Around 4% of those with long COVID are older than 65 years, the CDC estimates. But many experts believe this estimate vastly undercounts the number of seniors with long COVID because the symptoms may be confused with age-related conditions.

Long COVID, which is known to speed up the aging process, adds complexity to a patient population that might already be dealing with cardiovascular disease, diabetes, kidney dysfunction, joint pain, and symptoms of dementia.

Without clear diagnostic tools, many older adults may experience long COVID without knowing they have the condition. They’re also enduring symptoms of early aging and the economic consequences that go along with it.

New research published in The New England Journal of Medicine has shown that the number of patients being diagnosed with long COVID has decreased since the beginning of the pandemic, but these numbers might be disguising reality, experts said.

“Attributions to COVID and long COVID are actually declining even though it’s often the root cause of a condition,” said Ziyad Al-Aly, MD, clinical epidemiologist at the Washington University School of Medicine in St. Louis and a national leader in long COVID.

Older Adults Are Less Likely to Receive a Long-COVID Diagnosis

The big challenge, Al-Aly said, is that older patients may come into a doctor’s office or clinic with a heart problem like blood clots or kidney issues that are the result of long COVID, but they will be misdiagnosed as having a cardio condition or kidney problem.

In addition, studies have shown that seniors are among the least likely to be taken seriously by doctors when they suggest they may have long COVID, said David F. Putrino, PhD, director of Rehabilitation Innovation for the Mount Sinai Health System in New York City.

One study found that “medical gaslighting” — in which patients’ concerns may be dismissed — delayed many diagnoses among long-COVID patients. The study authors found that patients “blame the experts who hold gatekeeping power over their medical care.” Patients know something is wrong, but they’re not getting the care they need.

When patients complain of memory loss or heart palpitations or an inability to exercise, their doctors are more likely to blame it on aging and downplay their symptoms, Putrino said. “The diagnosis is harder for this age group to receive because there’s ageism at play,” he added.

He said that doctors can ensure that they’re not subjecting their patients to ageism by comparing the patient’s signs and symptoms, regardless of their age, with their pre-long COVID vitals and conditions. This way, physicians can see how healthy a patient was before acquiring COVID and whether it’s aging or something else that’s causing their symptoms, such as long COVID.

Another complicating factor: Much of the research that is conducted on new treatments and medications is less likely to include older adults. That means it’s unclear how a medication will affect this group, said Grace McComsey, MD, who leads one of the 15 nationwide long-COVID centers funded by the federal Researching COVID to Enhance Recovery Initiative in Cleveland.

“It should be mandated that older adults be included in long-COVID trials,” she said.

And just like other age cohorts, many of these patients aren’t getting any better, even years after being infected with SARS-CoV-2. As with many patients dealing with the condition, they’re sick for years with an expensive and complicated disease.

A July 2025 study published in The Journal of Gerontology examined Medicare data from 3.5 million patients and found that 4% of beneficiaries — or about 140,000 of those experiencing symptoms — had long-COVID symptoms for a year or more.

Long COVID Accelerates Aging

In older adults, the most common manifestation of long COVID is organ damage and accelerated aging in organ systems, including kidney disease, as well as diabetes, cardiovascular events, and neurologic disorders, said Al-Aly.

Research has shown that long-COVID patients, and especially older patients with this condition, are more likely to experience cardiac events, such as heart attacks and strokes, as well as kidney disease. These patients may require statins or angiotensin-converting enzyme inhibitors given prophylactically to reduce the risk for cardiac events, according to one recent study.

While the link between long COVID and early-onset dementia is less clear, that connection is starting to surface in some research. A study in BMC Geriatrics found that the risk for new-onset dementia after COVID is present and warrants more investigation.

“Generally in older adults — since the manifestations of neurologic disorders are common and because they’re in the age group that predisposes them to Alzheimer’s disease — long COVID may exacerbate symptoms,” said Al-Aly.

The Economic Impact on Older Adults

What’s more, these patients often haven’t had time to prepare for the accelerated aging that they experience as a result of long COVID. Patients appear to be years older than they are, based on their symptoms, which has an undue impact on their lives, said Nisha Viswanathan, MD, director of the UCLA Long COVID Program at UCLA Health.

When you have mild cognitive impairment with a gradual worsening of memory, you have time to make adjustments in lifestyle, such as finding a driver or someone to pay the bills.

“They’ve had a gradual period of time to get used to these changes,” said Viswanathan. And their kids are old enough to help out in caring for them.

But with long COVID, older adults may rapidly experience these cognitive declines at a younger age, without much time to prepare or adjust.

Viswanathan said that older adults with long COVID may need to transition to a greater level of care, either in assisted living or by hiring a caregiver at home, which Medicare doesn’t cover. For this reason, physicians may help by having the pharmacy deliver medications or working with family members to have a grocery store deliver food weekly.

Many of Viswanathan’s patients can’t afford the caretaking and other health-related expenses that Medicare won’t pay for, so they run through all their finances and may end up relying on Medicaid later in life.

Many of the treatments that would also be helpful for this group are expensive and out of reach for those on fixed incomes, which is the case for many seniors. Blood thinners taken for blood clots, low-dose naltrexone for brain fog and fatigue, and Xolair for managing autoimmune symptoms can all help older adults with their long-COVID symptoms, but they’re too expensive for many patients living on Social Security income.

A study published in JAMA Network Open found that the financial impacts of long COVID can last decades, but seniors who are retired and on fixed incomes don’t have the time to make up the difference.

“For many patients, especially those who were healthy prior to long COVID, I don’t think that they had anticipated running through their finances quite so quickly,” said Viswanathan.