How to ‘sense’ illness in your loved one

Created date

November 1st, 2019
An older woman sitting in a wheelchair smiles at a younger woman kneeling next to her. An older man stands behind her smiling down at them all.

Symptoms of illness are different in seniors than in younger adults. Your senses can help you recognize health changes in your loved one.

A serious illness or infection can come on quickly, especially in seniors. Some who are cognitively impaired or cannot speak may not be able to tell you if they feel ill, so if you are a family member or caregiver of someone with these deficits, you need to be on the alert for signs of illness. 

“Symptoms of illness in older adults are different from what you see in younger adults,” says Linda Toral, B.S.N., R.N., C.N.R.N., S.C.R.N., manager of the Neuro Rescue Network, part of the Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health in Baltimore, Md.

For example, younger adults may have an elevated temperature as the first sign of infection. Studies show, however, that older adults, especially those who have multiple chronic conditions, will not develop fevers.

“Even in healthy older adults, the immune system is not as vigorous,” Toral says. “This may prevent a febrile response to infection or blunt other symptoms.”

Your senses can be your tool to detect illness in your loved one.

What you might see

Your vision will be one of your best tools. Start with the skin. “A yellowish tinge to skin or eyes could be missed at first because it can happen gradually,” says Janet Katz, B.S.N., R.N., M.P.A., nursing supervisor of a home care company in Chicago, Ill. “A yellow color in the eyes or skin can mean jaundice, which is a symptom of a problem in the liver, gallbladder, or bloodstream.” 

You should also monitor for skin that is too pale or too red. “Paleness can be an indicator of numerous problems,” Katz says. “Redness or ruddiness, especially in the cheeks, could signal a fever.”

Any duskiness or bluish coloring to skin, lips, or nailbeds is usually very noticeable. It is a clear indication of a lack of oxygen, which should be treated as a medical emergency.

Watch for posture changes. How someone sits, stands, or positions themselves can be a signal that something is not right. “Pain may cause someone to lean a certain way, fidget, or not move around as much,” Katz says. “These types of signs can also mean someone feels as if they can’t get enough oxygen when they breathe.”

What you might hear

“When someone is eating or drinking, monitor them for coughing, choking, or any unusual sounds when they are chewing or swallowing,” Toral says.

Listen for changes that might signal pain. “Frequent sighing, grunting, or groaning could be a sign of pain or fatigue,” Katz says. “You may also hear congestion in the sinuses or wheezing when someone is breathing.”

Someone with chronic obstructive pulmonary disease may wheeze frequently, but if you notice an increase in volume or frequency, call a health care provider immediately. For wheezing in someone without lung disease, or for any sudden changes in respiratory status, dial 911.

What you might smell

When something is going wrong in the body, it may cause different odors. An unusual odor emanating from the skin could be a sign of liver or kidney disease.  A change in someone’s breath could mean a mouth infection or tumor, but it could also mean a liver or kidney problem.

A change in the smell of the urine may likely signal a urinary tract infection (UTI). Studies show that UTIs account for more than one-third of all nursing home-related infections, and they are second only to respiratory infections in older adults who live at home. “A common sign of a UTI in older adults is confusion,” Katz says. “For someone with dementia, it may manifest as a new type of confusion that comes on quickly or they might become incontinent,” Toral adds.

What you might feel

“The temperature or quality of the skin may seem different when someone has a change in their health status,” Katz says. “It could be cool, warm, hot, clammy, or sweaty.”

You may also be able to feel areas of swelling in the legs, feet, or anywhere else on the body. If you think someone is in pain but can’t figure out where, gently press on various areas of the body to see if it elicits a reaction.

Observe the big picture

Sometimes, there might be a few symptoms that are not necessarily obvious. “Someone might not be eating as much for a few days or seem to stumble or fall more often,” Toral says. “Since you know your loved one best, anything that seems abnormal, including increased fatigue or decreased responsiveness, should be investigated.”

Someone with high blood pressure may have a slight increased or decreased reading for a few days, or someone with diabetes might have a slightly higher or lower blood glucose level.

Your life as a caregiver can be busy and chaotic, so documenting all your observations may help you notice trends. A difference here or there may not mean much on its own, but it could be significant in the context of other changes.

If you are ever in doubt, call the doctor. “It is always a good idea to notify the health care provider about any change in status,” Katz says. “It can ease your mind and also help you keep ahead of an emerging medical problem.”