Age-related changes in the clinical picture of Long COVID
Fain, MJ; Horne, BD; Horwitz, LI; et al., Journal of the American Geriatrics Society
Published
September 2025
Journal
Journal of the American Geriatrics Society
Abstract
Background: This study evaluated the impact of aging on the frequency and prevalent symptoms of Long COVID, also termed post-acute sequelae of SARS-CoV-2, using a previously developed Long COVID research index (LCRI) of 41 self-reported symptoms in which those with 12 or more points were classified as likely to have Long COVID.
Methods: We analyzed community-dwelling participants ≥ 60 years old (2662 with prior infection, 461 controls) compared to participants 18-59 years (7549 infected, 728 controls) in the Researching COVID to Enhance Recovery adult (RECOVER-Adult) cohort ≥ 135 days post-onset.
Results: Compared to the Age 18-39 group, the adjusted odds of LCRI ≥ 12 were higher for the Age 40-49 group (odds ratio [OR] = 1.40, 95% confidence intervals [CI] = 1.21-1.61, p < 0.001) and 50-59 group (OR = 1.31, CI = 1.14-1.51, p < 0.001), similar for the Age 60-69 group (OR = 1.09, CI = 0.93-1.27, p = 0.299), and lower for the ≥ 70 group (OR = 0.68, CI = 0.54-0.85, p < 0.001). Participants ≥ 70 years had smaller adjusted differences between infected and uninfected symptom prevalence rates than those aged 18-39 for the following symptoms: hearing loss, fatigue, pain (including joint, back, chest pain and headache), post-exertional malaise, sleep disturbance, hair loss, palpitations, and sexual desire/capacity, making these symptoms less discriminating for Long COVID in older adults than in younger. Symptom clustering, as described in Thaweethai et al. (JAMA 2023) also exhibited age-related shifts: clusters 1 (anosmia and ageusia) and 2 (gastrointestinal, chronic cough and palpitations, without anosmia, ageusia or brain fog) were more likely, and clusters 3 (brain fog, but no loss of smell or taste) and 4 (a mix of symptoms) less likely to be found in older adults (relative risk ratios for clusters 3-4 ranging from 0.10-0.34, p < 0.001 vs. 18-39 year-olds).
Conclusions: Within the limits of this observational study, we conclude that in community-dwelling older adults, aging alters the prevalence and pattern of reported Long COVID.
Authors
Mindy J Fain, Benjamin D Horne, Leora I Horwitz, Tanayott Thaweethai, Meredith Greene, Mady Hornig, Ariela R Orkaby, Clifford Rosen, Christine S Ritchie, Hassan Ashktorab, Nina Blachman, Hassan Brim, Sarah Emerson, Nathan Erdmann, Kristine M Erlandson, Gabriel de Erausquin, Tamara Fong, Linda N Geng, Howard S Gordon, Jacqueline Rutter Gully, Jennifer Hadlock, Jenny Han, Weixing Huang, Prasanna Jagannathan, J Daniel Kelly, Jonathan D Klein, Jerry A Krishnan, Emily B Levitan, Grace A McComsey, Dylan McDonald, Aoyjai P Montgomery, Lisa O'Brien, Ighovwerha Ofotokun, Thomas F Patterson, Michael J Peluso, Priscilla Pemu, Alice Perlowski, Eric M Reiman, Martine Sanon, Sudha Seshadri, Judd Shellito, Zaki A Sherif, Cecilia Shikuma, Nora G Singer, Upinder Singh, Joel D Trinity, Juan Wisnivesky, Margot Gage Witvliet, Andrea Foulkes, Janko Ž Nikolich, RECOVER consortium
Keywords
Long COVID; age prevalence; epidemiology; older adults; patient‐reported outcomes
Short Summary
This RECOVER study looked at how Long COVID symptoms change as people get older and how often those changes happen. Researchers compared younger adults (ages 18–59) and older adults (age 60 and older) who did and did not have COVID-19. They found that Long COVID was most common in people ages 40–59, and less common in those ages 70 and older. Among the participants ages 70 and older, symptoms like fatigue, pain, and hearing problems were less helpful in identifying Long COVID because they were also common in older people who had never had COVID-19. Instead, symptoms of Long COVID in older adults were more likely to include problems with smell and taste as well as stomach issues. This finding is important because it helps doctors know what to look for when diagnosing and treating Long COVID in older patients.