COVID-19, a Diagnostic Challenge in Seniors

Some older adults have atypical symptoms, including changes of behavior or just seeming a bit ‘off.'

By now, we all know the typical symptoms of COVID-19: fatigue, sore throat, runny nose, cough, fever, chills, shortness of breath, loss of taste and smell, headache, muscle aches or gastrointestinal symptoms. In the elderly with COVID-19, however, the symptoms may be the same, but they may also differ. They may sleep more than usual, stop eating, speaking or walking. They could become apathetic, lethargic, confused, delirious, incontinent, lose orientation, become dizzy and faint. Or they might just have nausea, vomiting, diarrhea, abdominal pain, and painful swallowing. 

Why Symptoms Vary So Much in the Elderly

It’s not clear why some older people do well while others do not. There’s a range of illness in the elderly with a disproportionate death toll, but there are mild and atypical cases. 

Age-related changes in the immune system could cause these atypical symptoms. An overactive or an underactive immune reaction to SARS-CoV-2 can lead to different manifestations and varying severity of COVID-19. 

They also may not have a fever, which may relate to an inability to regulate temperature. Some underlying chronic illnesses may interfere with the signs of an infection, including fever and cough, like reduced cough reflexes from a previous stroke. 

Many of the atypical symptoms seem to be related to the effect on the central nervous system. 

Diagnostic Challenges

A problem with diagnosing COVID-19 in seniors is that symptoms could take longer to develop. Also, the symptoms differ so much that it’s easy to miss early signs of COVID-19. Misdiagnosing could mean that patients deteriorate before getting proper care; because they’re weak and dehydrated and thus prone to fall and break a bone or have head trauma. 

For early signs of infection, it is necessary to check daily for any single temperature reading of 37.8°C or higher, several readings of 37.2°C, or an increase of more than 1.1°C above a person’s usual temperature, increased heart and respiratory rates, and a lower oxygen level with a handheld oxygen saturation device. These are early warning signs that should raise a red flag and lead to testing for COVID-19.  

In severe cases, a senior may be unable to stay awake or have difficulty waking up, or have new onset of confusion, pain in the chest, shortness of breath or color change in the face or lips. These symptoms should lead to an urgent call to the doctor or ambulance. 

What Others Can Do 

For the rest of us: monitor, isolate and inform. It is essential to do what you can to monitor the person, isolate them, while diligently preventing spread by handwashing, social distancing, masks, and disinfecting potentially contaminated surfaces. And inform their doctor, call the coronavirus hotline to find out where to get a COVID-19 test, or in case of severe symptoms, call an ambulance. 

During recovery or afterwards, some elderly have enduring symptoms with continued changes in behavior, cognitive impairment, memory loss, lethargy and fatigue, poor appetite, incontinence, weakness, dehydration. These post-recovery symptoms resemble those experienced by younger adults, referred to as “long-haulers.” These symptoms will mean a need for extended care, mainly to prevent the patients from injuring themselves. 

Still, prevention is the best medicine: Seniors at home or in long-term care facilities need to be protected. – with PPEs, handwashing, disinfecting and distancing. Also, everyone, not only older adults, needs to be sure that their vaccinations are up to date and that they receive their annual flu shot. 

Preventing the spread of infection is especially important because it’s not clear who will have a mild or severe case. And prevention works both ways – even with atypical symptoms, seniors can infect others. 

In many countries, like the UK and Canada, the elderly are the first group to receive the vaccine and may tolerate it even better than younger adults. In Austria, the vaccine will likely be available for seniors, and they should be encouraged to get vaccinated as soon as possible. 

Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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