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May 19, 2020

Recognizing Risk Factors and Symptoms of COVID in Older Adults

Right now, there are multiple cases of COVID-19 in all 50 states, and COVID-19 is highly contagious. Older adults need to think about not only their “risk for exposure” but also their “risk for severe illness” – but what do these terms mean exactly? Tune in to this week’s podcast to learn more.

“Our goal for this pandemic is to arrive on the other side of quarantine healthy, sane, and kind. Satisfaction = Experience - Expectations.”- Paul Ollinger, Forge, April 13, 2020


In this week's episode, you'll learn about:

  • What does “risk for exposure” and “risk for severe illness” actually mean?
  • What are the risk factors for COVID-19 in older adults?
  • How do you know if you have “multiple chronic conditions”? (also called chronic co-morbidities)
  • How symptoms of COVID-19 may show up differently in an older adult than a younger adult

Part One of ‘Recognizing Risk Factors and Symptoms of COVID in Older Adults’


  • What does “risk for exposure” and “risk for severe illness” actually mean?


Therefore, if you live in a community that has a higher number of cases, it can spread much more quickly and easily in your community and therefore increases the “risk for exposure”.  If you have cases of COVID in your community, that means the virus can be spread by people who have been infected by the virus (known as “community spread”) – and do not know where or how they became infected.  Also, a person may have COVID and not have symptoms or even know that they are sick. 

When we use the term “risk for severe illness”, this means that there is a greater risk of getting sick enough that you need to be hospitalized, have a greater risk of developing a complication, and/or have a greater risk of dying from COVID if you get the virus. Older adults (those aged 65 and older) have a greater risk of severe illness and the older you are, the risk increases.

In fact, case-fatality (death) rates for COVID-19 increases dramatically with age:

65 to 70 years old


75 to 85 years old 


Over 85 years old 



If you are 65 or older, you're at higher risk but not all older adults age in the same way. Unlike childhood that has developmental milestones we all meet (for example, babies crawl, then walk, then run). With aging, normal aging doesn't have a normal trajectory of decline; a lot of that depends on your lifestyle choices:

  • Did you eat right? 
  • Did you exercise? 
  • Did you smoke? 
  • Did you drink? 
  • Did you get enough sleep? 

All those things within our control when everybody does them a little bit differently. As people age, you need to consider age PLUS what other chronic conditions that person has when sizing up your risk for severe illness if you are infected with the virus.

“Only five to six percent of older adults ever live in a nursing home. Ninety-five percent of older adults are living in their homes in the community.” — Melissa Batchelor (03:33-03:37)


  • What are the risk factors for COVID-19 in older adults?


Age itself is not the only thing that puts you at risk. But knowing if you are 65 or older is easy enough to recognize as a factor that puts you at higher risk for serious illness – most of us know how old we are.

Living in a nursing home is another easily identified risk factor for serious illness. Older adults who do end up living in a nursing home are the frailest, most debilitated, and the majority of residents have multiple chronic conditions in this population. Age combined with these factors is why they are the highest risk population for not surviving this virus if they are exposed and infected.

But for anyone, at any age, what are the other things that can put you at a higher risk for experiencing serious illness if you are infected with COVID? Having one or more of these chronic conditions:

  • Chronic lung disease – such as emphysema or COPD
  • Asthma - or any lung disease that affects breathing
  • Heart disease – such as high cholesterol, high blood pressure, atrial fibrillation, history of a heart attack or a stroke
  • Body Mass Index of 40 or higher – Click here to calculate your BMI 
  • Immune system issues – if you are on chemotherapy or you have HIV AIDS; had a bone marrow or organ transplant
  • Liver disease – such as cirrhosis or hepatitis
  • Chronic kidney disease – including being on dialysis
  • Diabetes 

Some of these risk factors for people all ages are harder for people to get a handle on, to know who's at greater risk for serious illness. How would you know if you had multiple chronic conditions? Well, here's an easy way to figure that out.

Part Two of ‘Recognizing Risk Factors and Symptoms of COVID in Older Adults’


  • How do you know if you have “multiple chronic conditions”? (also called chronic co-morbidities)


Do you take more than two medications for two different things? If you take a pill for your thyroid and a pill for your blood pressure, then you have multiple chronic conditions. This is one of those things that a non-medical person often has the hardest time recognizing. This is the quickest way to know - look at what prescription medications you're taking. 

Over 50 percent of older adults take four or more medications. You look at your medication list and you need to know what that medication is for. And if you don't know those two things, you need to contact your health care provider to do medication reconciliation. Your health care provider can help “reconcile” your medications and/ or let you know if you don't need medication anymore. 

“Over 50 percent of older adults take four or more medications.” —  Melissa Batchelor (06:31-06:35)


  • How symptoms of COVID-19 may show up differently in an older adult than a younger adult


Since the middle of March, we've learned that there is a much more extensive range of symptoms, the primary symptoms such as fever, cough, and/or difficulty breathing. Other symptoms include muscle aches, a sore throat, and/or a new loss of being able to taste or smell. Any of these symptoms need to be reported to your provider. 

If you're taking care of an older adult, you need to understand that they may not have these symptoms. In geriatrics, it's called the atypical presentation of illness

Older adults may not have a fever; they may be more tired than usual, are can’t stay awake, or have new confusion. These things may be a syndrome that’s called hypoactive delirium - which is a medical emergency and needs to be reported to their health care provider. 


Other atypical symptoms of illness in an older adult are thing like someone who's sleeping too much or can’t go to sleep; if they're not eating like they used to or they're not drinking; if they all of a sudden become incontinent of their bowel or bladder – these are symptoms that you need to report to your health care provider. An older adult, particularly if they have dementia (e.g., Alzheimer’s disease), may not be able to tell us what's wrong with them. If that’s the case, pay attention to their behavior and if you feel like something is “off” (e.g. “Mama’s just not right today”) – contact your health care provider to figure out what's going on. 

The good news is the majority of people that get covered are going to survive. We need to continue to do all the things that we can do to keep our immune systems healthy, to reduce our risk of being exposed to this virus, and to take care of one another. 

About Melissa Batchelor

I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at