Pulse oximeters are more useful screening methods for COVID-19 in older adults compared to temperature measurement.

Fever is considered a classic presentation of COVID-19. However, a new research from the College of Nursing, Washington State University, suggests that since older adults have a lower core body temperature (less than 98.6°F or even as low as 94°F), the standard definition of fever (≥100.4°F) may be a less useful indicator of infection in this population group. The study says, “Lower baseline temperatures may result in overlooking fevers. In fact, upwards of 30% of older adults with serious infections show a mild or no fever.”

In addition, COVID-19 symptoms such as fatigue, body ache, weakness, increasing loss of taste and smell may well be attributed to aging. Atypical symptoms are more often seen in older adults, which could be in the form of change in cognitive status or mobility. There is a delay in fever and respiratory symptoms.

The study cautions healthcare providers to look out for any fall in SpO2 (3–5%) after mild activity/ambulation, room air, and the presence of hypoxemia without tachypnea. This can be done in homes using a small, portable and an economical device, the pulse oximeter.

The authors recommend that pulse oximeters should be considered to screen for asymptomatic hypoxia in older adults, given their potential efficacy for detecting changes in SpO2.

Since the absence of fever does not always rule out the presence of an infection, screening for “silent hypoxia” with pulse oximeters could help identify older adults with COVID-19 pneumonia.

(Source: Frontiers in Medicine, April 14, 2021)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA