Causes of epistaxis in older adults

The lining of the nose can become fragile with age and dry indoor air. Nose picking, forceful blowing, nasal sprays or minor trauma may open a small vessel. Allergic rhinitis, a common cold or sinusitis can cause inflammation and repeated blowing. Hypertension may need review, although a nosebleed itself does not show what caused it. Blood-thinning medicines and some supplements can make bleeding harder to stop; never stop a prescribed medicine without advice. A nosebleed can be anterior or come from deeper in the nose, which is harder to control.

Sit upright, lean forward and pinch the soft part of the nose continuously while breathing through your mouth. Spit out blood rather than swallowing it. After bleeding stops, avoid nose blowing, picking, heavy lifting and hot drinks for a while. A clinician or pharmacist can advise on safe moisture measures and review medicines or blood pressure.

Get urgent help if bleeding is heavy, follows a significant injury, causes weakness or breathing difficulty, or does not stop with firm pressure. Seek prompt assessment for repeated episodes, bleeding from both nostrils, easy bruising, black stools, or use of anticoagulants. Call emergency services if the person becomes faint, confused or difficult to wake.

Ask whether dryness, rhinitis, sinusitis, blood pressure or a medicine could be contributing; how to protect the nasal lining; and whether an ear, nose and throat review is needed.