Here Consultant Physician Dr. Achala Balasuriya discusses how COVID-19 may present differently in the elderly The main symptoms of COVID-19 are fever, cough, pain in the throat, shortness of breath, myalgia and fatigue. It can also cause a headache, a productive cough, and loose stools, loss of smell and taste and red eyes. The disease [...]

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COVID-19 symptoms may be different in the elderly

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Here Consultant Physician Dr. Achala Balasuriya discusses how COVID-19 may present differently in the elderly

The main symptoms of COVID-19 are fever, cough, pain in the throat, shortness of breath, myalgia and fatigue. It can also cause a headache, a productive cough, and loose stools, loss of smell and taste and red eyes.

The disease has a wide variation in its presentation and generally has an incubation period of 14 days on average, but it can sometimes be as long as 37 days, according to some reports.

The usual risk factors for COVID-19 are advanced age, hypertension, immuno-compromised states such as chronic lung disease, malignancies, severe cardiovascular disease, chronic kidney disease, severe obesity, liver disease and diabetes.

Implications for the elderly

Theelderly are a major vulnerable group, as complications are higher among them, as has been reported. It has been estimated that COVID-19 kills 13.4% of patients 80 years and older, compared to 1.25% in their 50s and 0.3% in their 40s.

Hence, it is important to identify the disease presentation in the elderly as they may not have the common clinical signs.

An elderly infected person may not develop fever or even a cough. He/she may present with a sudden loss of appetite, sudden onset of confusion, inability to walk properly or even have a “fall”.

A geriatrician at the University of Lausanne Hospital Centre, Switzerland, Dr. Sylvain Nguyen, has listed ‘typical’ and ‘atypical’ symptoms in older COVID-19 patients in a forthcoming paper in the Revue Médicale Suisse.

In the atypical list are: changes in a patient’s usual status, delirium, falls, fatigue, lethargy, low blood pressure, painful swallowing, fainting, diarrhoea, nausea, vomiting, abdominal pain and loss of smell and taste.

These variations may happen due to the changes in the body as one gets older that prevent the immune system from mounting a normal immune response due to cellular ageing.

Absence of fever

As we age, our body’s natural defence against a virus infection fails to work optimally. The white blood cells (T and B cells) produced in the bone marrow are the first-line defence against viruses.

They produce antibodies against the invading organisms to destroy them and safeguard the host cells from being damaged. But with ageing, the bone marrow produces fewer white blood cells and the body’s natural immune responses like an increase in the core temperature (fever) to dispel the virus does not occur. Hence, an older person may fail to have the typical symptoms of fever and cough.

Mental confusion

Mental confusion may develop in an older person with COVID-19. It is known that flu and urine infections in the elderly often brings about a sudden onset of confusion (delirium). With COVID-19 also this has been found to occur among them. Although the exact reason is not clear, some scientists think this is related to cytokines, immune cells that are overwhelming many coronavirus patients’ bodies in a ‘storm’.

Why no cough?

Normally, when the virus enters a human body it affects the airways and lungs and in response a person develops airway secretions and a cough. However, in an older person the cough reflex is weak and instead he/she may be profoundly tired and lethargic. Sometimes pre-existing conditions like stroke may also interfere with the cough reflex.

Therefore, the absence of cough and fever should not exclude a diagnosis of COVID-19 in the elderly.

The number of people hit by the virus increases, we should protect our elders as they are the most vulnerable group. Pneumonia and multi-organ dysfunction brought on by the virus require intensive care management and a long stay in an ICU, with poor outcomes for the elderly.

As such, let us try to keep our elders at home as much as possible and be aware of the atypical presentations if infected by COVID-19.

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