(Kaiser Health News)Older adults with Covid-19,
the illness caused by the coronavirus, have several "atypical"
symptoms, complicating efforts to ensure they get timely and appropriate
treatment, according to physicians.
Covid-19
is typically signaled by three 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.
Instead, seniors may seem
"off" — not acting like themselves ― early on after being infected by
the coronavirus. They may sleep more than usual or stop eating. They may
seem unusually apathetic or confused, losing orientation to their
surroundings. They may become dizzy and fall. Sometimes, seniors stop
speaking or simply collapse.
"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.
Altered immune response
The reason has to do with how older bodies respond to illness and infection.
At advanced ages, "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.
"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."
Read early signals
Recognizing
danger signs is important: If early symptoms of Covid-19 are missed,
seniors may deteriorate before getting needed care. And people may go in
and out of their homes without adequate protective measures, risking
the spread of infection.
Dr. Quratulain Syed, an Atlanta
geriatrician, describes a man in his 80s who she treated in mid-March.
Over a period of days, this patient, who had heart disease, diabetes and
moderate cognitive impairment, stopped walking and became incontinent
and profoundly lethargic. But he didn't have a fever or a cough. His
only respiratory symptom: sneezing off and on.
The
man's elderly spouse called 911 twice. Both times, paramedics checked
his vital signs and declared he was OK. After another worried call from
the overwhelmed spouse, Syed insisted the patient be taken to the
hospital, where he tested positive for Covid-19.
"I
was quite concerned about the paramedics and health aides who'd been in
the house and who hadn't used PPE [personal protective equipment],"
Syed said.
Anecdotal case reporting
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.
"They get weak and dehydrated," he said, "and when they stand to walk, they collapse and injure themselves badly."
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.
Dr. Laura Perry, an assistant professor
of medicine at the University of California, San Francisco, saw a
patient like this several weeks ago. The woman, in her 80s, had what
seemed to be a cold before becoming very confused. In the hospital, she
couldn't identify where she was or stay awake during an examination.
Perry diagnosed hypoactive delirium, an altered mental state in which
people become inactive and drowsy. The patient tested positive for
coronavirus and is still in the ICU.
Dr.
Anthony Perry, an associate professor of geriatric medicine at Rush
University Medical Center in Chicago, tells of an 81-year-old woman with
nausea, vomiting and diarrhea who tested positive for Covid-19 in the
emergency room. After receiving IV fluids, oxygen and medication for her
intestinal upset, she returned home after two days and is doing well.
Another
80-year-old Rush patient with similar symptoms — nausea and vomiting,
but no cough, fever or shortness of breath ― is in intensive care after
getting a positive Covid-19 test and due to be put on a ventilator. The
difference? This patient is frail with "a lot of cardiovascular
disease," Perry said. Other than that, it's not yet clear why some older
patients do well while others do not.
Data collection of atypical symptoms
So far, reports of cases like these have been anecdotal. But a few physicians are trying to gather more systematic information.
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.
Data comes from hospitals and nursing homes in Switzerland, Italy and France, Nguyen said in an email.
On the front lines, physicians need to make sure they carefully assess an older patient's symptoms.
Other complicating factors
"While
we have to have a high suspicion of Covid-19 because it's so dangerous
in the older population, there are many other things to consider," said
Dr. Kathleen Unroe, a geriatrician at Indiana University's School of
Medicine.
Seniors may also do poorly because their routines have changed.
In nursing homes and most assisted living centers, activities have
stopped and "residents are going to get weaker and more deconditioned
because they're not walking to and from the dining hall," she said.
At home,
isolated seniors may not be getting as much help with medication
management or other essential needs from family members who are keeping
their distance, other experts suggested. Or they may have become
apathetic or depressed.
"I'd
want to know 'What's the potential this person has had an exposure [to
the coronavirus], especially in the last two weeks?'" said Vaughan of
Emory. "Do they have home health personnel coming in? Have they gotten
together with other family members? Are chronic conditions being
controlled? Is there another diagnosis that seems more likely?"
"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," Vaughan advised. "Be persistent. If you get a
'no' the first time and things aren't improving, call back and ask
again."
Full Article & Source:
Seniors with Covid-19 show unusual symptoms, doctors say
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