Long COVID, an often debilitating condition, has left doctors scrambling to find treatments and diagnostic tools. The problem is even more complicated for residents of nursing homes and long-term care facilities, many of whom are already experiencing a health decline.
A recent study published in the Journal of the American Geriatrics Society found that patients who were infected with SARS-CoV-2 struggled with cognitive issues and were more dependent on the staff for an average of 9 months after infection.
"Lasting effects might not be as noticeable with patients in nursing homes — a lot of them have impaired baseline function," said Sophie Clark, MD, geriatrician and assistant professor at the University of Colorado School of Medicine, Aurora, and the first author of the study. "It's hard because some of these patients are not able to report symptoms as well as younger, healthier patients. If something is going on in a young person, it's clearer. In an older population, the picture is muddier."
Clark and her team observed 171 residents at two facilities in Michigan. About half had tested positive for SARS-CoV-2 between March 2020 and October 2021; the rest did not contract the virus.
Researchers measured the level of assistance patients needed for tasks like dressing and bathing, along with their performance on cognitive tests, and compared the results to their pre-pandemic baseline.
Survivors of COVID-19 continued to experience its effects for an average of 9 months, and 30% of those infected died prior to the 1-year follow-up — nearly twice as many deaths as in the noninfected group.
"Before the pandemic, the two groups scored about the same on both tests," said Clark, who at the time of the study was a fellow at the University of Michigan, Ann Arbor. "But the patients who tested positive for COVID-19 showed a sudden decline [in physical and cognitive function] after infection."
Most participants in the study were women who were aged over 80 years and identified as White and non-Hispanic. Among them, half were diagnosed with dementia, and every participant had multiple chronic conditions. Almost all those who contracted COVID-19 during the study period had not received prior vaccination.
Many people with long COVID develop symptoms such as brain fog, extreme fatigue, and severe headaches that linger for months or even years. One in 10 people who have COVID-19 develop the post-COVID syndrome.
The study brings to light the need for ongoing research on long COVID among older patients and those in nursing homes, according to Lona Mody, MD, MSc, another author of the paper and interim chief of the Division of Geriatrics and Palliative Medicine, University of Michigan, Ann Arbor.
"It's important to set expectations for physicians who are working with the patients that there could be functional and cognitive decline after COVID-19 infection, such that patients might need more help from caregivers," Mody said. "With each circulating strain, the outcomes could be different."
Mody added that there is a bright side to the findings: patients who suffered from long COVID eventually recovered.
"If they overcome the acute phase of the illness, there is functional and cognitive decline to be expected," she said. "But there is hope."
Older patients who had COVID-19 have borne the brunt of the pandemic: Americans between the ages 65 and 74 account for 22% of COVID-19 deaths, despite comprising less than 10% of the population, figures from the US Centers for Disease Control and Prevention show. Meanwhile, people between the ages 75 and 84 account for 26% of deaths but represent less than 5% of the population.
The study's findings mirror what many caregivers have seen in nursing home settings, according to Karl Steinberg, MD, CMD, past president of the Society for Post-Acute and Long-Term Care Medicine and longtime nursing home and hospice medical director in Oceanside, California. However, he said that long COVID symptoms have become less common since the rollout of vaccines.
Steinberg said he has seen several patients who previously had COVID-19 exhibit cognitive decline, postural hypotension, depression, and failure to thrive. Although identifying long COVID in patients with existing morbidities may be challenging, tell-tale signs can alert clinicians, Steinberg said.
"It's hard to attribute these symptoms to COVID alone because in this population anything — the flu, a urinary tract infection — can be associated with declines in physical or cognitive function," Steinberg said. "But if someone with dementia is suddenly oxygen-dependent, it's easier to make that diagnosis."
While nursing homes have infection prevention protocols, they rarely have long COVID specialists on site, which makes research like this especially important. Employees of nursing homes might use the findings to discern what signs to look for in patients, he said.
The researchers noted that recent data show vaccination against COVID-19 can reduce the risk for long COVID. So, the experience of the patients in their study, who mostly contracted COVID-19 before vaccines were available, may not match the current state of vaccinated nursing home residents.
Steinberg said the findings also highlight the importance of vaccination, particularly among vulnerable populations.
"I think vaccines have made a huge difference, not just in severity in cases but I think with long COVID as well," he said. "That is perhaps the best weapon we have against long COVID."
The authors reported no relevant financial disclosures. The study was funded by the Agency for Healthcare Research and Quality, National Institute on Aging, Michigan Institute for Clinical and Health Research, and Veterans Affairs Ann Arbor Healthcare System.
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