Association between long COVID, functional activity, and health-related quality of life in older adults

Qualitative exploration of the acceptability of a 12-week intervention to reduce sedentary behaviour among ethnically diverse older adults

OBJECTIVE

The population of ethnically diverse older adults (OAs) is increasing in the UK; this group faces complex health challenges that are exacerbated by language difficulties, socioeconomic status and acculturation experiences. Moreover, this diverse group is the least active and sedentary subgroup within the wider population, which raises a major concern for their health and highlights the need for effective behaviour change interventions to motivate this group to be less sedentary. Therefore, this study aims to explore the acceptability of a 12-week intervention to reduce sedentary behaviour (SB) for ethnically diverse sedentary OAs.

DESIGN

The study employed a qualitative approach to assess the acceptability of the 12-week single-arm intervention for reducing SB.

SETTING

The study participants were recruited on a rolling basis from January to May 2024. The recruitment process was conducted through social community organisations and local religious groups in Swansea that provided leisure, sports and recreational activities for ethnically diverse OAs.

PARTICIPANTS

The target population for this study was ethnically diverse OAs aged ≥65 years (including women and men) among (n=20) OAs using in-depth interviews.

INTERVENTION

The intervention consisted of a 40-60 minute personalised one-to-one in-person health coaching session, a wearable activity tracker to remind participants to take breaks from prolonged sitting time, a pamphlet and weekly reminder messages via a mobile phone.

PRIMARY OUTCOME

To assess the acceptability of the intervention.

RESULTS

Reflexive thematic analysis was performed using a deductive approach by integrating four predetermined MRC framework themes. Four overarching themes were included in our analysis: (1) acceptability, (2) usability, (3) functionality and (4) recruitment and retention. OAs were satisfied with the intervention and found it effective and acceptable. The multicomponent intervention provided users with strategies to achieve the goal of reducing their sitting time and provided them with opportunities to be active and independent. In addition, there were personal (eg, health) and social (eg, family) factors that influenced their decision to participate in the intervention.

CONCLUSION

The findings of this study support the acceptability of the intervention with an ethnically diverse group of OAs. Initial evidence also suggests that the intervention has the potential to increase activity and minimise sitting time in ethnically diverse OAs and therefore will inform a future effectiveness trial. The inclusion of an ethnically diverse population in this study has helped us to understand the needs and challenges of these groups to identify how to design culturally sensitive interventions that are tailored according to their needs. These insights will be incorporated into the planned effectiveness trial.

The health-related quality of life among survivors with post-COVID conditions in the United States

BACKGROUND

Even after a mild initial SARS-CoV-2 infection, a considerable proportion of patients experience long-lasting symptoms. However, there is scarce data on how post-COVID conditions (PCCs) are associated with health-related quality of life (HRQL) among COVID survivors. We aimed to study this association among adult COVID survivors in the United States.

METHOD

The Behavioral Risk Factor Surveillance System 2022 data was utilized. The study population consisted of participants with a history of SARS-CoV-2 infection, categorized based on whether they had any PCCs. We evaluated the respondents' HRQL in the two groups according to 1) self-reported general health (SRGH), 2) self-reported mental health, 3) self-reported physical health, and 4) efficiency in daily activities.

RESULTS

A total of 108,237 COVID survivors were included (35% were 18-34 years old and 46.5% were male), among whom 22.7% had PCCs. Unfavorable SRGH was more common among COVID survivors with PCCs than those without PCCs (25.7% vs. 15.5%, p < 0.001). Also, rates of having unfavorable mental and physical health and compromised daily efficiency for more than 13 days a month were significantly higher among PCC-positive respondents (p < 0.001). In the regression analysis adjusted for sociodemographics, comorbidities, and behavioral determinants of health, the presence of PCCs appeared as independent associates of unfavorable SRGH (aOR: 1.39, CI95%: [1.28-1.52], p < 0.001). Among PCC-positive respondents, dizziness on standing, mood changes, and musculoskeletal pain accompanied the highest odds of unfavorable HRQL. Based on a multivariate logistic regression analysis, early middle age, obesity, physical inactivity, diabetes, cardiovascular and pulmonary diseases, cancer, depression, smoking, being single and less educated, and having low annual income were independent factors associated with increased odds of unfavorable SRGH among survivors with PCCs.

CONCLUSION

Our study corroborates that survivors with PCCs may experience significant adverse impacts on their health and daily life activities. Our results highlight the importance of further studies on PCCs' diagnosis, follow-up, and treatment.

The health-related quality of life among stroke survivors with post-COVID conditions living in the United States

BACKGROUND AND AIM

It is widely recognized that a considerable number of COVID-19 survivors continue to experience post-COVID conditions (PCCs). Given that stroke survivors face a heightened risk of PCCs compared to the general population, our objective was to assess the impact of PCCs on the health-related quality of life (HRQL) among stroke survivors in the United States.

METHOD

We used the Behavioral Risk Factor Surveillance System data 2022. Respondents with a history of COVID-19 infection and stroke were selected and classified based on whether they experienced PCCs. Finally, the HRQL-related items, including self-reported general health (SRGH), the number of days with compromised mental and physical health, and the daily efficiency, were compared between the two groups.

RESULTS

Overall, 3988 respondents (42.8 % aged above 64 years old, 45.8 % men) were enrolled. Compared to stroke survivors without PCCs, those with PCCs had significantly worse SRGH and a higher number of days with compromised mental and physical health. However, although multivariate regression analysis supported the adverse impact of PCCs on the SRGH of stroke survivors, the results were not statistically significant (aOR = 1.32,CI95 %:[0.98-1.78],p = 0.070). Fatigue and dyspnea emerged as the most significantly associated symptoms with impaired SRGH. Additionally, lower education and annual household income level, smoking, lack of physical activity, and comorbidities including diabetes, heart, and pulmonary disease were associated with a higher prevalence of unfavorable SRGH among stroke survivors with PCCs.

CONCLUSION

Our study highlights that PCCs might be associated with worse SRGH. Lower education, income, and physical activity, smoking, and comorbidities were associated with a higher rate of unfavorable SRGH among stroke survivors with PCCs.

Human herpesvirus reactivation and its potential role in the pathogenesis of post-acute sequelae of SARS-CoV-2 infection

The emergence of SARS-CoV-2 has precipitated a global pandemic with substantial long-term health implications, including the condition known as post-acute sequelae of SARS-CoV-2 infection (PASC), commonly referred to as Long COVID. PASC is marked by persistent symptoms such as fatigue, neurological issues, and autonomic dysfunction that persist for months beyond the acute phase of COVID-19. This review examines the potential role of herpesvirus reactivation, specifically Epstein-Barr virus (EBV) and cytomegalovirus (CMV), in the pathogenesis of PASC. Elevated antibody titers and specific T cell responses suggest recent herpesvirus reactivation in some PASC patients, although viremia is not consistently detected. SARS-CoV-2 exhibits endothelial trophism, directly affecting the vascular endothelium and contributing to microvascular pathologies. These pathologies are significant in PASC, where microvascular dysfunction may underlie various chronic symptoms. Similarly, herpesviruses like CMV also exhibit endothelial trophism, which may exacerbate endothelial damage when reactivated. Evidence suggests that EBV and CMV reactivation could indirectly contribute to the immune dysregulation, immunosenescence, and autoimmune responses observed in PASC. Additionally, EBV may play a role in the genesis of neurological symptoms through creating mitochondrial dysfunction, though direct confirmation remains elusive. The reviewed evidence suggests that while herpesviruses may not play a direct role in the pathogenesis of PASC, their potential indirect effects, especially in the context of endothelial involvement, warrant further investigation.

Unequal ageing: the quality of life of senior citizens in the EU before and after COVID-19. A multidimensional approach

Introduction

The ageing population presents a significant demographic and socio-economic challenge for the European Union (EU). Declining fertility rates, coupled with increasing life expectancy, have led to a growing proportion of older individuals within the population, raising concerns about their quality of life. This study aims to assess the quality of life for seniors across EU countries in the years 2015, 2019, and 2022, with a particular focus on the impact of the COVID-19 pandemic. The research seeks to answer the following question: How has the quality of life among seniors in the EU evolved over time, and how has the COVID-19 pandemic affected this trajectory? We hypothesize that the pandemic has exacerbated existing socio-economic inequalities, particularly affecting the most vulnerable older populations.

Methods

This study utilises the Synthetic Measure of Senior Quality of Life (SMSQoL) to evaluate the living conditions of seniors across four critical domains: health, finances, social relations, and environment. Data for the analysis were drawn from Eurostat and national statistical reports, complemented by pilot studies conducted in selected EU countries. The pilot studies focused on gathering qualitative data to supplement the quantitative measures, especially in areas where standardised data were incomplete or unavailable. The assessment spans three years: 2015 (pre-pandemic baseline), 2019 (immediate pre-pandemic), and 2022 (post-pandemic). The analysis includes 27 EU member states and uses both descriptive and inferential statistical methods to evaluate trends and disparities. Cross-sectional analysis was applied to examine the impact of differing social policies, levels of social security, access to healthcare, and economic strength across these countries.

Results

The analysis reveals significant disparities in the quality of life among seniors across EU countries, with pronounced differences between regions. In particular:Northern and Western Europe: seniors in these regions generally experienced improved overall life quality over the observed period. Countries such as Sweden and Germany reported gains in health, financial stability, and social relations, largely due to strong social policies and robust healthcare systems.Eastern Europe: Seniors in Eastern European countries, including Romania and Bulgaria, continued to face substantial challenges, with minimal improvements in quality of life. Economic instability, limited access to healthcare, and weaker social security systems were identified as key contributors to this stagnation.Impact of COVID-19: the pandemic exacerbated existing inequalities, particularly in the domains of social relations and finances. Seniors in economically vulnerable regions were disproportionately affected by social isolation and reduced income, intensifying the pre-existing challenges in their living conditions.Quantitative analysis confirmed that while some regions showed resilience, the most vulnerable populations experienced a sharp decline in their overall quality of life, particularly between 2019 and 2022.

Discussion

The findings from this study highlight the persistence of economic and social inequalities in the life conditions among seniors across the EU. While countries in Northern and Western Europe have made strides in improving senior living conditions, Eastern Europe continues to face significant challenges. The COVID-19 pandemic acted as a catalyst, exacerbating these inequalities, particularly in terms of social isolation and financial insecurity. These results align with previous studies that have highlighted the uneven impact of social policies and economic strength on senior well-being across Europe. The disparities underscore the need for more balanced and equitable policy interventions that can address the vulnerabilities of older populations, particularly in regions struggling with economic instability. Future research should focus on longitudinal studies that track the recovery trajectories of seniors post-pandemic and assess the effectiveness of policy measures aimed at mitigating these disparities.

Sleep problems and chronic conditions in single parents in Ghana: Serial mediating roles of health-related quality of life and functional limitations

OBJECTIVES

Data on the association between sleep problems and chronic conditions among single parents in low- and middle-income countries (LMICs) are limited, and no study has, to date, reported the serial mediation effects of functional limitations and poor health-related quality of life (HRQoL) in this association. This study examines the extent to which functional limitations and poor HRQoL serially explain the link between sleep problems and chronic conditions among single parents in Ghana.

METHODS

Data on 627 single mothers and fathers were obtained through a multi-stage stratified sampling technique. Sleep duration, nocturnal sleep problems, and daytime sleep problems were used to assess sleep problems. The EQ-5D-3L questionnaire was used to measure HRQoL. Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The mean age (SD) was 45.0 (14.66) years; 67.3% females. After full adjustment, sleep problems were significantly associated with increases in chronic conditions (β = .238, 95%CI = .100-.377), poor HRQoL (β = .604, 95%CI = .450-.757), and functional limitations (β = .234, 95%CI = .159-.307). Chronic conditions were positively influenced by poor HRQoL (β = .352, 95%CI = .284-.421) and functional limitations (β = .272, 95%CI = .112-.433). Sleep problems were indirectly related to chronic conditions via poor HRQoL (β = .213, BootSE = .039, 95%CI = .143-.295), functional limitations (β = .063, BootSE = .029, 95%CI = .013-.130) and functional limitations → HRQoL (β = .099, BootSE = .025, 95%CI = .054-.152), mediating 34.70%, 10.31% and 16.15% of the total effect, respectively.

CONCLUSIONS

Sleep problems and poor HRQoL were positively associated with chronic conditions. Functional limitations and poor HRQoL partially and serially explained this association. Efforts to address chronic conditions among single parents should consider interventions for sleep problems and physiological health outcomes, particularly in LMICs.

Functional Capacity Among Brazilian Older Adults 12 Months After COVID-19 Infection: A Cross-Sectional Study

Background/Objectives: Evidence suggests that older adults who survived COVID-19 were exposed to greater functional dependence in their daily living activities. This study aims to examine the prevalence of functional dependence and associated factors among Brazilian older people with functional dependence 12 months after COVID-19 infection. Methods: A cross-sectional study was carried out involving people aged 60 years or older in the state of Paraná, Brazil. One year after notification or hospital discharge due to COVID-19, between June 2021 and March 2022, participants responded to a questionnaire via telephone call about sociodemographic data and data on functionality using the Measure of Functional Independence (FIM). The outcome variable "assessment of functional capacity" was divided into functional dependence (FIM Total < 104) and functional independence (FIM Total ≥ 104). Results: A total of 768 older adults participated, with an average age of 68.03 ± 6.8 years (range between 60 and 100). A majority of them were female (50.3%), white (46%), with low education (37.4%), had a partner (56.3%), did not live alone (72.4%), and had their own home (52.2%). The prevalence of functional dependence was 7.2%. On average, participants scored 5.4 points lower on FIM one year after COVID-19 infection compared with those in the acute phase of COVID-19 (125.5 vs. 120.1; p < 0.001). Functional dependence was higher (p < 0.05) among women when compared to men (aOR = 2.28); in people who changed their work situation due to COVID-19 when compared to those with no change (aOR = 5.27); in people with fair/poor/bad self-reported health compared to those with excellent/good health (aOR = 2.97); in people with cardiovascular symptoms compared to those without cardiovascular symptoms (aOR = 3.37); and among the most severe cases of the disease (treatment in ICU) compared to mild cases (outpatient treatment) (aOR = 10.5). Conclusions: Most participants presented functional independence 12 months after COVID-19 infection. Cases of functional dependence were influenced by multidimensional factors, including physical health, economic, and psychosocial aspects.

Post-acute sequelae of SARS-CoV-2 infection (Long COVID) in older adults

Long COVID, also known as PASC (post-acute sequelae of SARS-CoV-2), is a complex infection-associated chronic condition affecting tens of millions of people worldwide. Many aspects of this condition are incompletely understood. Among them is how this condition may manifest itself in older adults and how it might impact the older population. Here, we briefly review the current understanding of PASC in the adult population and examine what is known on its features with aging. Finally, we outline the major gaps and areas for research most germane to older adults.

Long-term outcomes of older adults with acute COVID-19 following inpatient geriatric rehabilitation: a prospective cohort study from the Republic of Ireland

BACKGROUND

There is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation following COVID-19.

AIM

The primary aim of this study is to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation.

METHODS

This is a subgroup analysis of Irish data from a pan-European prospective cohort study. Functional ability, patient reported symptoms, and quality of life were measured using the Barthel index, the COVID-19 Yorkshire Rehabilitation Screen, and the EQ-5D-5L, respectively.

RESULTS

Thirty patients enrolled in the study. The rate of mortality was 23.3% at 6 months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at 6 months after discharge from rehabilitation.

CONCLUSIONS

Multidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow-up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.

Risk factors for long COVID syndrome in postmenopausal women with previously reported diagnosis of COVID-19

PURPOSE

Long COVID-19 syndrome occurs in 10-20 % of people after a confirmed/probable SARS-COV-2 infection; new symptoms begin within three months of COVID-19 diagnosis and last > 8 weeks. Little is known about risk factors for long COVID, particularly in older people who are at greater risk of COVID complications.

METHODS

Data are from Women's Health Initiative (WHI) postmenopausal women who completed COVID surveys that included questions on whether they had ever been diagnosed with COVID and length and nature of symptoms. Long COVID was classified using standard consensus criteria. Using WHI demographic and health data collected at study enrollment (1993-98) through the present day, machine learning identified the top 20 risk factors for long COVID. These variables were tested in logistic regression models.

RESULTS

Of n = 37,280 survey respondents, 1237 (mean age = 83 years) reported a positive COVID-19 test and 425 (30 %) reported long COVID. Symptoms included an array of neurological, cardio-pulmonary, musculoskeletal, and general fatigue, and malaise symptoms. Long COVID risk factors included weight loss, physical and mobility limitations, and specific heath conditions (e.g., history of heart valve procedure, rheumatoid arthritis).

CONCLUSIONS

Knowledge of risk factors for long COVID may be the first step in understanding the etiology of this complex disease.

Decadal Trends in Physical Activity Adherence Among Korean Older Adults: An Analysis of National Survey of Older Korean Data, 2011-2020

BACKGROUND/OBJECTIVES

This study investigated adherence to physical activity (PA) guidelines and associated sociodemographic factors among older Koreans from 2011 to 2020.

METHODS

Utilizing four public data sets from the National Survey of Older Koreans, the study included the data on 40,993 older adults 65 years and older in South Korea, collected between 2011 and 2020. Adherence to PA guidelines and sociodemographic factors were assessed through self-reported questionnaires. The data were analyzed using a two-way analysis of variance and post hoc tests.

RESULTS

Overall adherence increased from 39.1% in 2011 to 48.2% in 2017, then decreased to 37.6% in 2020 (p < .001). Men had higher adherence than women (p < .001). Age-related adherence peaked in the young-older group (65-74 years old) and was lowest in the oldest-old group (85+ years old) (p < .001). Marital status, education, and income were also significantly related to PA adherence (p < .001) across the years.

CONCLUSION

Although continuous increase in adherence to PA among Koreans 65 years and older was observed, the decline in PA levels during the COVID era underscored the need for targeted interventions and well-informed health care policies to address demographic challenges. Still, considering that data were collected during the recommended social distancing period, a cautions interpretation of these findings is warranted. Significance/Implications: Health policies aiming to improve adherence to PA guidelines should prioritize Korean older adults who are female, belong to the oldest-old group, are single, and have low education and income levels, with the goal of enhancing health equity.

Long COVID among Brazilian Adults and Elders 12 Months after Hospital Discharge: A Population-Based Cohort Study

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18-<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose-response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period.

Decline in Mobility and Balance in Persons With Post-COVID-19 Condition

OBJECTIVES

Post-COVID-19 condition (PCC) may impact mobility and balance and affect physical function. The objectives of the study were to estimate the prevalence of decline in balance and mobility in individuals with PCC; explore the association between comorbidities and sociodemographic characteristics with decline in balance and mobility; and evaluate correlations between decline in mobility and balance with change in performance of usual activities, personal care, and global health perception.

METHODS

The design was a cross-sectional study of persons with a COVID-19 diagnosis that was confirmed at least 3 months before the study. Those with PCC, defined as those still troubled by symptoms, were evaluated for decline in mobility and balance and with associated clinical and demographic factors using bivariate analysis and multivariable logistic regression. Correlations between decline in mobility and balance were also examined with change in ability to perform usual activities, personal care, and global health perception.

RESULTS

In 1031 persons with PCC, mobility deteriorated in 44.9%, and balance deteriorated in 37.1%. Older age, hospitalization, comorbidities, and obesity were associated with decline in mobility, while decline in balance was associated with older age and comorbidities. Reduced mobility was associated with changes in ability to carry out usual activities (rp = 0.6), conduct personal care (rp = 0.6), and global health status (rp = 0.5). Correlations between decline in balance and these same outcomes were 0.5, 0.5, and 0.45, respectively.

CONCLUSIONS

Almost half the participants with PCC had reduced mobility, and over a third reported deterioration in balance, with associated difficulties with daily functioning. Factors associated with greater decline help identify those most at risk.

IMPACT

Many people with PCC experience changes in mobility and balance, which can affect functional capacities and lead to physical therapist consultations. Further study should assess specific needs of these patients and determine effective physical therapist interventions to meet these needs.

LAY SUMMARY

Many persons with post-COVID-19 condition (PCC) experience symptoms resulting in functional problems, such as difficulties with personal care and performing usual activities. This study focused on difficulty in mobility and problems with balance. Almost half of persons with PCC in the study had declines in getting around and over a third had declines in balance. These problems were associated with older age and having other comorbid health conditions and were linked with decline in ability to perform personal care, carry out usual activities, and perceived global health status.

Association between healthy lifestyles and post-COVID-19 syndrome among college students

BACKGROUND

Post-COVID-19 syndrome still occurs in some populations. A healthy lifestyle is widely recognized as a first-line treatment to increase the body's antiviral resistance and tissue repair, but it is unclear whether a healthy lifestyle can promote or alleviate the symptoms of post-COVID-19 syndrome.

METHODS

A stratified random sampling method was used to select 498 participants from three universities in Fujian as the target of the questionnaire survey. The survey focused on students' healthy lifestyles and the symptoms of fatigue, anxiety, dyspnea, and depression that are common in post-COVID-19 syndrome.

RESULTS

Two months after developing COVID-19, some students continued to experience fatigue, anxiety, dyspnea, and depression, with fatigue being the most prominent symptom. The results of the study showed that there was a significant negative correlation (P < 0.01) between a healthy lifestyle and fatigue, anxiety, dyspnea, and depression among university students. Furthermore, when analyzing the different subdimensions of healthy lifestyles among university students, it was found that all dimensions showed varying degrees of negative correlation with fatigue, anxiety, dyspnea, and depression, except for health-related behaviors and interpersonal behaviors, which showed no relationship with fatigue (P < 0.01).

CONCLUSIONS

By improving healthy lifestyles, long-term COVID-19 symptoms can be reduced and improved and contribute positively to patient recovery, providing a viable rehabilitation option for long-term COVID-19 patients.

The association between suspected long-COVID and stimulant prescribing in the United States

OBJECTIVES

This study sought to determine the association between suspected long-COVID and receipt of a stimulant prescription among persons diagnosed with COVID-19 and to describe clinical and demographic factors associated with receiving a stimulant prescription.

METHODS

US patients 18 and older who had a COVID-19 diagnosis or a positive COVID-19 PCR test from April 1st, 2020 through December 21st, 2022 recorded in a national electronic health record data set obtained from TriNetX were assessed. Comparison subjects were propensity score matched on baseline covariates to those with a symptom of or diagnosis of long-COVID. A Cox Proportional Hazards models was used to estimate the influence of long-COVID on stimulant prescription receipt.

RESULTS

Those with long-COVID (n = 65,329) were twice as likely to be prescribed a stimulant as persons with only acute COVID-19 (n = 189,438, HR=2.162; 1.929-2.423). Among persons with long-COVID, persons with new onset ADHD (HR=7.196; 5.749- 9.007), opioid-related disorders (HR=2.140; 1.264-3.621) and mood disorders (HR=1.649; 1.336-2.035) were more likely to be prescribed a stimulant.

CONCLUSION

Further research describing the risks associated with increased stimulant use among persons with long-COVID is warranted.

Impact of Long COVID on Health-Related Quality of Life Among Patients After Acute COVID-19 Infection: A Cross-Sectional Study

Concerns have been raised globally regarding the long-term effects of the novel coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of long COVID on the health of patients recovering from acute COVID-19 in China. We conducted a cross-sectional questionnaire survey from 1 February to 9 March 2023. Propensity score matching (PSM) was used to understand the differences in health utility values between individuals with and without long COVID. Factors associated with health-related quality of life (HRQoL) were determined using a multiple linear regression model. A chi-square test was used to compare differences between the 2 groups for each dimension of the EuroQoL-5 Dimension-5 Level (EQ-5D-5L) scale. In total, 307 participants were included in the analysis, of which 40.39% exhibited at least 1 persistent symptom. The common symptoms of long COVID were fatigue/weakness, coughing, memory decline, poor concentration, and phlegm in the throat. Most patients with long COVID reported mild effects from their symptoms. After propensity score matching, the long-COVID group had lower health utility scores than the non-long-COVID group (0.94 vs 0.97). In the multivariable linear regression analysis, persistent symptoms and low annual household income were associated with lower health utility values (P < .05). Anxiety/depression and pain/discomfort were the major problems experienced by the participants with long COVID. Long-COVID symptoms following acute COVID-19 infection have a serious impact on health-related quality of life. Therefore, it is necessary to implement interventions to improve patient health after the recovery from acute COVID-19.

Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.

Functionality, physical activity, fatigue and quality of life in patients with acute COVID-19 and Long COVID infection

A prominent feature of COVID-19, both in the short and long term, is the reduction in quality of life (QoL) due to low functionality scores and the presence of fatigue, which can hinder daily activities. The main objective of this study is to compare the functional status, level of physical activity, fatigue, and QoL of patients with Long COVID to other COVID-19 patients who did not develop persistent illness, and to determine whether there is a relationship between these variables and QoL. A cross-sectional study was conducted with 170 participants who had been infected with COVID-19 or had developed Long COVID. The main variables studied were functionality, physical activity, QoL and fatigue, measured using the PostCOVID-19 Functional Status Scale (PCFS), International Physical Activity Questionnaire (IPAQ), Short Form 12 (SF-12), and Fatigue Severity Scale (FSS). The main findings show a significant relationship (p < 0.001) between reduced functionality, lower physical activity levels, increased fatigue severity, and poorer QoL in Long COVID patients. Furthermore, these variables are also related to worse QoL, but only functional status predicts it. In conclusion, our results have shown highly significant correlations between the group with COVID-19 and Long COVID regarding functional status, level of physical activity, QoL, and fatigue.

Risk Factors for Long COVID in Older Adults

As time has passed following the COVID-19 pandemic, individuals infected with SARS-CoV-2 have gradually exhibited a variety of symptoms associated with long COVID in the postacute phase of infection. Simultaneously, in many countries worldwide, the process of population aging has been accelerating. Within this context, the elderly population has not only become susceptible and high-risk during the acute phase of COVID-19 but also has considerable risks when confronting long COVID. Elderly individuals possess specific immunological backgrounds, and during the process of aging, their immune systems can enter a state known as "immunosenescence". This further exacerbates "inflammaging" and the development of various comorbidities in elderly individuals, rendering them more susceptible to long COVID. Additionally, long COVID can inflict both physical and mental harm upon elderly people, thereby reducing their overall quality of life. Consequently, the impact of long COVID on elderly people should not be underestimated. This review seeks to summarize the infection characteristics and intrinsic factors of older adults during the COVID-19 pandemic, with a focus on the physical and mental impact of long COVID. Additionally, it aims to explore potential strategies to mitigate the risk of long COVID or other emerging infectious diseases among older adults in the future.

Cross-cultural adaptation of the Greek version of post-COVID-19 Functional Status Scale: assessment of non-hospitalised post-COVID-19 survivors

The objective of the study was to translate and validate into the Greek language and setting the Post-COVID-19 Functional Status (PCFS) scale. Greeks aged ≥18 years who recovered form COVID-19 (≥ 14 days since diagnosis), were invited to participate. This cross-sectional study followed international guidelines regarding the translation process (forward and backward) and the evaluation of the PCFS. Reliability was assessed by test-retest analyses using the intraclass correlation coefficient (ICC) and 95%CI. For the validation, all participants completed the European Quality of Life-5 (EQ-5D-5L), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. 82 adults (49 females, aged 40.2 ± 6.1) participated in the study. The Greek version of the PCFS demonstrated excellent test-retest reliability, with an ICC of 0.9 (95% CI 0.90- 0.95). The Cronbach's alpha value was 0.9, indicating good internal consistency. The PCFS score was strongly correlated with the EQ-5D-5L (r=0.6, p≤0.001) and weakly correlated with the HADS (r=0.41;p≤0.001). The Greek version of the PCFS was successfully adapted into Greek and is recommended to be used across clinical settings and research.