Enhancing Long COVID Care for Older Adults Through Self-Management Strategies

Dear Editor,

We read with great interest the article “Challenges in Receiving Care for Long COVID: A Qualitative Interview Study Among Primary Care Patients About Expectations and Experiences” by Gardner et al., which highlights critical gaps between patients’ expectations and experiences in accessing long COVID care [1]. While the article provides valuable insights, we wish to draw attention to older adults, a population particularly vulnerable to long COVID and its associated challenges [2-5].

Older adults often face unique barriers in navigating fragmented healthcare systems, managing comorbidities, and accessing timely care [2-5]. These barriers are often magnified in low-to-middle-income countries, where resource constraints limit access to specialized care [4-5]. Self-management is a useful approach to manage longer-term chronic diseases like fatigue, diabetes, asthma, stroke, hypertension, and so on [6-7]. Integrating this approach into care frameworks for long COVID may offer an opportunity to empower patients and address some of these challenges while complementing primary care efforts [6-10].

Some self-management strategies for older adults:

Smoking Cessation and Alcohol Reduction: It is especially crucial for older individuals to adopt healthy lifestyle behaviors, such as ceasing smoking and reducing alcohol consumption, as they frequently deal with cardiovascular or respiratory comorbidities.

Nutritious Diet and Physical Activity: Older adults benefit from a nutrient-rich diet tailored to their unique nutritional needs, combined with regular physical activity—ideally aiming for at least 150 minutes per week of moderate-intensity exercise, adjusted to their abilities—to improve physical function and overall health.

Energy Conservation and Pacing: For older adults experiencing fatigue, balancing physical activity with adequate rest is essential to prevent overexertion and exacerbation of symptoms.

Seeking Support: Promoting the involvement of older persons with support networks, such as family, friends, and healthcare professionals, helps mitigate loneliness and enhance emotional well-being.

Symptom Monitoring: Recording symptoms over time can help older adults and their providers identify patterns and triggers, facilitating better care and treatment planning.

Comorbidity Management: Supporting elderly individuals in actively managing their chronic conditions alongside long-term COVID-19 symptoms is crucial. Empowering them through collaborative care plans that integrate professional guidance with self-care strategies can help reduce the overall disease burden.

Mental Health Support: Addressing anxiety, depression, and cognitive challenges through mindfulness practices, counseling, and community resources is essential for older adults coping with long COVID.

We emphasize that integrating these self-management strategies into primary care for older adults with long COVID could help mitigate frustrations highlighted in the article, such as inadequate care coordination and lack of symptom validation [6-9]. These approaches also align with patient-centered care by empowering older adults to take an active role in managing their health while fostering a collaborative relationship with their providers [6-7].

In low-to-middle-income countries, community-driven interventions tailored for older adults can enhance the scalability and cultural relevance of these strategies, ensuring they reach those most in need.

Thank you, Gardner et al., for shedding light on this pressing issue. We hope our perspective contributes to the dialogue on improving care for older adults with long COVID through self-management strategies.

References

1. Gardner E, Lockrey A, Stoesser KL, Leiser JP, Brown J, Kiraly B, Ose DJ. Challenges in Receiving Care for Long COVID: A Qualitative Interview Study Among Primary Care Patients About Expectations and Experiences. The Annals of Family Medicine. 2024;22(5):369-74. https://doi.org/10.1370/afm.314
2. Mansell V, Dykgraaf SH, Kidd M, Goodyear-Smith F. Long COVID and older people. The Lancet Healthy Longevity. 2022;3(12):e849-54. https://doi.org/10.1016/S2666-7568(22)00245-8
3. Tana C, Moffa L, Falasca K, Vecchiet J, Tana M, Mantini C, Ricci F, Ticinesi A, Meschi T, Cipollone F, Giamberardino MA. Approach to COVID-19 in older adults and indications for improving the outcomes. Annals of Medicine. 2023;55(2):2265298. https://doi.org/10.1080/07853890.2023.2265298
4. Rahman MS, Afroze L, Rahman MS. COVID-19 pandemic and older people in Bangladesh. Dr. Sulaiman Al Habib Medical Journal. 2020;2(3):83-4. https://doi.org/10.2991/dsahmj.k.200630.001
5. Siow WT, Liew MF, Shrestha BR, Muchtar F, See KC. Managing COVID-19 in resource-limited settings: critical care considerations. Critical Care. 2020;24:167. https://doi.org/10.1186/s13054-020-02890-x
6. Schulman‐Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, Redeker NS, Reynolds N, Whittemore R. Processes of self‐management in chronic illness. Journal of Nursing Scholarship. 2012;44(2):136-44. https://doi.org/10.1111/j.1547-5069.2012.01444.x
7. Grady PA, Gough LL. Self-management: a comprehensive approach to management of chronic conditions. American journal of public health. 2014 Aug;104(8):e25-31. https://doi.org/10.2105/AJPH.2014.302041
8. Brown K, Yahyouche A, Haroon S, Camaradou J, Turner G. Long COVID and self-management. Lancet. 2022;399(10322):355. https://doi.org/10.1016/S0140-6736(21)02798-7
9. Rahman MS, Lassi ZS. Self-management for elderly during the COVID-19 pandemic. Bangladesh Journal of Medical Science. 2021;20(3):694-5.
10. Humphreys H, Kilby L, Kudiersky N, Copeland R. Long COVID and the role of physical activity: a qualitative study. BMJ Open. 2021;11(3):e047632. https://doi.org/10.1136/bmjopen-2020-047632