Strict long COVID, symptom persistence, and functional decline among community-dwelling older adults in Quito,...

Long COVID is an increasingly recognized health concern in older adults, yet data from Latin America remain limited. Older adults may be particularly vulnerable to post-COVID sequelae because of frailty, multimorbidity, and reduced physiological reserve. This study aimed to estimate the prevalence of strict long COVID among older Ecuadorian adults and to characterize persistent post-COVID symptoms, clinical correlates, and functional/cognitive worsening.

We conducted a cross-sectional study of 1,050 community-dwelling adults aged 65 years or older with PCR-confirmed SARS-CoV-2 infection in Quito, Ecuador. Data were collected through structured face-to-face interviews and cognitive screening. Strict long COVID was defined as symptoms persisting for more than 12 weeks after SARS-CoV-2 infection. Symptoms lasting 4-12 weeks were classified as persistent post-COVID symptoms but were not considered strict long COVID. Multivariable logistic regression was used to evaluate factors associated with strict long COVID.

The mean age was 74.2 ± 7.5 years, and 565 participants (53.8%) were women. Overall, 191 participants met criteria for strict long COVID, corresponding to a prevalence of 18.2% (95% CI, 16.0-20.6). Persistent post-COVID symptoms lasting 4-6 weeks and 7-12 weeks were reported by 401 (38.2%) and 458 (43.6%) participants, respectively. Participants with strict long COVID had higher frequencies of dyspnea, cognitive impairment, sleep disturbance, myalgia, depression, anxiety, and difficulty sleeping. Functional/cognitive worsening was more frequent among participants with strict long COVID than among those without strict long COVID (53.4% vs. 36.6%; p < 0.001), particularly for walking or climbing stairs. In multivariable analysis, severe or critical acute COVID-19 was independently associated with strict long COVID (adjusted OR, 2.36; 95% CI, 1.62-3.41; p < 0.001). Female sex, age ≥ 81 years, incomplete vaccination, diabetes with organ involvement, hospitalization, and care dependence were not independently associated with strict long COVID.

Strict long COVID affected nearly one in five older adults with PCR-confirmed SARS-CoV-2 infection in Quito, Ecuador. Severe or critical acute COVID-19 was the main factor independently associated with strict long COVID, and affected participants had greater functional/cognitive worsening. These findings support integrating post-COVID screening, functional assessment, and geriatric rehabilitation into primary care for older adults in Latin America.