Vital Signs: Normal Ranges for Older Adults

How to use a range

A range is a starting point for conversation. Three ideas help:

• Know your parent's usual. A person whose blood pressure is always 110/70 and who reads 140/90 has changed more than one who always reads 140/90. Record readings when well; see keeping a health record at home.
• Look at trends, not single numbers. A few days of readings tell more than one.
• Look at the person. A normal number with new confusion or breathlessness is not reassuring, and an unusual number in someone who looks and feels well may be a measurement error.

Also remember that measurement technique changes the numbers. Poor posture, a wrong cuff, cold fingers, a full bladder or rushing can all shift them.

Blood pressure

Blood pressure is written as systolic over diastolic, in millimetres of mercury (mmHg). General ranges often used for adults:

• Optimal or normal in clinic: roughly below 120/80 up to about 129/84, depending on the guideline.
• Raised or high-normal: about 130 to 139 over 85 to 89.
• High (hypertension): clinic readings of 140/90 or above on repeated measurement, or home averages of about 135/85 or above, according to guidelines such as NICE NG136.
• Very high: 180/120 or above needs urgent attention, especially with symptoms.
• Low: below about 90 systolic, particularly with dizziness, fainting or weakness.

For older adults, targets are individual. Guidelines often suggest an aim of under about 140/90 in clinic (or under about 135/85 at home) for people over 80, and a lower aim for younger or fitter people, but frail older adults or those who faint on standing may have more relaxed targets. Check your parent's own number with their doctor.

Standing drop. A fall of 20 mmHg or more in systolic blood pressure within three minutes of standing is called orthostatic hypotension; see dizziness when standing. For technique, see how to measure blood pressure at home accurately.

Pulse (heart rate)

• Resting pulse in adults: about 60 to 100 beats per minute.
• Many fit older adults, and people on medicines such as beta-blockers, have lower rates, often in the 50s, and are well. A slow pulse with dizziness, fainting, breathlessness or chest pain is a reason to call.
• A resting pulse persistently above about 100, or sudden palpitations, needs review.
• An irregular pulse, particularly if new, should be mentioned to the doctor. Atrial fibrillation becomes more common with age.

Take the pulse at rest, after sitting for five minutes. Count beats at the wrist for 30 seconds and double, or use a monitor.

Breathing rate

• Normal at rest: about 12 to 20 breaths per minute in adults.
• Above 20 to 24 at rest, or increased effort, may indicate infection, lung or heart problems and should prompt a call.

Count breaths for a full minute without telling the person, as awareness changes the rate. Watch for breathlessness at rest, speaking in short phrases or using shoulder muscles.

Temperature

• Typical oral temperature: about 36.1 to 37.2 degrees Celsius (97 to 99 degrees Fahrenheit).
• Older adults often run lower, so a reading of 37.5 may be a meaningful rise.
• Fever is commonly 38.0 degrees Celsius or above, but may be absent in serious infection in older people.
• Low temperature below about 35 degrees Celsius with cold, drowsiness or confusion needs urgent attention.

Armpit readings are usually lower than oral ones. See digital thermometers and fever in older adults.

Oxygen saturation

• Typical at rest in healthy adults: about 95 to 100 per cent.
• 94 per cent or lower that is new and persistent deserves a call to the doctor.
• Below about 90 per cent needs urgent medical advice.
• People with long-term lung disease may have lower usual levels, such as 88 to 92 per cent, and a doctor-set target.

Cold fingers, nail polish and other factors cause errors; see pulse oximeters: how they work and how to use one, pulse oximeter accuracy and when oxygen saturation is low.

Blood sugar

Commonly published adult figures:

• Fasting, without diabetes: about 70 to 99 mg/dL (3.9 to 5.5 mmol/L).
• Prediabetes: fasting about 100 to 125 mg/dL, diagnosed by lab tests.
• Diabetes: fasting 126 mg/dL or higher on repeated lab tests, or other criteria.
• Two hours after a meal, without diabetes: usually below about 140 mg/dL.
• For many adults with diabetes: fasting or pre-meal targets of about 80 to 130 mg/dL and under about 180 mg/dL two hours after meals, with more relaxed targets for frail older adults.
• Low blood sugar: below about 70 mg/dL needs treatment; see low blood sugar in older adults.

A home meter does not diagnose diabetes. See fasting and post-meal sugar readings.

Weight and body mass index

BMI is weight in kilograms divided by height in metres squared. Common international categories for adults are 18.5 to 24.9 as healthy, 25 to 29.9 as overweight and 30 or more as obese. Several Indian and Asian guidelines use lower cut-offs because health risks occur at lower BMI in South Asians; for example, 23 and above may be considered overweight in some Asian guidance. In older adults, a BMI below about 22 to 23 may signal a risk of undernutrition, and unplanned weight loss matters more than the number. See weighing scales and unplanned weight loss in older adults. In heart failure, sudden gains of a kilogram or two over days suggest fluid; see daily weights in heart failure.

Other useful signs

• Urine: passing urine several times a day, pale to straw coloured, without pain. Very dark, very scanty or foul-smelling urine, or none for many hours, should be reported.
• Alertness: usual orientation and attention. New confusion is always a concern; see delirium in older adults.
• Skin: warm, dry or normal; cold, clammy, very pale or blue is concerning.
• Pain, appetite, sleep, mood.

A simple summary table in words

For a calm, well older adult at rest, the commonly cited orientation is:

• Blood pressure: about 110 to 140 systolic and 60 to 90 diastolic, with individual targets set by the doctor.
• Pulse: about 60 to 100, with lower rates common in some healthy people and those on certain medicines.
• Breathing: 12 to 20 per minute.
• Temperature: about 36 to 37.2 degrees Celsius.
• Oxygen saturation: 95 per cent or higher, unless the doctor says otherwise.
• Fasting blood sugar: 70 to 99 mg/dL without diabetes; the doctor sets the range with diabetes.

Hospitals often use early warning scores that combine these signs, such as the NEWS2 score developed by the Royal College of Physicians, because a combination of mildly abnormal signs can matter more than one. See monitoring an older adult during an acute illness at home.

Why ranges differ for older adults

• Arteries stiffen, so systolic blood pressure tends to rise and diastolic may fall.
• Blood pressure varies more, with meals, posture and time of day.
• Heart rate response to stress and illness is blunted, and medicines alter pulse.
• Fever response is weaker.
• Lung capacity falls, and oxygen levels may be a little lower.
• Kidney function changes how medicines and fluids are handled.
• Muscle mass falls and weight may mislead.
• Chronic illnesses and medicines shift usual values.
• Frailty may call for more relaxed targets, to avoid harm from over-treatment.

See frailty in older adults.

When numbers need a call

Call the doctor the same day if:

• Blood pressure is persistently above or below the targets set by the doctor.
• Pulse is very slow, very fast or newly irregular with symptoms.
• Temperature is 38.0 degrees Celsius or above, or low with symptoms.
• Oxygen saturation is lower than usual.
• Blood sugar is outside the agreed range.
• Weight changes quickly or steadily.
• Symptoms change, even with normal numbers.

Call 112 for chest pain, severe breathlessness, blue lips, fainting, stroke signs (face drooping, arm weakness, speech difficulty), a very low blood sugar with drowsiness, or sudden severe confusion.

Using ranges with calm

Numbers can make families anxious. Remember that a single outlier is common, that the doctor's targets may differ from those on a chart, and that your own observations of the person matter. Avoid comparing your parent with others. Use the log to show the doctor the pattern.

When to ask a professional

Ask your parent's doctor for personalised targets for blood pressure, sugar, weight, oxygen and pulse, and for the numbers at which to call. Write them at the front of the log. Ask for a review if home readings differ from clinic readings. Ask a pharmacist how medicines affect pulse, blood pressure and sugar. Do not stop or adjust medicines yourself.