R3 Seminar Recap: Long COVID in older adults: Insights from the RECOVER adult observational cohort

Existing findings and gaps in Long COVID research 

Dr. Russell (University of Arizona) presented findings from a review article in which she and her co-authors reviewed previously published studies to summarize existing knowledge on what was currently known about Long COVID in adults aged 65 or older and highlight gaps for future research.

Studying Long COVID in older adults is important to understand how Long COVID presents across the lifespan. Aging affects how the body responds to and recovers from illnesses like COVID-19. Additionally, some older adults have multiple health conditions and take several medications, which can influence how Long COVID develops and presents. 

Older adults may also experience different symptoms than younger adults. For instance, an older person having a heart attack may feel shortness of breath or confusion rather than the “crushing chest pain” commonly experienced by younger adults. Dr. Russell also shared that there are multiple reasons why older adults may report their symptoms differently than younger adults. For instance, they may be experiencing age-related cognitive decline that makes it difficult to describe their symptoms, or they may face technology barriers if research surveys are administered online. 

The review found that the most common Long COVID symptoms in older adults included shortness of breath, fatigue, problems with memory and thinking, and joint or muscle pain. Cognitive issues were nearly 2 to 3 times more common in older adults than in younger people.

The authors of the review article found that Long COVID was more common among the following groups:

• Older adults (although the studies reviewed defined “older adults” differently, most focused on adults aged 65 or older)
• Females
• People who identified as Black, American Indian, Alaska Native, or Hispanic
• People who had other medical conditions
• People who smoked
• People who had more severe COVID-19 symptoms

The following groups were less likely to develop Long COVID: 

• People who were vaccinated
• People who were physically active
• Those with higher education levels

Dr. Russell noted multiple limitations to the study. First, many of the papers reviewed were published before the National Academies of Science, Engineering, and Medicine established a definition of Long COVID (PDF, 242 KB) in 2023. Therefore, the studies included in the review relied on varying definitions of Long COVID. Second, the studies reviewed used different research methods, and many did not include a group of participants without Long COVID (a control group) for comparison. This makes it difficult for researchers to understand which effects can be attributed to Long COVID versus other factors. Third, the studies used different age ranges to define “older adults.” Dr. Russell emphasized the need for more research to better understand how Long COVID affects this age group.

“Our population is aging significantly and rapidly,” shared Dr. Russell. “Having a good understanding of the biology and clinical picture of Long COVID in our older patients is important, not only for proper and timely diagnosis, but also for implementing interventions, and hopefully in the near future, treatments.”

Read more about the review of Long COVID in older adults.

RECOVER observational study finds Long COVID risk is lower for older adults

Dr. Nikolich (University of Arizona) presented findings from a recently published paper examining how Long COVID affects different age groups within the RECOVER adult observational study. The study compared participants aged 60 or older with those aged 18 to 59, dividing them into age groups across the lifespan: 18 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 or older. Because almost 30,000 people have volunteered to take part in the of RECOVER observational study, researchers were able to study a large number of older adults prospectively (over a long period of time) and include a group of people who never had COVID for comparison. These qualities enabled this study to draw stronger conclusions than earlier, smaller studies. 

Compared with the 18 to 39 age group, Long COVID was most common among participants aged 40 to 59, lower in those aged 60 to 69, and lowest in those aged 70 or older. This pattern is similar to patterns seen in other post-infection syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some symptoms, like hearing problems and joint or chest pain, were less helpful in identifying Long COVID among older adults because they were already common in this age group. 

The study also found age-related differences within clusters of Long COVID symptoms. Dr. Nikolich shared that older adults (aged 60 and older) were more likely to experience milder symptom clusters:

• Cluster 1: Loss of taste or smell
• Cluster 2: Gastrointestinal problems, cough lasting weeks or longer, and irregular heartbeat (without brain fog, or loss of taste or smell)

In contrast, older adults were less likely to experience more severe clusters:

• Cluster 3: Brain fog without loss of taste or smell
• Cluster 4: A mix of symptoms, including joint pain, brain fog, muscle pain, hearing issues, and exhaustion

Dr. Nikolich also shared limitations to this study. The number of older participants in the study was relatively small compared to other RECOVER studies, with only 792 people aged 70 or older. Researchers were also concerned about a possible “survivor effect,” meaning there may be fewer older adults with Long COVID because older adults were more likely to die from acute COVID. In addition, older adults may underreport Long COVID symptoms because they might attribute them to normal aging rather than to a specific health condition.

He emphasized that future research should continue to use RECOVER’s observational study data to better understand how Long COVID progresses in older adults over a longer period of time. Researchers can also analyze biosamples (such as blood or urine) collected from RECOVER participants in this age group to study immune and inflammatory responses related to Long COVID.

Quinn Barnette (RTI International) led the discussion and Q&A after the presentations. He asked if there was a key message that the speakers would like to communicate with clinicians and policymakers. Both presenters emphasized the importance of listening to older patients, whose concerns may not always be taken seriously. Dr. Russell said, “It's common for older patients to feel like their concerns are not being heard.” Dr. Nikolich added, “Long COVID patients...have been told that a lot of this is in their head, and that this is not real. [Long COVID] is extremely real. It's debilitating, it's devastating.”

To find recordings and transcripts of more R3 seminars, visit the RECOVER YouTube channel and the R3 Seminar webpage.