Keep a high index of suspicion for COVID-19 in older patients

Healthcare professionals should follow advice from Public Health England and be aware that older patients can become suddenly unwell

Picture shows an older woman lying in bed looking unwell. Follow Public Health England advice and also be aware that older patients can become suddenly unwell, says advanced clinical practitioner Neal Aplin.
Picture: iStock

I am an advanced clinical practitioner in older people’s care and have been on the NHS front line assessing and nursing those with coronavirus-type symptoms.

I am also a veteran of the 2009 swine flu pandemic, but I have seen COVID-19 cause much more sudden serious illness in older patients than I saw then. This rapid deterioration was noticeable in the first patient I nursed with COVID-19, a 91-year-old man living with frailty and multiple co-morbidities, including cardiovascular disease and hypertension. 

Sudden decline and dropping oxygen saturations

Sudden decline was also the experience with two other patients on the ward where I work. They were both male, aged 81 and 91, and had multiple co-morbidities. Both had been non-specifically unwell for 12 to 24 hours with mild pyrexia but no other presenting signs or symptoms.

But both then deteriorated suddenly, with dropping oxygen saturations. The 81-year-old also presented with hypoactive delirium and significant hypotension.

All three patients were diagnosed with COVID-19 within a seven-day period, and all displayed similar signs of mild pyrexia and feeling non-specifically unwell between 12 and 24 hours before their sudden deterioration. Interestingly, all three also had a low lymphocyte count.

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COVID-19 can cause non-specific symptoms and pyrexia initially, and my experience suggests older patients with co-morbidities can decline rapidly and will require oxygen therapy and acute care. This presentation, with quick deterioration, has been corroborated by the experiences of my colleagues.

Current advice from Public Health England should be followed regarding testing for the virus. If pyrexia is present (37.8˚C or above), with no other symptoms, testing for COVID-19 should be performed.

Although mild pyrexia and feeling non-specifically unwell could indicate many conditions in an older person, in the current climate and with infection numbers climbing rapidly, I believe those caring for older patients should have a high index of suspicion for COVID-19 and be aware that such patients could become suddenly unwell.

Key steps when nursing an older person with suspected COVID-19

  • Older people with cardiovascular disease, diabetes, chronic respiratory disease or cancer are more likely to develop serious illness
  • Be aware that older people with multiple co-morbidities can decline rapidly
  • Seek prompt review of patients if there is a suspicion of COVID-19
  • Have a high index of suspicion for COVID-19 if older patients become non-specifically unwell or develop a cough, shortness of breath or fever
  • Follow current guidelines from Public Health England on the assessment and management of patients with suspected COVID-19

Picture of Neal Aplin,  an advanced clinical practitioner at Great Western Hospitals NHS Foundation Trust in Swindon, who stresses the need to follow advice from PHE and be aware that older patients can become suddenly unwell.Neal Aplin is an advanced clinical practitioner, Great Western Hospitals NHS Foundation Trust, Swindon



Find out more

Public Health England – COVID-19: guidance for health professionals