By Judith Graham OCTOBER
20, 2020
“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’ve become critically ill from the coronavirus, Walters, 65, describes what
she calls “brain fog” — difficulty putting thoughts together, problems with
concentration, the inability to remember what happened a short time before.
This sudden cognitive
dysfunction is a common concern for seniors who’ve survived a serious bout of
COVID-19.
“Many older patients are
having trouble organizing themselves and planning what they need to do to get
through the day,” said Dr. Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai
Health System in New York City. “They’re reporting that they’ve become more and
more forgetful.”
Other challenges abound:
overcoming muscle and nerve damage, improving breathing, adapting to new
impairments, regaining strength and stamina, and coping with the emotional toll
of unexpected illness.
Most seniors survive
COVID-19 and will encounter these concerns to varying degrees. Even among the
age group at greatest risk — people 85 and older — just 28% of those with
confirmed cases end up dying, according to data from the Centers for Disease Control and Prevention. (Because
of gaps in testing, the actual death rate may be lower.)
Walters, who lives in
Indianapolis, spent almost three weeks in March and April heavily sedated, on a
ventilator, fighting for her life in intensive care. Today, she said, “I still
get tired real easy and I can’t breathe sometimes. If I’m walking sometimes my
legs get wobbly and my arms get like jelly.”
“Emotionally, it’s been
hard because I’ve always been able to do for myself, and I can’t do that as I
like. I’ve been really nervous and jittery,” Walters said.
Younger adults who’ve
survived a serious course of COVID-19 experience similar issues but older
adults tend to have “more severe symptoms, and more limitations in terms of
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 Critical Illness, Brain Dysfunction and Survivorship Center
at Vanderbilt University Medical Center. Most likely, he speculated, a year
after fighting the disease at least half of the critically ill older patients
will not have fully recovered.
The aftereffects of
delirium — an acute, sudden change of consciousness and mental acuity — can
complicate recovery from COVID-19. Seniors hospitalized for serious illness are
susceptible to the often-unrecognized condition when they’re immobilized for a
long 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 a heightened risk of losing independence, developing
dementia and dying. It can manifest as acute confusion and agitation or as
uncharacteristic unresponsiveness and lethargy.
“What we’re seeing with
COVID-19 and older adults are rates of delirium in the 70% to 80% range,” said
Dr. Babar Khan, associate director of Indiana University’s Center for Aging
Research at the Regenstrief Institute, and one of Walters’ physicians.
Gordon Quinn, 77, a
Chicago documentary filmmaker, believes he contracted COVID-19 at a conference
in Australia in early March. At Northwestern Memorial Hospital, he was put on a
ventilator twice in the ICU, for a total of nearly two weeks, and remembers
having “a lot of hallucinations” — a symptom of delirium.
“I remember vividly
believing I was in purgatory. I was paralyzed — I couldn’t move. I could hear
snatches of TV — reruns of ‘Law & Order: Special Victims Unit’ — and I
asked myself, ‘Is this my life for eternity?’” Quinn said.
Given the extent of
delirium and mounting evidence of neurological damage from
COVID-19, Khan said he expects to see “an increased 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 securing 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 rehabilitation hospital, before
returning home and getting several weeks of home-based therapy. Today, he’s
able to walk nearly 2 miles and has returned to work, feeling almost back to
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 beginning in
early May.
Talaganis had a
complicated case of COVID-19: His kidneys failed and he was put on dialysis. He
experienced cardiac arrest and was in a coma for almost 58 days while on a
ventilator. He had intestinal bleeding, requiring multiple blood transfusions,
and was found to have crystallization and fibrosis in his lungs.
When Talaganis began his
rehab on Aug. 22, he said, “my whole body, my muscles were atrophied. I couldn’t
get out of bed or go to the toilet. I was getting fed through a tube. I
couldn’t eat solid foods.”
In early October, after
getting hours of therapy each day, Talaganis was able to walk 660 feet in six
minutes and eat whatever he wanted. “My recovery — it’s a miracle. Every day I
feel better,” he said.
Unfortunately,
rehabilitation needs for most older adults are often overlooked. Notably, a
recent study found that one-third of critically ill older
adults who survive a stay in the ICU did not receive rehab services at home
after hospital discharge.
“Seniors who live in more
rural areas or outside bigger cities where major hospital systems are providing
cutting-edge services are at significant risk of losing out on this potentially
restorative care,” said Dr. Sean Smith, an associate professor of physical
medicine and rehabilitation at the University of Michigan.
Sometimes what’s most
needed for recovery from critical illness is human connection. That was true
for Tom and Virginia Stevens of Nashville, Tennessee, in their late 80s, who
were both hospitalized with COVID-19 in early August.
Ely, one of their
physicians, found them in separate hospital rooms, frightened and miserable.
“I’m worried about my husband,” he said Virginia told him. “Where am I? What is
happening? Where is my wife?” the doctor said Tom asked, before crying out, “I
have to get out of here.”
Ely and another physician
taking care of the couple agreed. Being isolated from each other was dangerous
for this couple, married for 66 years. They needed to be put in a room
together.
When the doctor walked
into their new room the next day, he said, “it was a night-and-day difference.”
The couple was sipping coffee, eating and laughing on beds that had been pushed
together.
“They both got better
from that point on. I know that was because of the loving touch, being
together,” Ely said.
That doesn’t mean
recovery has been easy. Virginia and Tom still struggle with confusion,
fatigue, weakness and anxiety after their two-week stay in the hospital,
followed by two weeks in inpatient rehabilitation. Now, they’re in a new
assisted living residence, which is allowing outdoor visits with their family.
“Doctors have told us it
will take a long time and they may never get back to where they were before
COVID,” said their daughter, Karen Kreager, also of Nashville. “But that’s OK.
I’m just so grateful that they came through this and we get to spend more time
with them.”
Judith Graham: khn.navigatingaging@gmail.com, @judith_graham
https://khn.org/news/older-covid-patients-battle-brain-fog-weakness-and-emotional-turmoil/
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