Acute Symptoms in Elderlies: What to Do at Home and When to Call a Doctor

Almost everyone caring for a senior loved one has to deal with acute symptoms such as excessive vomiting, fatigue, high fever or unusual high or low blood pressure at some point. Sometimes, the symptoms get better on their own or with common over-the-counter medications like fever or pain reliever. Other times, similar symptoms can worsen quickly, making you wonder if you should have contacted a doctor earlier. 

This article provides family caregivers with a general guide of how to handle common acute symptoms at home. A previous similar article focused on symptoms related to lung disease like shortness of breath and coughing. Make sure you read it here if your elderly loved one has a chronic respiratory condition like CODP or asthma.

1. Vomiting

Vomiting can be brought on by various triggers, from temporary circumstances like motion sickness or the flu to severe conditions like a stroke or concussion. The common causes of vomiting include:

  • Digestive causes: Food poisoning or food-borne diseases, Crohn’s disease, gastroesophageal reflux disease (also known as GERD or acid reflux), appendicitis, gallstones
  • Infections: Viral gastroenteritis (stomach flu), urinary tract infection (UTI), pneumonia, etc.
  • Other causes: intestine blockage, migraine headache, heart attack, stroke, concussion, a body response to severe pain

Vomiting is often accompanied by other symptoms, which can help you identify the possible causes. For instance, if you experience vomiting, diarrhoea and stomach pain, the cause is likely to be food poisoning. If high fever is present with vomiting but without an upset stomach, it is a good reason to suspect an infection and to visit a doctor. However, excessive vomiting is almost always a sign of a more serious health issue and needs to be attended to by a healthcare professional. 

A health risk associated with vomiting, especially excessive vomiting, is dehydration. It can escalate quickly in seniors if not well managed, causing kidney failure, brain edema, low blood volume (​​medically called hypovolemia), seizures, accelerated heart load, coma, and even death. Common signs and symptoms of dehydration to look for include: 

  • Thirst and dry mouth
  • Dry lips and skin
  • Sunken eyes and cheeks 
  • Dark urine colour and lack of need to pass urine
  • Fever without sweating
  • Headache, dizziness, tiredness, rapid heartbeat: these are signs of severe dehydration

The most crucial step to take care of someone experiencing vomiting is to keep the person hydrated. Make sure to sip on water or suck on ice frequently, even if it feels uncomfortable doing so. Non-carbonated sports drinks or other drinks with electrolytes help to replenish the body with lost liquid, essential minerals and energy to recover. Caffeinated drinks, carbonated and sugary drinks should be avoided. 

If the vomiting persists despite the measures taken and your loved one appears to be severely dehydrated, take them to the Emergency Room. They need to be cared for urgently by professionals. 

2. Fever

A fever is an increase in the body's temperature above its normal thermostat. It is believed to be a body’s defence mechanism to fight against viruses and bacteria which tend to fare worse in warmer environments. 

Despite its protective role, a fever is often uncomfortable and a sign of a medical issue. You may feel hot, chill, shivery, sweating and generally tired. Depending on the underlying causes, there might be aches, pains and other distressing symptoms. A fever may indicate: 

  • Viral illnesses, like the flu or Covid-19 or Dengue Fever
  • Infections brought on by bacteria, such as pneumonia, urinary tract infection (UTI), wound or bedsore infection, digestive tract infection, skin infection 
  • Flare-ups of a chronic condition like rheumatoid arthritis
  • A side effect of prescription drugs
  • Other less common but severe conditions like a tumorous growth or septic shock

Fever caused by flu and Covid-19 without other severe symptoms can be safely treated at home. Home care measures include resting, taking fever relief medications, using cold compress and changing to light and dry clothing. Fever can cause excessive sweating and dehydration, so make sure you drink a lot of liquids to stay hydrated.

However, you should call a doctor if you have a persistent fever  that lasts 3 days or longer. This signals a potentially more serious infection or illness. You should also contact a doctor immediately if the fever is accompanied by difficulty in breathing, chest pain, disorientation, seizures or tremors, or unexpected rashes. (Read our article on signs and symptoms of acute lung disease when an elderly has trouble breathing here.)

In caring for an elderly loved one, it is important to know the accurate baseline temperature for a few reasons. Firstly, although 37°C is considered to be normal body temperature, it is not the case for everyone. Furthermore, seniors often have lower body temperatures than young adults. A mild fever in an elderly might in fact be a severe one, if the senior usually has a low body temperature. Finally, most people’s temperatures fluctuate throughout the day, by 0.5°C to 1°C between the morning and afternoon, even when they are healthy. For a fair evaluation, make sure you compare the temperature when you suspect a fever with the baseline at a similar time of the day when your beloved senior is well. 

3. Abnormally high blood pressure 

Hypertension (high blood pressure) is one of the most prevalent medical conditions among people above 65 years old in Singapore. However, almost half of the people suffering from it are not aware of their condition, due to lack of apparent symptoms associated with high blood pressure. Generally speaking, a person with consistent blood pressure of 140/90mmHg is diagnosed with high blood pressure. (Learn more about hypertension and how to read blood pressure measurements in our article here.)

Blood pressure of 180/120 mmHg or greater is considered high and requires medical attention. You are likely to notice a spike in blood pressure because you measure your blood pressure regularly due to diagnosed hypertension. In such cases, take the prescribed medications, rest and follow other instructions your doctor gave you. 

Contact a doctor immediately if you do not have medications at home, or have taken medications but blood pressures do not come down to baseline. 

In rare cases, high blood pressure can lead to a stroke, heart attack, organ failure or other life-threatening symptoms. This is known as hypertensive crisis and is considered an emergency. Head to the Emergency Room if you have blood pressure reading of 180/120mmHg or higher together with symptoms such as difficulty breathing, chest pain, blurred vision, dizziness and vomiting, disorientation or confusion, seizure, fainting. 

As hypertensive crisis may precipitate a stroke, watch out for stroke symptoms in your elderly senior using the B.E.F.A.S.T guide: 

  • Balance: Ask your elderly if they feel dizzy or out of balance, check the way the senior walks for signs of trouble balancing equally on both sides.
  • Eyes: Ask if the senior has double or blurred vision, or suddenly can not see from either side of the eyes.
  • Face: Notice signs of facial drooping. A good way to test is to ask the person to smile, an uneven smile could be a symptom of a stroke. 
  • Arms: Check if they can raise both arms evenly. A stroke can make one arm drift downwards. 
  • Speech: Slurred speech or sudden trouble speaking or understanding is one of the common symptoms of a stroke.
  • Time: Call 995 immediately if your elderly loved one shows any of the above symptoms. 

Learn more about how high blood pressure can lead to a stroke and its early signs here.

4. Abnormally low blood pressure

Blood pressure of 90/60 mmHg or less is considered to be low blood pressure, medically referred to as hypotension. Similar to hypertension, people having low blood pressure usually do not exhibit symptoms and thus, may not be aware of the condition. It is more common among the elderlies but younger adults, especially those who are very physically active, can have it too. 

Some people with low blood pressure experience dizziness or lightheadedness when changing abruptly from a sitting or lying down position to standing. Known as orthostatic hypotension or postural hypotension, this is often not a serious issue and can be addressed by managing triggers. These triggers can involve changing positions too fast, a drop in blood sugar, dehydration due to sweating or not taking enough fluid. Observe your own triggers and adjust accordingly. The following ideas might be helpful: 

  • Always stand up slowly from the seated position.
  • Give yourself a few minutes to step out of bed or sitting up from a lying position
  • Elevate the foot of your bed when sleeping
  • Eat small, frequent meals to avoid blood sugar drop
  • Ensure sufficient daily fluid intake

If you monitor blood pressure regularly and see persistent readings indicating low blood pressure (90/60 mmHg or lower), contact a healthcare provider for a diagnosis. A more serious health issue might be at play, including: 

  • A heart or lung condition, e.g., arrhythmias (irregular heartbeat), heart attack, heart failure, or pulmonary embolism.  
  • Low blood volume due to blood loss or dehydration 
  • Other chronic or acute conditions such as Parkinson's disease, diabetes or an acute allergic reactions
  • Side effects of medications

Once the underlying cause is identified and treated, low blood pressure will improve.

5. Low blood oxygen

Blood oxygen level, or blood oxygen saturation, indicates the amount of oxygen in your blood. Healthy blood oxygen saturation ranges from 97 to 100%. However, older people and people with chronic lung disease or sleep apnea may have lower ranges. For instance, doctors consider blood oxygen levels of 95% in people over the age of 70 to be adequate, and 90% in those with lung disease to be acceptable. 

Low blood oxygen, medically known as hypoxemia, refers to blood oxygen levels lower than a person’s baseline. Without sufficient oxygen, critical organs like the heart, lung and brain might have difficulty functioning, leading to a variety of symptoms, such as: 

  • Shortness of breath
  • Chest pain
  • Rapid breathing
  • Rapid heartbeat
  • Nausea, dizziness, headache
  • Disorientation or confusion
  • Bluish-colored lips, nails or skin

You may notice these symptoms before checking blood oxygen and realising that it is low.

Blood oxygen level can be measured at home using a finger clip-on device called the pulse oximeter, displayed as SpO2. In fact, if your senior loved one has chronic lung or heart disease, it is a good idea to buy a pulse oximeter and monitor blood oxygen regularly. Find out your baseline and ask your doctor for recommended actions for each level of drop, with and without other symptoms. 

Covid-19 is known to cause silent oxygen drop in a number of people. If your senior loved one has tested positive to Covid-19 and is developing symptoms, you may want to monitor blood oxygen level as a precaution. Contact a healthcare provider promptly if there is a drop in SpO2 reading, even if other symptoms are manageable. 

6. Severe pain in the chest or abdomen

The chest and abdomen house critical organs of the body. Sudden, unusual, intense and prolonged pain in this area that persists for 24 hours or more can signal that you need to visit the doctor. Pain in the chest can be a symptom of a heart attack or a lung infection. Chest pain associated with shortness of breath or radiation of pain to the neck or upper limbs and profuse sweating may signal a heart attack.

Sudden onset of severe pain may signal aortic dissection which is a tear in the lining of the main artery of the body.

Call a doctor promptly if you experience this type of pain. 

Intense episodic pain in the back and lower abdomen can indicate kidney stone. Pain in the lower stomach or pelvic area can signal appendicitis, kidney infection or a bowel obstruction. 

Learn more about abdominal pain in our article covering common gastrointestinal issues in the elderly here.

7. Changes in bowel and urination habit

Sudden changes in the pattern of passing motion or urine can be symptoms of a variety of digestive and kidney issues. In addition to changes you can feel such as constipation, diarrhoea, infrequent or excessive urination, the colours of the stool and urine can be telling. Black or bloody stools indicate bleeding along the digestive tract. Similarly, brown or red-coloured urine may suggest an underlying  kidney issues. Cloudy urine can manifest when you have urinary tract infection (UTI), kidney stone or kidney disease. 

Contact your primary healthcare provider if the changes or irregularities in bowel and urination habits persist. They need to be investigated by a healthcare professional. In some cases, you may need to be referred to a specialist for a thorough examination.  

Read about chronic kidney disease in the elderlies here and other diseases of the urinary tract like kidney stone and UTI here.

8. Loss of appetite 

Loss of appetite is easy to spot. The elderly may eat smaller portions than usual, say they are not hungry, or do not want to eat. If poor appetite happens as a result of a known illness, you can expect that it will gradually resolve by itself when the senior recovers.

However, loss of appetite persisting for 2 weeks or more without a known cause is often a sign of an underlying condition. Other symptoms may also be present, including fatigue, nausea, vomiting, loss of smell or taste, loss of weight, and digestive discomforts like abdominal pain, diarrhoea or constipation. Contact a healthcare provider for a check-up or a diagnosis. Appetite usually improves once the underlying cause is identified and treated.

At home, you can stimulate the elderly’s appetite with more appetising and flavourful food that suits their preferences. Here are 8 top dishes you can try to boost your beloved’s appetite and nutrition.

9. Loss of sleep 

Frequent loss of sleep, or insomnia, is defined by a consistent inability to fall or stay asleep even when given the chance to do so. In addition to being tired, sleepy and easily irritable during the day, long-term insomnia is associated with higher risk of high blood pressure, cardiovascular disease, diabetes, dementia, and a number of mental illnesses. 

One or a few nights of insomnia occurring due to anxiety, stress, a cup of strong tea or coffee late in the day or a disruption to the nightly routine is not a medical concern. You can get back to a sound nightly sleep by managing the source of anxiety or stress, putting a day cap for caffeinated drinks and alcohol, or establishing a sleep conducive pre-bedtime routine. 

However, insomnia that lasts for 4 weeks or more should be reported to a doctor, and insomnia that lasts for 3 months or more should be treated. It may be related to underlying health issues such as hyperthyroidism (overactive thyroid), heart diseases, Alzheimer’s disease, dementia,  cancer, sleep apnea, asthma, COPD (Chronic Obstructive Pulmonary Disease). Treating the related health issue may relieves insomnia in these cases. 

If all other causes are ruled out, insomnia is diagnosed as primary, which is to say, there is no cause to it. The doctor may prescribe sleep therapy, melatonin supplements or sleeping pills to help improve sleeping patterns. 

Learn more about lack of sleep, its complications, causes, treatment and useful tips to sleep better here.

10. Fatigue

Fatigue refers to the constant state of tiredness, lack of energy and motivation to perform daily tasks. Fatigue differs from usual tiredness because it does not go away with rest and sleep. 

Fatigue can be a symptom in various medical conditions, from a flu to sleep disorder to cancer. Often, it manifests with other symptoms which are as diverse as the conditions fatigue is linked to. Aside from medical causes, distressful life events can trigger fatigue. 

If your elderly loved one complains of fatigue that does not get better with rest and is not linked to any known medical conditions or life occurrences, contact a doctor for an examination. 

11. Takeaway Message

When dealing with acute symptoms, recognising the right time to visit a doctor or hospital can make a difference in treatment outcome. However, being overly cautious and heading to the emergency room when you can safely treat the symptom at home can cause unnecessary stress, hassle and medical bills. We hope the article helps you better determine when to call on a medical professional and when to safely apply self-care at home. 

As one of the leading home care providers in Singapore, Ninkatec provides housecall GP, home nurse and technology for you and your family to best recover at home. Ninkatec doctors come to you so you can safely focus on healing and well-being in the comfort of your home. Chat with us below if you have any questions about the above or other acute symptoms affecting your senior loved one. 


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