In addition to differing symptom presentations and health challenges during the coronavirus disease 2019 (COVID-19) pandemic, caretakers and medical professionals should be aware of older adults’ mental and emotional health.

Although fever and respiratory symptoms are recognized as COVID-19 symptoms across all demographics, some symptoms can have differing presentations in those aged 65 years and older. Some older adults may not present with a fever at all, and respiratory symptoms can be hidden or exacerbated by comorbidities, such as chronic obstructive pulmonary disease (COPD).

To accurately assess temperatures in older adults, the Infectious Disease Society of America has recommended alternative definitions, including a single oral temperature over 100°F, 2 oral repeated temperatures over 99°F, or an increase in temperature of 2°F over the baseline temperature.

Testing procedures may also differ for older adults. According to an article published in the Journal of Geriatric Emergency Medicine, the CDC recommends priority COVID-19 testing for older adults, patients with chronic medical conditions, and immunosuppressed individuals. The article authors specified that older adults with fever and/or respiratory symptoms who test negative for influenza should be prioritized for COVID-19 testing.

The authors noted that accessing medications is particularly vital for older adults, although it also presents challenges. They advised that caregivers review patients’ medications to ensure an adequate supply, and 90-day prescriptions should be filled, if possible. Having adequate amounts of OTC medications is also important, especially acetaminophen for fever control.

Those in senior living facilities are at particular risk, the authors said. Transferring residents between facilities may present significant risks and should be evaluated carefully. Making those decisions should balance concerns such as comorbid illness burdens or frailty with the potential for contracting COVID-19 or spreading it to others. Resources for forward triage—the decision whether to move an older adult from the emergency department to their home, a living facility, or another hospital environment—can include telehealth, community paramedicine, home-based primary care, or home health nursing.

Ultimately, the authors concluded that older adults who need only COVID-19 and influenza testing, or those with less acute medical needs, should be referred to testing locations or medical settings outside of the emergency department.

In addition to medical and health considerations, the COVID-19 pandemic could exacerbate the social isolation that many older adults already feel. Lack of visitors in senior living facilities or medical institutions also exacerbates these feelings. The authors recommended frequent phone calls and video chats whenever possible, whether from friends, family, or neighbors.

REFERENCE
Malone M, Hogan T, Perry A, Biese K, et al. COVID-19 in Older Adults: Key Points for Emergency Department Providers. Journal of Geriatric Emergency Medicine; March 18, 2020. https://gedcollaborative.com/article/covid-19-in-older-adults-key-points-for-emergency-department-providers/. Accessed April 3, 2020.