Age-related changes in the clinical picture of Long COVID

View Publication on PubMed

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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