What are the normal values for geriatric vital signs, including heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature?

Normal Values for Geriatric Vital Signs

Traditional "normal" vital sign ranges are unreliable in geriatric patients and require age-adjusted thresholds, with critical values being heart rate >90 bpm and systolic blood pressure <110 mmHg for patients ≥65 years. 1

Age-Adjusted Vital Sign Thresholds for Geriatric Trauma and Emergency Assessment

Heart Rate

• Critical threshold: >90 beats/min (compared to >130 bpm in younger adults) 1, 2
• Mortality increases considerably in elderly patients when heart rate exceeds 90 bpm, particularly in geriatric males 1, 2
• This represents a significantly lower threshold than the traditional tachycardia definition of >100 bpm used in younger populations 1

Blood Pressure

• Critical systolic threshold: <110 mm Hg (compared to <90 mm Hg in younger adults) 1, 2
• Elderly patients frequently have baseline higher blood pressure, making "normal" readings potentially represent relative hypotension 1
• For stable geriatric patients without acute trauma, target blood pressure ranges are:
  • Systolic: 120-139 mm Hg (with 130-139 mm Hg for those >80 years or with frailty) 3, 4, 5
  • Diastolic: 70-79 mm Hg (target <80 mm Hg) 3, 4

Respiratory Rate

• Normal range: 5-40 breaths/min for initiating rehabilitation 1
• Critical threshold: >24 breaths/min indicates clinical instability 1
• Stop mobilization if respiratory rate falls below 5 or exceeds 40 breaths/min 1

Oxygen Saturation

• Normal range for elderly (>64 years): 95.8% ± 2.7% (mean ± SD) 1
• Two standard deviation range: 92.7-98.3% for seated adults >64 years 1
• Critical threshold: <90% or PaO₂ <60 mm Hg indicates need for oxygen therapy 1
• Target maintenance: SpO₂ ≥92% with PaO₂ ≥8 kPa 1
• Mean PaO₂ for elderly >64 years: 11.89 kPa (89 mm Hg) with range 9.02-14.76 kPa 1

Temperature

• Normal threshold: <37.8°C 1
• Fever definition: >38°C 1
• Critical for discharge assessment: temperature >37.8°C indicates clinical instability 1

Critical Clinical Context

Why Traditional Vital Signs Fail in Geriatric Patients

Elderly patients with trauma may have chronic occult hypoperfusion, making "normal" initial vital signs unreliable. 1 This occurs because:

• Baseline physiologic differences alter expected responses to injury 1
• Medications (beta-blockers, antihypertensives) obscure normal physiologic responses 1
• Chronic conditions create different baseline values 1

Alternative Markers for Geriatric Assessment

When vital signs appear "normal" but clinical concern persists, use:

• Serum lactate levels as predictor of occult hypoperfusion 1
• Base deficit assessment (serial measurements recommended) 1
• Mental status changes (even with normal vital signs) 1

Clinical Stability Criteria for Geriatric Patients

A geriatric patient is considered clinically stable when ALL of the following are met:

• Temperature ≤37.8°C 1
• Heart rate ≤100 beats/min 1
• Respiratory rate ≤24 breaths/min 1
• Systolic blood pressure ≥90 mm Hg 1
• Oxygen saturation ≥90% or PaO₂ ≥60 mm Hg on room air 1
• Ability to maintain oral intake 1
• Normal mental status 1

However, for trauma triage in geriatric patients specifically, use the more sensitive thresholds of HR >90 bpm and SBP <110 mm Hg to avoid under-triage. 1, 2

Common Pitfalls

• Assuming "normal" vital signs rule out serious pathology in elderly patients - they do not 1, 2
• Using younger adult thresholds for triage decisions - this leads to under-triage and increased mortality 1
• Failing to obtain baseline vital signs and lactate/base deficit early - these are essential for detecting occult shock 1
• Not accounting for medication effects (particularly beta-blockers preventing tachycardia response) 1