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Age‐Related Changes in the Clinical Picture of Long COVID
Journal article   Peer reviewed

Age‐Related Changes in the Clinical Picture of Long COVID

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, …
Journal of the American Geriatrics Society (JAGS), Vol.73(10), pp.3123-3137
10/2025
DOI: 10.1111/jgs.70043
PMID: 40888500

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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. Distribution of Long COVID/PASC symptom clusters by age group, with clusters 1 and 2 denoting milder and 3 and 4 more severe symptom clusters as defined by Thaweethai et al. (JAMA 2023).
 Epidemiology age prevalence Long COVID older adults patient‐reported outcomes

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