When a 75-year-old man from Bangalore started experiencing confusion and talking irrelevantly, his family got worried and rushed him to a hospital in November 2023. Harish (name changed) was diagnosed with pneumonia, a lung infection. Confusion or delirium in the elderly is an overlapping symptom that has varied precursors, say experts.
Speaking about Harish’s case, Dr Subrata Das, senior consultant, internal medicine and diabetology, Sakra World Hospital, Bangalore says, “Harish was diabetic and he showed no symptoms of pneumonia except delirium that results in mental confusion which was noticed by the family.”
It’s always the family members and the caretakers who pick up signs of confusion or a state of being lost in the elderly, he adds.
Overlapping symptoms in elderly: What do they indicate?
Overlapping symptoms such as fatigue, confusion, headache, loss of appetite and weight loss, should not be ignored as a natural part of the ageing process, says Dr Das.
“Elderly commonly experience overlapping symptoms and they could indicate infection, vitamin deficiency, or metabolic issues in most cases” explains Dr Hemalata Arora, senior consultant, Internal Medicine, Nanavati Max Super Speciality Hospital, Mumbai. She adds, if the symptoms last for over a week, it requires medical consultation.
Dr Arora advises “caretakers must closely examine if any ailments are a cause of change in food, activity and sleep.”
Common symptoms that overlap in elderly
1. Forgetfulness
One of the most ignored symptoms among elderly is forgetfulness. “Forgetfulness, which is episodic and minor, is often caused by an electrolyte imbalance or low sodium in the elderly,” says Dr Arora. Sometimes this is due to excessive water intake which dilutes the sodium levels, she adds.
Loss of memory can also be due to Urinary Tract Infections (UTIs), explains Dr Arora.
When forgetfulness is caused by a neurological condition, it could suggest dementia, Parkinson’s, or delirium among others.
2. Confusion
Those recovering from an infection or illness, including UTI, often experience confusion or delirium. “Others common reasons for confusion are low sugar and sodium levels, electrolyte imbalance and dehydration in elderly,” explains Dr Das.
Dr Arora advises elders to drink fluids based on their thirst. One should know that low sodium [less than 120 milliequivalents per liter (mEq/L)] can further affect kidney functioning if not treated immediately.
3. Headache
Headache is another symptom that is often ignored, says Dr Das. The causes include high blood pressure, stress, migraines or cardiovascular diseases.
Recalling another recent case, Dr Das said that an octogenarian consulted him for a severe headache. “He had a history of cough, chronic bronchitis, and chronic obstructive pulmonary disease. Upon investigation, it was learned that he had hypercapnia, high carbon dioxide in his blood which resulted in headache,” he said.
4. Fatigue
Fatigue is not a common sign of aging, says Dr Das. Fatigue can be a manifestation of anemia, high blood sugar, thyroid dysfunction or an underlying infection.
Fatigue and malaise that come with weight loss require further assessment. It could also indicate malignancy in rare cases.
5. Loss of appetite
Loss of appetite is a common and often an unidentified symptom by family. Elderly who have issues with chewing, poor-quality dentures tend to show loss of appetite. This could also result in malnutrition in elderly which can lead to weight loss.
Dr Das explains, “Chronic infections such as tuberculous, electrolyte imbalance, liver, kidney and heart diseases, low cortisol, a hormone that affects metabolism are the common causes.”
It can also be psychologically caused due to sadness, loneliness or in severe cases, depression. In rare cases, it indicates cancer in the colon, stomach and pancreas.
6. Sudden fall
Sudden falls in elderly can be caused due to heart-related issues such as when sinoatrial (the heart’s natural pacemaker that generates 60-100 beats per minute) may not be working properly, says Dr Das. Other causes are irregular heart rhythms, sudden drop in BP and stroke. Sometimes, it indicates seizures in elderly.
Postural imbalance is another common reason behind falls. Additionally, a fall can happen when the blood pressure drops due to sudden change in posture from sitting to standing, medically termed as Postural syncope or hypotension,” said Dr Das.
He adds, “Another common reason behind sudden fall could be micturition syncope where the person suddenly falls after urination due to a drop in blood pressure.”
7. Acidity and abdominal pain
Abdominal pain and acidity could indicate infection, metabolic problems or vitamin deficiencies, says Dr Arora. Dr Das adds that sometimes it suggests stomach ulcers. “Acidity symptoms can mimic a heart attack which must not be ignored,” said Dr Das.
In rare cases, abdominal pain with poor appetite and weight loss, could indicate malignancies, cautions Dr Arora.
8. Leg swelling
Swelling in both legs could be a symptom of low protein, anemia in elderly, certain medications, or heart, kidney and liver diseases, says Dr Das.
Unilateral swelling, swelling in one leg, is often misleading as it could indicate a fracture due to a mistaken hit or in severe cases, it could indicate blood clots, explains Dr Arora. If left untreated, this could cause sepsis (blood poisoning) in the elderly.
9. Dry skin and itch
Dry skin in elderly is common as their skin loses its moisture-retaining capacity. However, extreme dry skin and itch, also called pruritus, can be a symptom of kidney and liver issues and thyroid diseases.
Experts caution that if this persists despite usage of moisturizers and lotions, they need to get examined.
10. Constipation
Commonly caused by slowing metabolism, it could indicate abdominal bloating, flatulence or accumulation of gas, says Dr Arora.
Constipation can be ignored if it is caused due to eating a different kind of food. But one can’t ignore constipation that prolongs over a week as it could indicate polyp, a form of cancer, explains Dr Arora.
Takeaways
- Overlapping symptoms in elderly such as confusion, abdominal pain, fatigue that lasts for more than a week requires medical consultation.
- Most symptoms are picked up by the family members or caretakers rather than the person him/herself.
