Age-Related Changes in the Clinical Picture of Long COVID

Authors

• Mindy J. Fain, University of Arizona College of Medicine – Tucson, Tucson, AZ
• Benjamin D. Horne, Intermountain Health, Salt Lake City, UT
• Leora I. Horwitz, NYU Langone Health, New York, NY
• Tanayott Thaweethai, Harvard University, Boston, MA
• Meredith Greene, Indiana University Center for Aging Research at the Regenstrief Institute, Indianapolis, IN
• Mady Hornig, Northwell Health System, Manhasset, NY
• Ariela R. Orkaby, Harvard Medical School, Boston, MA
• Clifford Rosen, MaineHealth Institute for Research, Scarborough, ME
• Christine S. Ritchie, Harvard Medical School, Boston, MA
• Hassan Ashktorab, Howard University College of Medicine, Washington, DC
• Nina Blachman, NYU Grossman School of Medicine, New York, NY
• Hassan Brim, Howard University College of Medicine, Washington, DC
• Sarah Emerson, Providence Medical Research Center, Spokane, Washington, DC
• Nathan Erdmann, UAB Department of Medicine, Birmingham, AL
• Kristine M. Erlandson, University of Colorado Anschutz Medical Campus, Aurora, CO
• Gabriel de Erausquin, University of Texas Health Sciences Center, San Antonio, TX
• Tamara Fong, Harvard Medical School, Boston, MA
• Linda N. Geng, Stanford University School of Medicine, Stanford, CA
• Howard S. Gordon, Jesse Brown VA Medical Center, Chicago, IL
• Jacqueline Rutter Gully, Dysautonomia International, East Moriches, NY
• Jennifer Hadlock, Institute for Systems Biology, Seattle, Washington
• Jenny Han, Emory University School of Medicine, Atlanta, GA
• Weixing Huang, Harvard University, Boston, MA
• Prasanna Jagannathan, Stanford University School of Medicine, Stanford, CA
• J. Daniel Kelly, University of California, San Francisco, CA
• Jonathan D. Klein, Stanford University School of Medicine, Stanford, CA
• Jerry A. Krishnan, University of Illinois at Chicago, Chicago, IL
• Judd Shellito, LSU Health Sciences Center - New OrleansFollow
• et al

Document Type

Article

Publication Date

9-1-2025

Publication Title

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.

PubMed ID

40888500

Publisher

American Geriatrics Society

Comments

See article for full author list.

Rights

© 2025 The American Geriatrics Society.

Recommended Citation

Fain, Mindy J.; Horne, Benjamin D.; Horwitz, Leora I.; Thaweethai, Tanayott; Greene, Meredith; Hornig, Mady; Orkaby, Ariela R.; Rosen, Clifford; Ritchie, Christine S.; Ashktorab, Hassan; Blachman, Nina; Brim, Hassan; Emerson, Sarah; Erdmann, Nathan; Erlandson, Kristine M.; de Erausquin, Gabriel; Fong, Tamara; Geng, Linda N.; Gordon, Howard S.; Gully, Jacqueline Rutter; Hadlock, Jennifer; Han, Jenny; Huang, Weixing; Jagannathan, Prasanna; Kelly, J. Daniel; Klein, Jonathan D.; Krishnan, Jerry A.; Shellito, Judd; and al, et, "Age-Related Changes in the Clinical Picture of Long COVID" (2025). School of Medicine Faculty Publications. 4006.
https://digitalscholar.lsuhsc.edu/som_facpubs/4006
10.1111/jgs.70043