Management of COVID-19 Symptoms in Older Adults

Initial Assessment and Management

For an 80-year-old COVID-19 positive individual with cough and nasal congestion, symptomatic management with paracetamol for fever if present, adequate hydration, and codeine linctus or codeine phosphate tablets to suppress distressing cough is recommended, as older patients with comorbidities are at higher risk for developing severe pneumonia, which could lead to respiratory failure and death 1
Monitor for fever, which is typically most common around five days after exposure to COVID-19, and advise adequate fluid intake (no more than 2 liters per day) to avoid dehydration 1
Use paracetamol for fever and other symptoms rather than NSAIDs until more evidence is available 1

Encourage the patient to avoid lying on their back as this makes coughing ineffective, and start with simple measures such as honey (if not contraindicated) 2
For distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1, 2

Implement controlled breathing techniques, including proper positioning (sitting upright to increase ventilation), pursed-lip breathing (inhale through nose, exhale slowly through pursed lips), and leaning forward with arms bracing a chair to improve ventilatory capacity 1
Be aware that breathlessness can cause anxiety, which can further worsen breathlessness 1

Closely monitor for signs of clinical deterioration, particularly in high-risk age groups, and watch for development of shortness of breath, which may indicate progression to pneumonia 3
Establish a clear treatment escalation plan given the risk of rapid deterioration in elderly COVID-19 patients 2

If the patient develops moderate to severe breathlessness and is approaching end-of-life care, consider morphine sulfate with appropriate dosing based on prior opioid exposure 1
For opioid-naive patients able to swallow, morphine sulfate immediate-release 2.5-5 mg every 2-4 hours as required, and always consider concomitant use of an antiemetic and a regular stimulant laxative when using opioids 1

Ensure appropriate isolation measures are in place to prevent transmission to caregivers 3