The dangerous way flu symptoms are disguised in older adults

You’ve heard the warnings about this year’s flu season, and it can be scary. The number of illnesses, hospitalizations, even deaths, is higher than normal.

It’s important to see a doctor the moment you have any flu symptoms, such as fever, chills, aches, coughing or other respiratory symptoms.

But what if you don’t have symptoms, but still have the flu? For older adults, this is a more frequent reality than most people realize, including doctors. And that’s even more scary.

Adults 65 and over often don’t present any of the usual flu symptoms. A recent study showed that health professionals often don’t know this, and fail to test these adults for the influenza virus, even when they’ve been sick enough to be hospitalized.

Even for normally healthy adults, this can be a problem. And for those with pre-existing health conditions, it can be a death sentence.

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Why flu symptoms may be hidden

As we age, our bodies are less likely to present the typical symptoms of a disease. It’s easy to dismiss vague symptoms like fatigue or poor appetite, when in reality they warrant serious attention.

Two factors can explain why so many older adults have the “hidden flu,” staring with an aging immune system.

Like all our other bodily systems, the immune system undergoes changes as we age. This includes being less responsive to infections.

The symptoms we experience with an illness such as the flu are actually the outward indications of our immune system’s response to infection. So, it stands to reason that as our immune systems age, our symptoms may actually become less severe.

Because of this, older adults who have the influenza virus often show none of the typical symptoms. Studies have shown that fever in particular is much less likely to be present in older adults who are ill with the influenza virus.

Decreased physiologic reserve

In our twenties, our bodies are at their peak of resilience, with lots of capacity to respond to stressors. Our organs coordinate well to correct for things like illness. This capability of our organs to carry out their functions under stress is known as ‘physiologic reserve.’

As we age, our physiologic reserves diminish. Our bodies and minds bounce back less quickly. So, when an illness places stress on our body, things can go a bit crazy, and we show symptoms that aren’t typical.

In the case of influenza, older adults often have unspecific signs, while failing to show any typical symptoms. These vague signs include weakness, loss of appetite, dizziness or lightheadedness, and general malaise (a ‘blah’ or unwell feeling).

One particularly important symptom to watch for is delirium (not to be confused with dementia). Delirium is simply a state of heightened confusion brought about by stress on the body, including illness.

Delirium can be hard to spot, since it often makes a person quieter. Hospital staff have been reported to miss this symptom as much as 70% of the time in patients.

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Make sure flu doesn’t go unnoticed

There are ways to avoid being an “invisible” case of the flu, and to help the adults in your life get the treatment they need.

• Take flu symptoms seriously. Sometimes, only one flu symptom may show itself. Perhaps you have a fever of 100 degrees, or an annoying cough. If these persist for more than a day or two, go to your doctor. Don’t assume it will go away, or that it’s “probably nothing.” This flu season, it could be something.
• Watch for atypical flu symptoms. If you care for or live with an older adult, be alert for the uncommon flu symptoms we’ve discussed here. Don’t dismiss a loss of appetite or depressed mood as ‘just getting older.’ Get them to a doctor right away.
• In particular, delirium is something you should watch for. It may appear as confusion, restlessness or agitation, or personality changes, but it’s just as likely that the person will just become quieter and more withdrawn. (As an aside, it’s not just flu that can cause delirium. Older adults have been known to become delirious when they have a urinary tract infection, pneumonia, or even during a silent heart attack).

Give your body a fighting chance

Declining physiologic reserve doesn’t have to lead to poor health. Your level of physiologic reserve is dependent on the state of your health as much as on your age. Your body is kind of like your car: the better your treat it, and the more carefully you maintain it over time, the longer it will function optimally. Here’s how to keep your motor running smoothly:

• Avoid smoking. No need to elaborate here.
• Drink in moderation, or not at all.
• Feed your body well. A balanced diet rich in proteins, fats, and carbohydrates is the way to go. A well-nourished body is a higher-functioning body, at any age.
• Get moving. A sedentary lifestyle will lead to an earlier diminishing of your physiologic reserves. The more active you remain, the better your body will be able to fight off infection.