In a striking study published in The BMJ early this year, 27,698 out of 87,337 (32%) COVID-19 survivors aged 65 and older reported at least one persistent or new Long COVID symptom up to four months after the acute phase of infection. 

To Liron Sinvani, M.D., director of Geriatric Hospitalist Service at Northwell Health and a researcher of quality of care in hospitalized older adults, the message is clear: clinicians must “reframe” how they look at and approach Long COVID in seniors. “We need to improve our approach to and management of Long COVID,” she writes in MedPage Today.*

Redefining Long COVID in Seniors 

Sinvani believes that the first step to improvement is viewing Long COVID in older adults as a geriatric syndrome. This phrase describes older adult health conditions that often have unique features like incontinence and frailty, which can’t be easily categorized and often have poor outcomes. “Redefining Long COVID as a geriatric syndrome will allow us to approach it with the unique lens needed for older adults,” says Sinvani, “a particularly vulnerable population.” 

Like many geriatric syndromes, Long COVID is complex and not well understood. At the same time, older adults tend to be more susceptible to Long COVID due to the greater number of underlying medical conditions and increased medication use that are common among that population in the U.S.  

Sinvani explains that Long COVID has been more “elusive” than other geriatric syndromes because of its newness, and the vast range of symptoms that are difficult to diagnose and can be dismissed as “old age.” Without a definitive diagnosis and clear management strategy, patients and families can be left feeling frustrated and abandoned, she says.

5-Point Plan

Not unlike other geriatric syndromes, Sinvani says a comprehensive approach to Long COVID diagnosis and management in older adults is needed. She offers a five-point plan for healthcare professionals:

• Any new symptoms after COVID-19 in older adults should be taken seriously, and a thorough medical history and physical examination initiated.
• Ensure proper management of underlying conditions such as high blood pressure, diabetes, and heart disease.
• Ensure that older adults stay socially and mentally engaged, and physically mobile. (Many cut back on activity during the pandemic.)
• Include social determinants of health in daily practice, like food and housing security, disparities of which are likely to be made worse by the pandemic.
• Include and support caregivers—“an essential part of the care team.”

Staying Vigilant

Through their ongoing research to better categorize Long COVID, Sinvani and her colleagues are working toward improved diagnosis and management of the complex syndrome.

Until then, Sinvani says “we must remain vigilant when seeing our patients who fall into this high-risk category for Long COVID, refrain from dismissing symptoms as just ‘old age,’ and listen to the caregivers and loved ones who are on the front lines of helping care for these patients.”

*Sinvani, L. (2022, Long COVID in Older Adults: An Elusive Geriatric Syndrome. Medpage Today. https://www.medpagetoday.com/opinion/second-opinions/98971