Fever in the elderly: Prevention and treatment

Fever at any age is not a disease by itself but usually the symptom of an infection. Though fevers are extremely common in the society, it carries a higher degree of severity in the elderly and those with chronic illnesses such as uncontrolled diabetes, liver and lung diseases. Infectious diseases account for more than 40 per cent of deaths in geriatric population. Due to absence of classical features of fever, exact diagnosis could be easily missed. In those with multiple illnesses and advancing age, the manifestations of fever could be in the form of confused behaviour, urinary incontinence or even a fall from the bed.

Two common illnesses, pneumonia and influenza, can be much more severe in the elderly requiring hospitalisation. Weak immunity increases the risk of development of not only complications from influenza and pneumonia but also is contagious to those of the same age especially in geriatric homes. Urinary tract infection can also produce fever and it is more common in those on catheters and with improperly managed diabetes.

Skin infections can occur due to dryness, pressure or ageing. If you are on medications for high BP, cholesterol, Parkinsonism or diabetes, it will be dangerous to discontinue them; dosages may be modified based on geriatric physician/family physicians’ advice.

Management of fever should include adequate intake of fluids, ensuring optimal urinary output, paracetamol in the recommended minimum dosages and identification of the cause of fever if indicated. Most of the deadly ones are preventable with adult immunisation. eg. Influenza, Pneumonia, Herpes zoster etc.

(The author is a geriatric expert and chairman and managing director of Jothydev’s Diabetes Research Centre in Thiruvananthapuram, Kochi)