Serious illness in an older person often does not look the way it does in a younger adult. An infection may cause confusion instead of fever, and a heart problem may cause breathlessness or tiredness instead of chest pain. Families who know the person well are often the first to notice that something has changed.
With age, the body's responses to illness change. The immune system may not produce a high fever. Pain may be less noticeable or described vaguely. Memory problems or hearing difficulties can make it harder for the person to explain how they feel. As a result, a serious problem such as pneumonia, a urinary infection, a heart attack or a bowel problem may show up in unexpected ways.
For families and caregivers, the key question is: is this a change from how the person usually is? Someone who was walking yesterday and cannot stand today, or who was chatting normally and is now muddled, needs to be assessed, even if there is no obvious explanation.
A sudden change in thinking, attention or alertness — sometimes called delirium — is a medical warning sign. It can be caused by infection, dehydration, low or high blood sugar, medicines, constipation, urinary retention and many other conditions. Delirium often develops over hours to days and may come and go. It is different from dementia, which usually changes slowly over months or years; however, people with dementia are at higher risk of delirium, and a sudden worsening should be taken seriously.
Being unable to walk, get out of bed, feed themselves or use the toilet as usual — or a new fall — may be the first sign of an illness. Do not assume these changes are simply due to age.
A person who stops eating or drinking for a day or more can quickly become dehydrated and weak. It may also signal infection, pain, swallowing problems, low mood or a medicine side effect. See our guide on preventing dehydration in older adults.
Faster breathing, breathlessness when talking or at rest, or a new cough may indicate a chest infection or heart problem. In older people, a heart attack may cause breathlessness, sweating, nausea or sudden tiredness rather than typical chest pain.
Passing very little urine, being unable to pass urine despite feeling the need, new incontinence or pain on passing urine can all indicate problems that need assessment. An inability to pass urine with lower abdominal discomfort needs prompt attention.
New or worsening leg swelling, a single swollen and painful calf, unexplained bruising or bleeding (particularly in people taking blood-thinning medicines), black stools, or a red, hot and swollen area of skin should all be reported to a doctor.
Seek emergency care immediately if an older person has:
In Sri Lanka, call 1990 Suwa Seriya for an emergency ambulance, or seek immediate care at an appropriate hospital.
Other changes are not always emergencies but should be assessed the same day or as soon as practical. These include new confusion that is mild but persistent, reduced eating and drinking for more than a day, fever, a new cough, burning when passing urine, increasing swelling of the legs, new difficulty walking, or a person who "just isn't right" in a way the family cannot explain.
For an older person who is stable but finds travel difficult, a doctor home visit can be one way of getting this review. If the person is getting worse, or if you are in doubt, seek hospital care.
In Sri Lanka, call 1990 Suwa Seriya for an emergency ambulance, or seek immediate care at an appropriate hospital. Do not wait for a home visit.
Published by: Sineth Hospitals
Medically reviewed by: Dr. Seneth Gajasinghe, MBBS (Colombo), MD (Colombo), Medical Director, Sineth Hospitals
Last reviewed:
You know the person best. A sudden change from their usual self is a valid reason to seek medical advice, even if you cannot say exactly what is wrong.
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