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July/August 2023
Speech Therapy Helps Older Adults With Long COVID The COVID emergency may be over, but many still struggle with the effects of the virus. While the height of the pandemic is now part of our collective past, many older adults are still struggling with communication issues and other difficulties associated with long COVID. Regardless of how these symptoms manifest, they can be particularly challenging for older adults who concurrently also may be developing or managing age-related cognitive or physical degeneration. A 2022 study of long COVID patients 65 and older published in The Lancet showed that this demographic cohort of patients was at a higher risk for the development of additional symptoms post-COVID, including fatigue, hypertension, and mental health concerns.1 A 2021 study also showed that adults older than 70 are more prone to developing long COVID symptoms at nearly a two-to-one ratio than are COVID patients aged 18 to 49.2 Many older adults with long COVID report a condition commonly referred to as “brain fog,” documented by evidence that the COVID-19 virus can directly infect and reduce the function of some brain cells.3 Brain fog is experienced as new difficulties surface in thinking and concentrating, as well as a variety of speech communication problems, such as trouble remembering, using intended words, or using well organized sentences. Brain fog can last for weeks, months, or longer after a person recovers from COVID-19 illness and can linger when other symptoms have stopped. Older adults can also experience more physically based symptoms, including vocal fatigue and dry throat, which have been tied to prolonged mask use. Patients who have received medical interventions, such as intubation or medications, may experience upper respiratory infections and acid reflux, both of which can also affect their ability to communicate. A Yale University study of older patients (average age 83) found that individuals were likely to experience a decline in function after being intubated.4 Long COVID Affects All Age Groups Researchers report that among the many challenges of long COVID, cognitive impairment or speech and language difficulties persist. During recovery, people of all ages report that they have trouble remembering, using intended words, or expressing ideas in coherent sentences. Left untreated, these issues may worsen over time, which is particularly troublesome for older adults who may already experience related health conditions. There’s no formal assessment for long COVID. Compounding this issue is that symptoms vary in presentation and severity from person to person. Symptoms can also change over time; some long COVID patients even report the development of new symptoms that weren’t present during the initial infection. About 90% of patients who test positive for COVID return to relatively normal health one to two weeks after diagnosis, though it’s not unusual for some symptoms to continue for six weeks or so. In these instances, there can be overlap between a normal recovery and the development of long COVID. When this occurs, the types of symptoms and severity are considered in addition to duration. Though treatments for a large number of long COVID symptoms range in effectiveness, there is hope. Reports indicate that it’s important to address cognitive-based symptoms as early as possible, not just to help improve individual quality of life during long COVID recovery but also to stop symptoms from worsening.6 Research Continues Speech Therapy and Long COVID • Cognition. As brain fog can prevent a return to work and interfere with family responsibilities, speech therapists can address memory and attention deficits, issues with organization and problem-solving, and changes in the ability to socially interact. • Communication. Researchers have discovered that the low-oxygen levels experienced by some COVID patients can be linked to speech and language difficulties in recovery, including those pertaining to the ability to verbalize thoughts, reading comprehension and retention, writing abilities, and general word recall. • Speaking ability. Long COVID patients also may experience physical issues that impair their ability to communicate and create strain on the vocal cords. This can include hoarseness, volume, clarity, and even vocal quality changes. Regardless of symptoms, the goal of speech therapy for long COVID is two-fold: to help create a treatment plan to minimize and manage communication difficulties associated with long COVID and to enable patients to restore quality of life, and confidently return to work, handle daily life, and resume an active lifestyle. Speech Therapists Support Recovery Some patients may simply want to strengthen their current skills or learn about new strategies that accommodate long-term or permanent changes. When speech therapists create individualized plans with patients, they find that it helps support ownership and commitment, especially when the patients see the positive progress they are making. What’s most interesting is new evidence of similarities between effective treatment modalities for long COVID and those for mild traumatic brain injury (TBI).7 A trained speech therapist can draw upon strategies that have been successfully used with TBI patient recovery and apply them to long COVID. While the cause and diagnoses differ, both long COVID and mild TBI patients exhibit comparable symptom clusters or subgroupings, which provides insights into what approaches might be effective. As the data continue to emerge, speech therapists are getting a better handle on some of the subgroups or phenotypes of long COVID and are beginning to see more subtle cognitive communication problems, such as brain fog and fatigue, which result in attention problems. Long COVID patients, especially older adults, may find it difficult to keep track of things, become more forgetful, and stay organized. While there are some assessment tools for mild TBI that are valid and sensitive, speech therapists are now moving to more personalized or contextualized assessment procedures for long COVID that involve self-reporting and questionnaires that are standardized and thoroughly researched. Addressing Emotional Effects One key element of recovery for patients is a sense of being supported. Virtual speech therapy programs can create access to peer support and help to assure patients they aren’t alone in their journey to recovery. Convenient Access to Personalized Care Thankfully, speech therapy is now available outside the clinic setting as video technology provides a platform that allows geriatric patients to access online speech therapy in the comfort and privacy of their own homes. Virtual speech therapy is easily accessible on a home laptop, computer, or tablet with internet access. It’s ideally suited for older patients who embraced this technology during the pandemic—whether to speak to their loved ones or for telehealth services. Today, older adults have some familiarity with general telehealth services as medical providers began expanding this care option during the pandemic. In fact, one unexpected upside to the global pandemic is that telehealth and virtual medical care proved to be effective delivery models for reaching older adult patients. One study found that of patients older than 65, many were satisfied with telehealth throughout the pandemic and want it to remain accessible.8 Using virtual services also eliminates the transportation concerns that many older adults develop as they age—either because of their own changing driving skills or their need to rely on public transportation or others to provide rides to and from medical appointments. Additionally, this approach reduces time spent in waiting rooms—which may have caused concern about further exposure to COVID or other illnesses. Virtual visits are also easier to fit into a busy schedule, are more available than office appointments, and help patients avoid missing work or other activities. Virtual speech therapy companies are even using an algorithmic matching system to filter down to the best group of therapists for the individual patient. This pairing process is based on the therapist’s experience, education, classes, special training, and interests, as well as the precise age groups or conditions that the clinician has worked with. Furthermore, with health organizations and insurers increasing access to virtual speech therapy, people are scheduling and conducting speech therapy with the additional reassurance that the services are covered when they select an in-network provider. Criteria for Selecting a Virtual Speech Therapy Provider • Ask the provider if they have a plan of care focused on long COVID treatment and support. • Confirm the company’s relationships with payers that offer the solution as an in-network benefit. • Look for a provider that offers a dynamic solution, such as synchronous one-on-one engagement with the speech therapist as well as a practice portal for asynchronous learning capabilities that allow patients to practice on their own at their own pace. These capabilities extend the opportunities for continued advances following each visit. With the option for asynchronous learning, there are opportunities to engage others, such as the patient’s caregiver or family members. Some activities require two people, such as an exercise specifically designed for an individual with dementia or Alzheimer’s in which the caregiver or family member creates additional questions or develops opportunities for sentence completion that further extend the practice sessions. Regardless of whether speech therapy services are provided virtually or in person, the benefits they can provide to recovering long COVID patients are clear. Speech therapists provide the support and understanding these patients need to create a new communication path for their future. As a result, they can express their feelings, speak about any troubling physical or emotional issues, and engage in social conversations and discussions. In the absence of speech therapy, cognitive and physical communication challenges are not likely to resolve or may even worsen over time. With timely intervention and speech therapy services, problematic communication issues can be resolved, ensuring that individuals enjoy happier, healthier lives. For more information, visit https://greatspeech.com/covid-recovery. — Avivit Ben-Aharon, MS ED, MA, CCC-SLP, is the CEO and clinical director at Great Speech, Inc, a virtual speech therapy company founded in 2014. She trailblazed nationwide virtual access to speech therapy, allowing anyone who is committed to improving their communication to receive expert services, regardless of location or scheduling limitations. Her work has been featured on Good Morning America, the US News and World Report, the Miami Herald, and more. She graduated from The City University of New York with a Master of Arts in Speech-Language Pathology and Hunter College with a Master of Science in Special Education and Teaching. Connect with her on LinkedIn or email her at avivit@greatspeech.com.
References 2. Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626-631. 3. Recovering from brain fog. Kaiser Permanente website. https://mydoctor.kaiserpermanente.org/covid-19/recovering-from-brain-fog. Accessed April 17, 2023. 4. Survival rate after intubation for the elderly. The Garrett Law Firm website. https://elderlawaustin.com/survival-rate-after-intubation-for-the-elderly/#:~:text=A%20Yale%20 5. Burns A. Long COVID: what do the latest data show? KFF website. https://www.kff.org/policy-watch/long-covid-what-do-latest-data-show/. Published January 26, 2023. Accessed April 17, 2023. 6. Ramage AE. Potential for cognitive communication impairment in COVID-19 survivors: a call to action for speech-language pathologists. ASHAWire website. https://pubs.asha.org/doi/10.1044/2020_AJSLP-20-00147. Published November 12, 2020. 7. Transcript: ASHA Voices: what we're learning about long COVID. The ASHA Leader website. https://leader.pubs.asha.org/do/10.1044/2022-0317-transvoices-long-haul-covid. Accessed April 17, 2023. 8. Melchionna M. Older adults satisfied with telehealth during COVID-19 pandemic. mHealthIntelligence website. https://mhealthintelligence.com/news/older-adults-satisfied-with-telehealth-during-covid-19-pandemic#:~:text=New%20research%20showed%20that%20adults, |
