The extent of long COVID and its characteristics among the older population

By Bhavana KunkalikarReviewed by Danielle Ellis, B.Sc.Oct 5 2022

In a recent study published in the International Journal of Infectious Diseases, researchers explored the characteristics of long coronavirus disease (COVID) among older adults.

Background

A significant majority of COVID-19 survivors, including those who experienced mild acute infection, have reportedly experienced long-COVID. The affected people frequently suffer from incapacitating symptoms that reduce their physical and cognitive abilities as well as their quality of life. Recent longer-term follow-up investigations have revealed that many individuals still do not fully recover even a year after infection. Even though older adults make up a significant fraction of those with severe COVID-19 infections, little is currently known regarding the prevalence and risk factors of symptomatic long-COVID in this population.

About the study

In the present study, researchers examined the risk factors associated with two typical long-COVID symptoms named fatigue and dyspnea and described long-COVID symptoms in older persons.

The five multidisciplinary hospital-based COVID-19 recovery centers in Israel, Switzerland, Spain, and Italy participated in this multicenter prospective cohort study. Consecutive adult patients who visited the facilities between May 2020 and March 2021 and were over 18 years were included. Patients had to have a COVID-19 diagnosis confirmed by polymerase chain reaction (PCR) at least 30 days before the clinic visit to be enrolled for a visit.

The attending physician interviewed the patients during their clinic appointment, asking them to describe their long COVID symptoms and rating each symptom on a 0–3 Likert scale. People reporting at least three ongoing symptoms were considered to have a significant burden of long-COVID symptoms. In addition, patients had a full pulmonary function test (PFT) during the clinic visit in accordance with American Thoracic Society recommendations, independent of their symptoms. PFT results were expressed as a percentage of expected normal values based on the patient's height, age, and gender as determined during the visit. The team compared the manifestations in young adults aged between 18 and 65 years and elderly individuals aged over 65 years.

During the clinic visit, data on demographics such as age, marital status, gender, physical activity pre- and post-COVID-19, body mass index (BMI), comorbidities, smoking status, and acute COVID-19 characteristics were collected. These data were collected by the doctors at the time of the clinic visit.

Results

The study included a total of 2333 individuals. The average age was 51 years, while 20.5% of the population was over 65 years. The average amount of time between the COVID-19 onset and the visit to the clinic was 146 days. Compared to the percentage of women in the younger group, the proportion of women over 65 was lower. The prevalence of smoking, inactivity, comorbidities, and medication use were all higher among older people.

Compared to younger individuals, severe COVID-19 was reported by 58.4% and 24.4%, while hospitalization was noted in 79.1% and 39.8% of older and younger patients, respectively. In contrast to larger proportions of sore throat, nasal congestion, headache, chest discomfort, and anosmia/ageusia, all of which are more prevalent in younger persons, dyspnea was found to be the only symptom that was considerably more common in older adults having acute COVID-19.

Compared to younger participants, older people entered the recovery clinic around a month earlier. Furthermore, 64.2% of younger patients and 80% of older patients both reported symptoms. Nevertheless, their frequencies of high burden symptoms were comparable. Fatigue was reported by 38.7% and 39.4%, and dyspnea by 29.9% and 27.3% of younger and older patients, respectively.

Higher incidence rates of long-COVID fatigue were associated with the female gender, obesity, smoking, and hypertension. Long-COVID fatigue was independently correlated with obesity and feminine gender. Since the acute illness was also significantly associated with fatigue, evaluation at a shorter time interval was necessary. Notably, age was not a risk factor for long-COVID fatigue. Additionally, higher rates of long-COVID dyspnea were linked to the female gender, physical activity status before COVID-19 diagnosis, COVID-19 severity, obesity, and hypertension.

Long-COVID dyspnea was associated with obesity, female gender, limited pre-COVID-19 physical activity, as well as chronic pulmonary disease. However, long-COVID dyspnea did not show any association with older age. Additionally, dyspnea was significantly linked to a shorter duration between an acute disease diagnosis and examination.

Conclusion

Overall, the study findings showed that older people with long-COVID experience different symptoms along with more significant pulmonary impairment. Women and obese people are particularly vulnerable to long-COVID. The researchers believe it is necessary to conduct extensive research to better understand the natural history of long-COVID in the aged population and evaluate potential therapies to promote recovery and wellbeing.