Management of COVID-19 Symptoms in an 80-Year-Old Man
For an 80-year-old COVID-19 positive man with cough and nasal congestion, the next step should be symptomatic management with paracetamol for fever if present, adequate hydration, and codeine linctus or codeine phosphate tablets to suppress distressing cough. 1
Initial Assessment and Management
- Recognize that 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 1
- 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
Managing Cough
- Encourage the patient to avoid lying on his back as this makes coughing ineffective 1
- Start with simple measures such as honey (if not contraindicated) 1
- For distressing cough, consider short-term use of:
- Codeine linctus
- Codeine phosphate tablets
- Morphine sulfate oral solution 1
Managing Nasal Congestion
- Over-the-counter medications used for common cold and flu symptoms can safely relieve similar symptoms in COVID-19 2
- Consider nasal decongestants while being mindful of potential side effects in elderly patients 2
Managing Breathlessness (if present or develops)
- Implement controlled breathing techniques:
- Proper positioning (sitting upright to increase ventilation)
- Pursed-lip breathing (inhale through nose, exhale slowly through pursed lips)
- 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
Monitoring for Disease Progression
- Closely monitor for signs of clinical deterioration, particularly in this high-risk age group 1
- Watch for development of shortness of breath, which may indicate progression to pneumonia 1, 3
- Establish a clear treatment escalation plan given the risk of rapid deterioration in elderly COVID-19 patients 1
Considerations for Severe Disease
- 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 1
- Always consider concomitant use of an antiemetic and a regular stimulant laxative when using opioids 1
Important Precautions
- Avoid nebulized therapies due to risk of aerosol generation and viral transmission 4
- If oxygen supplementation becomes necessary, be aware of the aerosol-generating potential of all devices 4
- Ensure appropriate isolation measures are in place to prevent transmission to caregivers 1
- Consider early hospital referral if symptoms worsen, particularly if the patient develops dyspnea or uncontrolled fever 3