The COVID-19 pandemic has impacted global health. Older adults face a disproportionately higher risk of severe illness and adverse outcomes from COVID-19 compared to younger age groups. Recognizing how the virus presents in this demographic is important for timely intervention and improved health outcomes.
Common Manifestations
Older adults with COVID-19 often experience symptoms similar to those seen in younger individuals, though their presentation can be more subtle or severe. Fever is a frequent symptom, reported in a significant percentage of older patients. However, some older individuals might not develop a fever, or their fever might be a lower temperature than what is typical for younger adults due to a naturally lower baseline body temperature.
Cough, especially a dry cough, is another widely observed symptom. Shortness of breath or difficulty breathing (dyspnea) is also commonly reported, and its occurrence may be higher in older patients compared to younger ones. Fatigue and muscle aches are general symptoms that can be present, along with a new loss of taste or smell, which can interfere with appetite. Other common, though less frequent, symptoms include a sore throat, headache, congestion, runny nose, nausea, vomiting, and diarrhea.
Unconventional Presentations
Beyond the typical respiratory and flu-like symptoms, older adults frequently present with atypical manifestations of COVID-19, which can complicate diagnosis. Confusion or delirium is a recognized atypical sign, occurring in a notable percentage of older patients. This altered mental state can be one of the earliest or sole indicators of infection.
Increased falls or general weakness are also common atypical presentations. A general feeling of being “off,” increased sleepiness, or a marked reduction in energy levels can signal the onset of the illness. Loss of appetite or a significant decrease in food and fluid intake, sometimes leading to dehydration, may be observed. Worsening of existing chronic conditions, reduced mobility, or new onset of incontinence can also be subtle yet important clues to a COVID-19 infection in older individuals.
Factors Increasing Vulnerability
Several age-related physiological changes contribute to why older adults may experience different or more severe COVID-19 symptoms. A primary factor is immunosenescence, the age-related decline in the immune system’s effectiveness. This weakening makes it harder for the body to identify and fight off viruses like SARS-CoV-2 and build protective immunity. This less robust immune response contributes to severe illness, hospitalization, and mortality.
The presence of multiple underlying health conditions, known as comorbidities, also plays a significant role in increased vulnerability. Conditions such as heart disease, diabetes, lung disease, and kidney disease are more prevalent in older adults and can further strain an already compromised immune system. Frailty, characterized by reduced physiological reserve and increased susceptibility to stressors, further compounds the risk, making older adults more prone to severe outcomes and prolonged recovery.
When to Seek Care
Prompt medical attention is important for older adults with suspected COVID-19 due to their increased risk of severe complications. Caregivers or individuals should seek immediate medical care if there is difficulty breathing or persistent pain or pressure in the chest. These signs can indicate serious respiratory involvement.
New confusion or an inability to wake or stay awake are also urgent warning signs requiring immediate medical evaluation. Bluish lips or face, or a change in skin color that may appear whitish or grayish in darker skin tones, suggests low oxygen levels and requires emergency intervention. Any sudden change in a person’s “normal” behavior or overall condition, especially if accompanied by other symptoms, warrants contacting a healthcare provider for guidance.