Heart failure symptoms in older adults

An older person may not describe breathlessness clearly. They might stop walking as far, sleep sitting more upright, avoid stairs, eat less, or need more help with washing and dressing. Fluid build-up can cause swollen feet or ankles and a cough, while reduced circulation can cause fatigue or weakness. New confusion, restlessness, or a fall can sometimes accompany illness and should not be dismissed as normal ageing.

Several conditions can look similar, including infection, anaemia, lung disease, medicine effects, or an irregular rhythm such as atrial fibrillation. A clinician needs the person's usual abilities, symptom timing, medicine list, and examination to identify the cause.

Compare current function with the person's usual routine and write down changes in walking, sleep position, appetite, swelling, cough, and alertness. Check that prescribed medicines are taken as directed, but do not alter doses without advice. Arrange prompt medical review for a new decline, especially after an infection or medicine change. Bring hearing aids, glasses, and a complete medicine list to the appointment so the assessment is easier.

Call emergency services for severe breathlessness, chest pressure, fainting, sudden confusion, blue or grey lips, or a sudden inability to stand or speak normally. New weakness on one side, facial drooping, or difficulty speaking is also an emergency. Do not leave a very unwell older person alone while waiting for help.

Ask how to distinguish the person's usual tiredness from a meaningful decline, which symptoms require same-day advice, how medicines should be supervised, and whether a chronic disease review would improve the monitoring plan.