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Fever in the elderly

D C Norman1, T T Yoshikawa

  • 1West Los Angeles Veterans Affairs Medical Center, California, USA.

Infectious Disease Clinics of North America
|March 1, 1996
PubMed

Insights

Fever in older adults often signals serious infections, but may be absent in 20-30% of cases. Clinicians must recognize atypical signs like fatigue or falls as potential infection indicators in the elderly.

Area of Science:

  • Geriatrics
  • Infectious Diseases
  • Internal Medicine

Background:

  • Infections in elderly patients often present with nonspecific, atypical, or unusual manifestations.
  • Fever, a common sign of serious illness in younger populations, may be absent in older adults.
  • Recognizing nonclassical signs is crucial for timely diagnosis and treatment of infections in geriatrics.

Purpose of the Study:

  • To highlight the importance of considering infections in elderly patients presenting with atypical symptoms.
  • To inform clinicians about the varied clinical presentations of infections in the geriatric population.
  • To emphasize that fever may be absent in a significant percentage of elderly patients with serious infections.

Main Methods:

  • Review of clinical presentations of infections in elderly individuals.
  • Analysis of the diagnostic challenges posed by atypical symptoms in geriatric patients.
  • Discussion of key concepts related to fever and infection in older adults.

Main Results:

  • Fever in the elderly generally indicates a serious infection, frequently bacterial.
  • A significant proportion (20%-30%) of elderly patients with serious infections may not exhibit fever.
  • Atypical signs such as functional decline, cognitive changes, weight loss, fatigue, falls, and pain can be indicators of infection.

Conclusions:

  • Clinicians must maintain a high index of suspicion for infections in elderly patients, even in the absence of fever.
  • A baseline temperature increase of at least 2°F should be considered a fever in the elderly.
  • Fever of Unknown Origin (FUO) in the elderly is most commonly caused by infections, connective tissue diseases (CTD), and malignancies.

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