When screening frail, elderly residents for the coronavirus, care providers should be aware that the key symptoms of the disease may be masked, according to the authors of a new set of recommendations in the Journal of Geriatric Emergency Medicine.
Fever has been shown to be the most common sign of COVID-19. But fever and respiratory symptoms often present differently in older adults than in a younger cohort. In fact, fever in the elderly may be blunted or absent entirely during an infection, wrote geriatrician Kathleen Unroe, M.D., MHA, from the Regenstrief Institute, and colleagues. In one emergency department-based study, only 32% of patients over age 60 with influenza had triage temperatures greater than 100 degrees Fahrenheit.
“Temperature may be even less sensitive among our most frail older adults, those in senior living, who carry the highest risk from infection,” Unroe explained.
Respiratory symptoms may also be masked – or exacerbated by co-occurring diseases such as COPD. To prevent missed diagnoses, clinicians may need to adopt new clinical practices as the understanding of the virus improves, said Unroe, who specializes in long-term care.
To tease out symptoms in these at-risk residents, Unroe recommends referring to the Infectious Disease Society of America’s modified definition of fever for older adults:
- A single oral temperature over 100°F, or
- 2 oral repeated temperatures over 99°F or
- An increase in temperature of 2°F over the baseline temperature
“As our understanding of this virus continues to improve, we must revise our practices of care, both clinically and residentially, to make sure that our most vulnerable populations are protected,” Unroe concluded.
