

The implications are significant, not only for patients, but also for health care providers, friends and family. “You really have to check in with people who are older and vulnerable and have had Covid and not just assume they’re okay just because they tell you they’re okay,” Jackson said. “We need to be more proactive in involving them and finding out, really, how they are doing.”

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