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CONSIDER: ATYPICAL PRESENTATION

Overview/Definition

Because illness in older adults is complicated by physical changes of aging and by multiple medical problems, it is essential for nurses to recognize more commonly seen atypical presentations of illness in older adults. For example, subtle changes like a decrease in function or a diminished appetite very often are the first signs of illness in an older adult. This section provides specific information on the atypical presentation of illness in older adults.

Assessment/Screening Tools

Altered Presentation of Illness in Elderly Persons
Illness Atypical Presentation
Infectious diseases
  • Absence of fever
  • Sepsis without usual leukocytosis and fever
  • Falls, decreased appetite or fluid intake, confusion, change in functional status
"Silent" acute abdomen
  • Absence of symptoms (silent presentation)
  • Mild discomfort and constipation
  • Some tachypnea and possibly vague respiratory symptoms
"Silent" malignancy
  • Back pain secondary to metastases from slow growing breast masses
  • Silent masses of the bowel
"Silent" myocardial infarction
  • Absence of chest pain
  • Vague symptoms of fatigue, nausea and a decrease in functional status.
  • Classic presentation: shortness of breath more common complaint than chest pain
Non-dyspneic pulmonary edema
  • May not subjectively experience the classic symptoms such as paroxysmal nocturnal dyspnea or coughing
  • Typical onset is insidious with change in function, food or fluid intake, or confusion
Thyroid disease
  • Hyperthyroidism presenting as "apathetic thyrotoxicosis," i.e. fatigue and a slowing down
  • Hypothyroidism presenting with confusion and agitation
Depression
  • Lack of sadness
  • Somatic complaints, such as appetite changes, vague GI symptoms, constipation, and sleep disturbances
  • Hyper activity
  • Sadness misinterpreted by provider as normal consequence of aging
  • Medical problems that mask depression
Medical illness that presents as depression
  • Hypo- and hyper- thyroid disease that presents as diminished energy and apathy

 

For more detailed information please see "Want to Know More" section of this topic.

Last updated - January 2005