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Editor’s Note: Find the latest news and guidance on COVID-19 at Medscape’s Coronavirus Resource Center.
“Lord, give me back my memory.”
For months, as Marilyn Walters has struggled to recover from COVID-19, she has repeated this prayer day and night.
Like other older adults who became critically ill from the coronavirus, Walters, 65, describes what she calls “brain fog”: difficulty gathering thoughts, trouble concentrating, an inability to remember what happened shortly before.
This sudden cognitive dysfunction is a common concern for older people who have survived a severe attack of COVID-19.
“Many older patients have trouble getting organized and planning what they need to do to get through the day,” said Dr. Zijian Chen, medical director of the Mount Sinai Health System Post-COVID Care Center in New York City. “They are reporting that they have become increasingly forgetful.”
Other challenges abound: overcoming muscle and nerve damage, improving breathing, adjusting to new impediments, regaining strength and stamina, and dealing with the emotional toll of an unexpected illness.
Most older people survive COVID-19 and will encounter these concerns to varying degrees. Even among the age group most at risk, people 85 and older, only 28% of people with confirmed cases end up dying, according to data from the Centers for Disease Control and Prevention. (Due to gaps in testing, the actual death rate may be lower.)
Walters, who lives in Indianapolis, spent nearly three weeks in March and April heavily sedated, with a ventilator, fighting for her life in intensive care. Today, she said, “I still get tired very easily and sometimes I can’t breathe. If I walk, sometimes my legs wobble and my arms go like jelly.”
“Emotionally, it’s been difficult because I’ve always been able to do it myself, and I can’t do it the way I like. I’ve been very nervous and nervous,” Walters said.
Younger adults who have survived a severe course of COVID-19 experience similar problems, but older adults tend to have “more severe symptoms and more limitations in what they can do,” Chen said.
“Recovery will be on the order of months and years, not days or weeks,” said Dr. E. Wesley Ely, co-director of the Center for Critical Illness, Brain Dysfunction and Survival at Vanderbilt University Medical Center. Most likely, he speculated, a year after battling the disease, at least half of critically ill older patients will not have fully recovered.
The aftermath of delirium (a sudden and acute change in consciousness and mental alertness) can complicate recovery from COVID-19. Older people hospitalized for serious illness are susceptible to the often-unrecognized condition when they are immobilized for long periods of time, isolated from family and friends and given sedatives to ease agitation or narcotics for pain, among other contributing factors.
In older adults, delirium is associated with an increased risk of losing independence, developing dementia, and dying. It may manifest as acute confusion and agitation, or as unresponsiveness and unusual lethargy.
“What we’re seeing with COVID-19 and older adults are delirium rates in the 70% to 80% range,” said Dr. Babar Khan, associate director of the Indiana University Center for Research on Aging at the Regenstrief Institute, and one of Walters’ Doctors.
Gordon Quinn, 77, a Chicago documentary maker, believes he contracted COVID-19 at a conference in Australia in early March. At Northwestern Memorial Hospital, he was placed on a ventilator twice in the ICU, for a total of almost two weeks, and he recalls having “many hallucinations,” a symptom of delirium.
“I vividly remember believing I was in purgatory. I was paralyzed, I couldn’t move. I could hear TV clips, reruns of ‘Law & Order: Special Victims Unit,’ and I would ask myself, ‘Is this my life for eternity? ? ‘”Quinn said.
Given the extent of delirium and growing evidence of neurological damage from COVID-19, Khan said he expects to see “a higher prevalence of ICU-acquired cognitive impairment in older COVID patients.”
Ely agrees. “These patients will urgently need to work on recovery,” he said. Family members should insist on obtaining rehabilitation services (physical therapy, occupational therapy, speech therapy, cognitive rehabilitation) after the patient leaves the hospital and returns home, he advised.
“Even at my age, people can get incredible benefit from rehab,” said Quinn, who spent nearly two weeks at Chicago’s Shirley Ryan AbilityLab, a rehab hospital, before returning home to several weeks of therapy. domiciliary. Today, he can walk almost 2 miles and has returned to work, feeling almost normal.
James Talaganis, 72, of Indian Head Park, Illinois, also benefited from rehab at Shirley Ryan AbilityLab after spending nearly four months in various hospitals in early May.
Talaganis had a complicated case of COVID-19: His kidneys failed and he was put on dialysis. He went into cardiac arrest and was in a coma for almost 58 days while on a ventilator. She had intestinal bleeding, requiring multiple blood transfusions, and was found to have crystallization and fibrosis in her lungs.
When Talaganis began his rehab on August 22, he said: “My whole body, my muscles were atrophied. I couldn’t get out of bed or go to the bathroom. They fed me through a tube. I couldn’t eat solid food.”
In early October, after receiving hours of therapy every day, Talaganis was able to walk 660 feet in six minutes and eat whatever she wanted. “My recovery is a miracle. Every day I feel better,” he said.
Unfortunately, the rehabilitation needs of most older adults are often overlooked. In particular, a recent study found that one-third of critically ill older adults who survive an ICU stay did not receive home rehabilitation services after hospital discharge.
“Older people who live in more rural areas or outside of larger cities where major hospital systems provide state-of-the-art services are at significant risk of losing this potentially restorative care,” said Dr. Sean Smith, associate professor of physical medicine and rehabilitation at the University of Michigan.
Sometimes what is needed most to recover from a critical illness is the human connection. That was true for Tom and Virginia Stevens of Nashville, Tennessee, in the late 1980s, who were hospitalized with COVID-19 in early August.
Ely, one of their doctors, found them in separate hospital rooms, scared and miserable. “I’m worried about my husband,” she said Virginia told him. “Where am I? What’s going on? Where is my wife?” said Dr. Tom asked, before yelling, “I have to get out of here.”
Ely and another doctor caring for the couple agreed. Being isolated from each other was dangerous for this couple, married for 66 years. They needed to put them together in a room.
When the doctor entered his new room the next day, he said that “it was a difference between day and night.” The couple were drinking coffee, eating and laughing in beds that had been together.
“They both got better from that point on. I know it was from the loving contact, being together,” Ely said.
That does not mean that recovery has been easy. Virginia and Tom are still struggling with confusion, fatigue, weakness, and anxiety after their two-week stay in the hospital, followed by two weeks of inpatient rehab. Now, they are in a new assisted living residence, which allows open-air visits with their family.
“Doctors have told us that it will take a long time and that they may never go back to where they were before COVID,” said his daughter, Karen Kreager, also of Nashville. “But that’s okay. I’m so thankful they’ve been through this and we can spend more time with them.”
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