Supporting Elderly Recovery: Navigating Health Challenges After Illness

Q: Supporting Elderly Recovery: Navigating Health Challenges After Illness

Hello： 1. <br>In elderly patients with fever and shortness of breath, the primary consideration is infection, especially pneumonia. <br>If there are confirmed cases in the household, it is likely that the grandfather may also be infected (rapid testing at the emergency department

The elderly person was generally healthy but is unable to get up after a serious illness?

Hello, doctor.
I would like to ask for advice regarding medical management for my grandfather, who is currently 97 years old.
Two years ago, he experienced confusion upon waking up and had low blood pressure.
After being taken to the hospital, he was diagnosed with ascites and subsequently diagnosed with liver cirrhosis by a gastroenterologist.
He was prescribed diuretics and has been taking medications including aspirin and antihypertensive drugs.
Initially, his condition was severe, and we thought he might not survive, but after hospitalization, he recovered.
Although his physical strength is not as good as before, he has been able to travel and generally walks around.
His dietary intake is normal, and his blood pressure is maintained around 110/60, with a heart rate usually around 50.
About a year ago, his weight dropped from 80 kg to 65 kg.

However, a few days ago (on October 2nd, Sunday), he suddenly reported weakness in his legs and felt unable to use them.
He then developed a fever of up to 39 degrees Celsius.
That day, he was given antipyretics, and a family member who lives with him tested positive for COVID-19.
I suspect he may have contracted it as well, but after three days of rapid testing, including for my grandmother who sleeps in the same room, all results were negative.
Since my grandfather has not been vaccinated, we were hesitant to seek medical attention on the day of the fever.
After taking antipyretics, he had a slight appetite and drank Ensure.
The next morning, his temperature was 37.5 degrees Celsius, so we continued with antipyretics (like acetaminophen) until Wednesday when his temperature normalized.
However, his physical condition is significantly worse than before.
For the past two days, his oxygen saturation measured between 90-94%, but improved to 98% by Thursday.
His blood pressure and other values are normal, but I noticed something concerning: on Thursday morning, when palpating the radial artery, it felt like a strong beat followed by a weak one, then a pause, and this pattern continued until Friday morning when it returned to a more normal rhythm without obvious variations.
Given that he is an otherwise healthy elderly man who suddenly experienced an unexplained fever (a serious illness) and was bedridden for two days, now having difficulty turning over and walking with shortness of breath, should we proceed with rehabilitation, or wait until his strength improves before seeking a comprehensive physical examination? I suspect that the shortness of breath and fever may indicate pneumonia.
I hope that at least he can regain some quality of life and, through rehabilitation (or identifying the cause of the fever for improvement), return to a state of self-sufficiency.
What should I do? Additionally, my grandfather may have strained his back when he got up on the day he developed the fever, and he currently experiences back pain.
Can I administer pain relief medication and then gradually start him on rehabilitation exercises or online elderly rehabilitation activities?
I have many questions and a complex emotional state, and I would appreciate your advice on supportive care or medical management for my grandfather.
Thank you very much for taking the time to read this lengthy inquiry, and I hope you can address my numerous questions.

Yongyuan de Ling, 90~99 year old female. Ask Date: 2022/10/08

Dr. Cai Dongqi reply Family Medicine

Hello: 1.
In elderly patients with fever and shortness of breath, the primary consideration is infection, especially pneumonia.
If there are confirmed cases in the household, it is likely that the grandfather may also be infected (rapid testing at the emergency department may be more reliable than home testing).
2.
Elderly individuals naturally experience a decline in balance and muscle strength, making it difficult for them to be as active as younger individuals.
Rehabilitation assessment should be conducted after the acute symptoms have resolved.
3.
In older adults, it is advisable to avoid invasive treatments.
Current medical autonomy allows for advance directives, and it would be beneficial to consult with the hospital for guidance.

Reply Date: 2022/10/08

More Info

Supporting elderly recovery after illness is a multifaceted challenge that requires careful consideration of the individual's medical history, current health status, and the appropriate interventions to enhance their quality of life. In the case of your grandfather, who is 97 years old and has a complex medical history, there are several important factors to consider.

Firstly, it is crucial to address the acute symptoms he is experiencing, such as weakness in his legs, difficulty moving, and the recent fever. Given his age and history of liver cirrhosis, he is at a higher risk for complications from infections, including pneumonia, especially since he has been in close contact with someone who tested positive for COVID-19. The sudden onset of fever and weakness could indeed indicate an underlying infection, and it would be prudent to seek medical evaluation as soon as possible. A thorough examination, including blood tests and possibly imaging studies, can help identify any infections or other issues that may be contributing to his current state.

In terms of rehabilitation, it is essential to approach this carefully. After a period of illness and bed rest, elderly individuals often experience deconditioning, which can lead to significant weakness and mobility issues. While it is tempting to start rehabilitation exercises immediately, it is best to wait until his acute symptoms have stabilized and any underlying issues have been addressed. Once he is medically cleared, a structured rehabilitation program can be beneficial. This program should be tailored to his abilities and limitations, focusing on gentle exercises to improve strength, balance, and mobility.

Regarding the pain he is experiencing in his back, it is important to manage this effectively. If he has sustained a strain or injury while attempting to get out of bed, appropriate pain management is crucial. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be used, but it is advisable to consult with a healthcare provider before administering any medication, especially considering his age and medical history.

As for initiating rehabilitation exercises at home, it is advisable to start with very gentle movements that do not exacerbate his pain. Simple range-of-motion exercises can help maintain joint flexibility and prevent stiffness. However, it is essential to monitor his response to any activity and adjust accordingly. If he experiences increased pain or discomfort, it is best to stop and consult with a healthcare professional.

In addition to physical rehabilitation, consider the psychological and emotional aspects of recovery. Social interaction, mental stimulation, and emotional support are vital for elderly individuals, especially after a health crisis. Engaging him in conversations, encouraging him to participate in light activities, and ensuring he feels supported can significantly enhance his recovery process.

Lastly, it is important to maintain open communication with healthcare providers. Regular follow-ups can help monitor his progress and make necessary adjustments to his treatment plan. If his condition does not improve or worsens, do not hesitate to seek immediate medical attention.

In summary, supporting your grandfather's recovery involves a careful balance of medical evaluation, pain management, gradual rehabilitation, and emotional support. By addressing his acute symptoms first and then gradually introducing rehabilitation, you can help him regain his strength and improve his quality of life. Always consult with healthcare professionals for personalized advice and treatment options tailored to his specific needs.

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