Monitoring an Older Adult During an Acute Illness at Home

First decide: can this be managed at home?

Illness at home is reasonable to monitor when:

• Your parent is alert, knows who and where they are and speaks normally for them.
• Breathing is comfortable.
• They can drink and keep fluids down.
• They are passing urine.
• Temperature is not very high and symptoms are mild to moderate.
• A doctor knows about the illness and has advised home care, or you have called for advice.
• A capable adult can stay with them and check regularly.

Call a doctor early rather than late. In older people, the first sign of serious infection may be confusion, a fall or refusing food, not a high fever. See fever in older adults: why it can be subtle and when to call.

What to measure

Gather your devices and a notebook. Set up a simple chart with times down the side and the columns below. A single set of checks every four to six hours is a usual pattern while awake, with extra checks if the person worsens or the doctor advises. Do not disturb sleep for checks unless the doctor asks or you are worried.

1. Temperature. Use a digital thermometer by the same method each time and record the method. See digital thermometers: choosing and using them for older people. Note fever (about 38.0 degrees Celsius or above), but also low readings (below about 36 degrees Celsius in a person whose usual is higher, or below about 35 degrees Celsius) and shivering.

2. Pulse. Count at the wrist for 30 seconds and double it, or use a monitor or oximeter. Rest rates above about 100, below about 50 (if not usual), or irregular patterns are worth reporting. Fever, dehydration, pain and infection all raise pulse.

3. Breathing rate. Count breaths for a full minute while your parent rests, without telling them. About 12 to 20 per minute is typical; above 20 to 24 is a concern. Note effort, speaking in short phrases, wheeze or noisy breathing.

4. Oxygen saturation. If you have an oximeter and a doctor has advised, check on a warm, still finger without nail polish. About 95 per cent or higher at rest is typical; lower than usual, or below about 94 per cent that is new and persistent, should be reported; below about 90 per cent needs urgent help. Remember its limits; see pulse oximeters: how they work and how to use one, pulse oximeter accuracy and when oxygen saturation is low.

5. Blood pressure. Sitting, rested, correct cuff. Very low readings (for example, a systolic below about 90 or well below usual) with dizziness, a fast pulse or cold skin are concerning. In illness, blood pressure often falls, and the doctor may temporarily review medicines; do not stop any yourself. See how to measure blood pressure at home accurately.

6. Blood sugar. For people with diabetes, check more often during illness, as the doctor advised, since infection and poor eating cause swings; see how to test blood sugar at home step by step and diabetes and low-sugar emergencies. Do not skip checks if the person is not eating.

7. Alertness and behaviour. Is your parent their usual self? Can they answer questions, recognise family, stay awake and follow a conversation? Any new confusion, agitation or drowsiness is a red flag; see delirium in older adults.

8. Fluids in and out. Record what they drink and how often they pass urine, and the colour. Aim for regular small sips unless the doctor has restricted fluids. Dark, scanty or no urine over six to eight hours suggests dehydration.

9. Food and medicines. Note what they eat and which medicines have been taken, vomited or missed.

10. Other symptoms. Cough, pain, diarrhoea, vomiting, rash, burning urine, swelling, wounds, headaches, stiff neck, new weakness.

A simple chart

For each check, write: date and time; temperature and method; pulse; breaths per minute; oxygen if used; blood pressure; sugar if relevant; alertness (usual, a bit drowsy, confused, hard to wake); fluids and urine; medicines; notes. Photograph it for a phone or video consultation; see using home readings in a teleconsultation.

Hospitals use early warning scores, such as the National Early Warning Score (NEWS2), that combine breathing rate, oxygen, blood pressure, pulse, temperature and alertness into one number. Your chart collects the same information, which the doctor can use. Do not try to score it yourself; just record carefully.

Caring for the person

• Fluids: offer small, frequent sips of water, oral rehydration solution, soup or diluted juice, unless the doctor has limited fluids because of heart or kidney problems.
• Food: offer small, easy meals as tolerated; do not force.
• Rest and comfort: keep the room comfortable; avoid heavy blankets in fever, and keep warm if cold.
• Position: sit up for coughing or breathlessness; lie on the side if nauseous.
• Medicines: continue regular medicines unless the doctor says otherwise. Ask the doctor or pharmacist before giving any fever or pain medicine, and check that products do not duplicate ingredients. Some regular medicines, such as water tablets, certain blood pressure medicines, some diabetes tablets and painkillers, may need a temporary adjustment during dehydrating illness; this is the doctor's decision.
• Hygiene: wash hands, keep the area clean, and use masks or isolation if the illness is infectious and others are vulnerable.
• Safety: watch for falls; help to the toilet; keep a light on at night. See falls risk assessment at home.
• Do not leave a very sick or confused person alone.

Red flags: seek urgent help

Call 112 or go to hospital now for:

• Severe breathlessness, fast breathing, blue or grey lips.
• Chest pain, collapse or fainting.
• Very drowsy, hard to wake, new confusion or fits.
• Cold, clammy, mottled or very pale skin.
• Very fast or very slow pulse with weakness.
• Stiff neck with fever or headache, or a rash that does not fade when pressed.
• Not passing urine for many hours with illness.
• Very low or very high temperature with other worrying signs.
• Persistent vomiting with inability to keep fluids down, blood in vomit or stools.
• Severe abdominal pain.
• Any time you feel the person is seriously ill.

Sepsis, a life-threatening reaction to infection, can look like several of these. Guidelines such as NICE NG51 emphasise early recognition and quick treatment.

Call the doctor the same day for:

• Fever of 38.0 degrees Celsius or above.
• Worsening cough, breathlessness or chest pain.
• Burning urine, back or flank pain, or new incontinence.
• Poor drinking or eating for more than a day, or dizziness.
• Diarrhoea or vomiting lasting more than a day, particularly in someone on heart, kidney or diabetes medicines.
• Blood sugar outside the agreed range.
• No improvement within 24 to 48 hours of the first symptoms, or any worsening.
• A wound that looks red, swollen or smelly.

Illnesses that need special care

• Chest infection or pneumonia: breathing rate and oxygen matter; see pneumonia in older adults: prevention and recovery.
• Urinary infection: often causes confusion in older adults without burning.
• Diarrhoea and vomiting: dehydration and kidney strain are risks.
• Heart failure, kidney disease or diabetes: illness can quickly upset balance; follow condition-specific plans. See home monitoring in chronic kidney disease and daily weights in heart failure.
• Dementia: the person may not be able to report symptoms; look for behaviour changes.
• Heat illness: in hot weather, high temperature with confusion needs urgent cooling and help.

Preparing for a phone call or ambulance

Keep ready: the chart, medicine list, allergies, diagnoses, doctor's number and discharge summaries; see keeping a health record at home. Say clearly: age, main problem, how long, the latest readings, how alert the person is, and what you are worried about. Ask the doctor what warning signs to watch and when to call back. Unlock doors and arrange for someone to guide the ambulance.

Looking after the caregiver

Caring for a sick parent is tiring. Share night checks, rest when you can, eat and drink, and ask for help from family, neighbours or a nurse. Do not hesitate to seek medical help because you fear overreacting.

Indian practicalities

• Keep devices in a cool dry box; check batteries before they are needed.
• Know the nearest hospital and its emergency number, and a transport plan, especially at night or during rains.
• During heat waves and power cuts, keep rooms cool, offer fluids and watch for dehydration.
• Keep oral rehydration salts in the home, prepared according to the packet instructions.
• Ask the family doctor whether a home nursing service or teleconsultation is available.

When to ask a professional

Contact the doctor early in any acute illness, share the chart, ask what to monitor and how often, and ask for clear thresholds for calling back or going to hospital. A doctor or nurse can advise on fluids, food and medicines. Call 112 for severe or rapidly worsening symptoms.