Fain, Mindy J, Horne, Benjamin D, Horwitz, Leora I et al. · Journal of the American Geriatrics Society · 2025 · DOI
This study looked at how Long COVID symptoms change as people get older. Researchers compared people aged 18–39 with those aged 40–70+ who had recovered from COVID-19 infection at least 135 days earlier. They found that middle-aged adults (40–59) were more likely to have Long COVID than young adults, but surprisingly, adults aged 70+ were actually less likely to report it—and when they did, their symptoms looked different, with less fatigue, pain, and brain fog compared to younger people.
This study highlights that Long COVID presents differently in older adults, which may lead to underdiagnosis or misattribution of symptoms to normal aging. Understanding age-specific symptom patterns is critical for developing targeted diagnostic criteria, treatment approaches, and rehabilitation strategies across the lifespan, particularly relevant as ME/CFS affects patients of all ages.
This observational study cannot establish causation or explain why aging alters Long COVID presentation. The lower prevalence in adults ≥70 may reflect survival bias (sicker individuals may not have survived to participate) or recall bias rather than true biological age effects. Results are specific to community-dwelling survivors and may not generalize to hospitalized or institutionalized populations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Fain, Mindy J, Horne, Benjamin D, Horwitz, Leora I, Thaweethai, Tanayott, Greene, Meredith, Hornig, Mady, et al. (2025). Age-Related Changes in the Clinical Picture of Long COVID.. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.70043
BibTeX
@article{mecfsatlas-fain-2025-age-related,
author = {Fain, Mindy J and Horne, Benjamin D and Horwitz, Leora I and Thaweethai, Tanayott and Greene, Meredith and Hornig, Mady and Orkaby, Ariela R and Rosen, Clifford and Ritchie, Christine S and Ashktorab, Hassan and Blachman, Nina and Brim, Hassan and Emerson, Sarah and Erdmann, Nathan and Erlandson, Kristine M and de Erausquin, Gabriel and Fong, Tamara and Geng, Linda N and Gordon, Howard S and Gully, Jacqueline Rutter and Hadlock, Jennifer and Han, Jenny and Huang, Weixing and Jagannathan, Prasanna and Kelly, J Daniel and Klein, Jonathan D and Krishnan, Jerry A and Levitan, Emily B and McComsey, Grace A and McDonald, Dylan and Montgomery, Aoyjai P and O'Brien, Lisa and Ofotokun, Ighovwerha and Patterson, Thomas F and Peluso, Michael J and Pemu, Priscilla and Perlowski, Alice and Reiman, Eric M and Sanon, Martine and Seshadri, Sudha and Shellito, Judd and Sherif, Zaki A and Shikuma, Cecilia and Singer, Nora G and Singh, Upinder and Trinity, Joel D and Wisnivesky, Juan and Witvliet, Margot Gage and Foulkes, Andrea and Nikolich, Janko Ž and RECOVER consortium},
title = {Age-Related Changes in the Clinical Picture of Long COVID.},
journal = {Journal of the American Geriatrics Society},
year = {2025},
doi = {10.1111/jgs.70043},
note = {PubMed: 40888500},
url = {https://www.mecfsatlas.com/evidence/fain-2025-age-related},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/fain-2025-age-related
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