New study says more than 30% of older adults develop long COVID

INTERVIEWER: Well, while we're talking about older adults, there's an interesting new study with Minnesota Connections that looks at long COVID in adults 65-plus. And it finds that 32% of older adults in the US who survived COVID infections had symptoms of long COVID up to four months after infection-- symptoms like memory fog, fatigue, and heart, lung, and kidney problems.

Joining us right now is Dr. Ken Cohen. He's the co-author of the study and the Executive Director of Translational Research for Optum Care, which is based in the Twin Cities. Doctor, are you with us?

KEN COHEN: I am. Apologies for our earlier snafu. It's great to be with you, Kathy.

INTERVIEWER: Likewise. Thank you for joining us. Technology is great when it works. The suite of symptoms for long COVID is confounding-- trouble with memory, and speech, and fatigue, as I mentioned, and heart, lung, and kidney problems among other things. These can also be symptoms of so many other ailments. Is long COVID overlooked as the cause?

KEN COHEN: That's potentially the case. And when we did this study, we looked at over 80,000 individuals that had COVID and specifically teased out what were the COVID-specific symptoms. And then we compared them to over 88,000 individuals that had not had COVID. So we do believe that the symptoms that we identified are specific to long COVID.

INTERVIEWER: Why do older adults have such a high rate of long COVID symptoms?

KEN COHEN: Interestingly, if you look at the severity of COVID infection, it does vary with age, with older adults having more severe disease. And it also varies with other health-related problems so that individuals with hypertension, diabetes, obesity, underlying heart or lung disease also have worse clinical courses with COVID. And those diseases are all more prevalent as individuals get older. So it's easy to understand why an older population might have a higher prevalence of long COVID.

INTERVIEWER: Can long COVID exacerbate existing conditions-- say, if someone has high blood pressure or maybe the beginning of cognitive decline, might that make it worse?

KEN COHEN: Our study didn't specifically look at that, but other studies have. And if you do look at individuals, for example, that have COPD or emphysema who develop COVID, they clearly have a worse respiratory outcome. And similarly, patients that have underlying heart failure will have a worse outcome. So I do believe that when there are significant underlying medical problems, those can be worsened by acute COVID infection.

INTERVIEWER: I'm curious about the cognitive impairment that seems to be a part of the equation for many older long COVID patients-- and for that matter, some younger patients too. Do we know how that happens?

KEN COHEN: We don't. It is possible that that might be an artifact of the study. And what I mean by that is that some individuals with early Alzheimer's disease may be unrecognized by both the patient and the family. And when they come under a bright light of being seen by the medical community for acute COVID infection, it may be then clinically apparent and first shared with patients and families.

So it could be an artifact. But that being the case, we did definitely notice a higher prevalence of both memory difficulties and new onset dementia in the senior population. And interestingly, we also broke this population down to those individuals between age 65 and 75 and those individuals older than 75. And although problems with memory and new onset dementia were higher in the senior group in general, clearly, there was a higher risk in that older population than in the 65 to the 75-year-olds.

INTERVIEWER: Interesting. Say, why is Optum interested in this?

KEN COHEN: There are over half a billion cases now worldwide, and we know over 200 million cases in the US at this point. If even a small fraction of those individuals wind up with long COVID, then this will pose an enormous problem to the health care system and also to employers. So it's of interest to Optum to try to identify exactly what are the conditions that are specific to long COVID. And then once those are understood, we can begin to tease them out one by one and look at how best to evaluate and treat them, since, at the end of the day, the goal is to have everybody recover from COVID.

INTERVIEWER: By the way, this is a pretty extensive study. What was the big takeaway for you? What was the big surprise?

KEN COHEN: I think the most important takeaway was the fact that the incidence of long COVID symptoms was so much higher than it was in the commercial population. We did a similar study in the 18 to 64-year-old population, and the incidence in seniors is over twice as high. So that was one striking finding.

The other striking finding is that once patients are hospitalized for COVID, then the likelihood of long COVID becomes markedly elevated relative to the group that wasn't hospitalized. So we have very clear data now that the worse the initial infection, the higher the likelihood of long COVID.

So a very important point since there are still unvaccinated individuals out there. And if we can reduce the severity of initial infection across the population, we can, by inference, reduce the likelihood of long COVID.

INTERVIEWER: So a good argument for vaccination, especially for older folks.

KEN COHEN: Absolutely.

INTERVIEWER: Dr. Cohen, I appreciate your time. Thank you for putting up with our technical difficulties. It was nice talking with you.

KEN COHEN: Glad to be with you, and hope you have a wonderful afternoon.

INTERVIEWER: You too. Thank you so much. That was Dr. Ken Cohen, the co-author of a study on long COVID in older adults. He's also the Executive Director of Translational Research for Optum Care based in the Twin Cities.