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Symptoms of COVID-19 in the Elderly
Sep 23, 2020
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COVID-19 symptoms and the elderly at risk
People diagnosed with COVID-19 have reported on having a wide range of symptoms, from mild to severe. Although anyone can have symptoms of COVID-19, older adults who have severe underlying conditions like heart or lung disease or diabetes, may be the most at risk for developing complications that could greatly impact a person’s health. The CDC confirms that in general, your risk of getting severely ill from COVID-19 increases as you get older. “In fact, 8 out of 10 COVID-19-related deaths reported in the United States have been among adults aged 65 years and older.”
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Research also suggests that within the elderly community, there may be symptoms of COVID-19 that become overlooked, putting their health more at risk and in danger for hospitalization, requiring ventilators to assist with breathing, and even death.
Common Symptoms of COVID-19
The most common symptoms associated with COVID-19 are fever, coughing, or shortness of breath— this has become a well known association with the infectious disease caused by a newly discovered coronavirus. These symptoms stand out because COVID-19 primarily acts as (but is not limited to) an attack on the respiratory system. In an article by UCFS Health as well as CNN Health, doctors and medical researchers are discovering that although symptoms can be consistent across many age groups, the symptoms shown in older adults could be a bit different to monitor.
We understand the confusion and frustration here— how after so many months of extensive research conducted, is there still no sure tail sign that a person’s symptom means they have COVID-19, and how does COVID-19 directly affect the older age group most at risk? COVID-19 has proven over and over that it is not black and white, and medical professionals and major organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are releasing new research everyday. As provided by the CDC, symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
● Fever or chills
● Cough
● Shortness of breath or difficulty breathing
● Fatigue
● Muscle or body aches
● Headache
● New loss of taste or smell
● Sore throat
● Congestion or runny nose
● Nausea or vomiting
● Diarrhea
Not All Symptoms are Black and White
Judith Graham for CNN Health supports the research saying COVID-19 is typically signaled by three major symptoms: a fever, an insistent cough and shortness of breath. But older adults — the age group most at risk of severe complications or death from this condition ― may have none of these characteristics. Seniors may show concerning signs like acting “off” i.e. not acting like themselves. Caretakers in particular should look out for health and personality changes like a senior sleeping much more than usual, or showing loss of appetite. They may also lose a sense of their surroundings, experience more overall confusion, or stop speaking as much.
"With a lot of conditions, older adults don't present in a typical way, and we're seeing that with COVID-19 as well," said Dr. Camille Vaughan, section chief of geriatrics and gerontology at Emory University.
A large reason why older people may have a wider variety of symptoms with the onset of contracting COVID-19 is because older bodies respond much differently to illness and infection. "Someone's immune response may be blunted and their ability to regulate temperature may be altered," said Dr. Joseph Ouslander, a professor of geriatric medicine at Florida Atlantic University's Schmidt College of Medicine. This is an important thing to note since many studies are associating high, dangerous temperatures with this form of coronavirus. "Underlying chronic illnesses can mask or interfere with signs of infection," he said. "Some older people, whether from age-related changes or previous neurologic issues such as a stroke, may have altered cough reflexes. Others with cognitive impairment may not be able to communicate their symptoms."
Spotting Early Signs in the Elderly
It’s undoubtedly a difficult time for most healthcare workers. Hospitals and long-term care facilities are undergoing constant changes to rules and regulations, and with most visitation rights removed to prevent the spread of COVID-19, it’s more important now than ever to check in on the eldely people you care for at whatever capacity you can. If you’re the one responsible for an elderly person, recognizing danger signs is crucial, because if early signs of COVID-19 are missed, seniors may deteriorate before getting the medical attention they need.
Atlanta geriatrician Dr. Quratulain Syed, provides the example of a man in his 80s who was treated by the Dr. in mid-March. The patient had several underlying conditions: heart disease, diabetes and moderate cognitive impairment, and over a period of days eventually became incontinent and profoundly lethargic. The man didn’t have a fever at any point— his only respiratory symptom was sneezing on and off. The spouse of the patient called 911 a few times, and paramedics reported back with healthy vitals. After a third call of concern, Syed had the patient admitted to the hospital where he tested positive for COVID-19.
A large problem lies in the inability for some eldely people to communicate, which can be the case for many people suffering from neurological diseases and disorders like Alzheimer's, delirium, and stroke. If a person seems their “normal” somewhat confused self, how are they able to tell you they’re feeling “off” ? Dr. Sam Torbati, medical director of the Ruth and Harry Roman Emergency Department at Cedars-Sinai Medical Center, describes treating seniors who initially appear to be trauma patients but are found to have COVID-19. Torbati has seen older adults who are profoundly disoriented and unable to speak and who appear at first to have suffered strokes. "When we test them, we discover that what's producing these changes is a central nervous system effect of coronavirus," he said.
In Switzerland, Dr. Sylvain Nguyen, a geriatrician at the University of Lausanne Hospital Center, has put together a list of typical and atypical symptoms in older Covid-19 patients in a forthcoming paper in the Revue Médicale Suisse. Included on the atypical list are changes in a patient's usual status, delirium, falls, fatigue, lethargy, low blood pressure, painful swallowing, fainting, diarrhea, nausea, vomiting, abdominal pain and the loss of smell and taste.
The New Normal
Caregivers and frontline workers alike need to carefully assess an older patient's symptoms, no matter how far off it may seem in its relationship to COVID-19. At home, there’s the likelihood that these seniors may become isolated, and not be receiving the proper care with medication management or other basic needs because of family members keeping their distance. If you don’t feel comfortable being the person to look out for an elderly loved one, you should seek out the services of someone who can be more hands on, while still taking the proper preventative measures to keep the household safe.
A decline in a senior’s mental state could also be attributed to the fact that they’re undergoing a major shift in routine. Whether they are living in a nursing home or with a family member, life has shifted to months of isolation and extreme caution with any outing. This has played a part in the decline of many seniors’ health since the activities that would get them up and moving around, have stopped all together. Dr. Vaughan of Emory writes, "Someone may be just having a bad day. But if they're not themselves for a couple of days, absolutely reach out to a primary care doctor or a local health system hotline to see if they meet the threshold for [coronavirus] testing. Be persistent. If you get a 'no' the first time and things aren't improving, call back and ask again."
Learn about the symptoms of COVID-19 & how it spreads. Know the difference between asymptomatic & symptomatic.
Learn why the elderly have a higher risk for severe illness from COVID-19 & why the risks are higher when they have underlying health conditions.
Learn about the signs when your loved one faces comprehension difficulties. Know how a cognitive impairment disease can affect you & your loved ones.
You’ve heard the name many times by now— Coronavirus (or COVID-19) is a disease that’s become so deadly it’s spiraled us into a global pandemic. For those unfamiliar with how it got its name, in COVID-19, 'CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for the disease. According to the CDC, “coronavirus” is actually an umbrella term for a family of viruses that can cause illness in animals or humans.
No matter what age, we all have moments of confusion. But when your elderly loved one is consistently exhibiting these signs, it might be because s/he is undergoing cognitive impairment. Having difficulty comprehending is a common sign these problems; however, it is often brushed aside as "old age." The person experiencing these difficulties may make excuses: the TV shows today are too complicated, their family members talk too fast, the lights are too dim to read. Ignoring the signs of comprehension difficulties, though, just make life harder for everyone involved. Comprehension and Confusion Comprehension is the opposite of confusion. Comprehension is a complex process in the brain through a system of nerves and chemicals, and it involves language, recognition, and function processes. Cognitive impairment disorders like dementia and Alzheimer's disrupt those complex processes. It can manifest as sudden memory loss, impaired motor coordination, and other more subtle thought processes that we will discuss. When someone has difficulty with comprehension, s/he has trouble putting together the various actions needed to perform a task. For example, your mom might need a cup from the cupboard. In order to do so, she must first decide she wants the cup. Then she might need to get out of her chair, walk across the kitchen, raise her hand, open the cupboard, and take the cup out of the cupboard. If she has difficulty with comprehension, she will have a hard time putting all of these elements to work to achieve her goal, which might result in several different outcomes: she could fall, break the cup, or just forget what she was doing before she reaches the cupboard. She knows what she wants to do but has trouble making all the connections necessary to get there. How Cognitive Impairment Affects Your Loved One Difficulty comprehending is frustrating for your elderly loved one and for you, but the first step toward helping your loved one is understanding what s/he is experiencing. Here are some examples of how someone with dementia or Alzheimer's disease might have trouble comprehending everyday situations. TV/books: Someone with dementia might not be able to follow a basic storyline and could not tell somebody else what is going on in the TV show or book. Social situations: Someone with dementia might see two children playing and interpret that they are fighting or vice versa. The person with dementia may step in and try to resolve the situation without realizing what is actually happening. Conversations: As with the TV/book example, someone with dementia can't follow an everyday conversation . S/he doesn't know who or what is being discussed and especially cannot tell when the subject matter has changed. Time: Someone with trouble comprehending will have difficulty telling time and might not know whether it is day or night. How Cognitive Impairment Affects You Because of these comprehension difficulties, the person experiencing dementia or Alzheimer's disease will rely on the people around him/her to tell him/her what is going on. For instance, your loved one may constantly ask you to repeat yourself. S/he may also have trouble following instructions. These situations can be aggravating for you, particularly if they are new, however it is important to understand that your loved one is not trying to bother you by failing to follow directions or asking you to repeat information over and over. These are symptoms of cognitive impairment , and neither you nor they can control it. If your family member begins to exhibit any of these signs, take him or her to your physician with a description of the comprehension difficulties you've noticed so that s/he has plenty of information for a cognitive function assessment. If the doctor diagnoses dementia or Alzheimer's, ask specific questions about treatment so that you can do your part to serve your loved one despite mild cognitive impairment. It is important to get help for your loved one, and there is no reason for you to care for your loved one alone. Caring for an aging relative requires time, patience, and expert care. Complete Care At Home can help you create a customized plan to meet the unique needs of your loved one with dementia or Alzheimer's disease. Contact us today for an expert assessment.
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