If your elderly parent has tested positive for COVID-19, the most important first steps are contacting their doctor about antiviral treatment within the first few days of symptoms and watching closely for emergency warning signs like confusion, trouble breathing, or oxygen levels dropping below 95%. Most older adults can recover safely at home with the right support, but the window for starting treatment that prevents hospitalization is narrow, so acting quickly matters more than anything else.
Call Their Doctor About Antivirals Right Away
Antiviral treatment works best when started early in the illness, ideally within the first five days of symptoms. Adults 65 and older qualify for treatment because age alone is a risk factor for severe COVID. The goal of these medications is to keep a mild or moderate case from becoming a hospitalization. If your parent’s symptoms are still manageable and they aren’t already sick enough to need the ER, they’re a candidate.
The catch is that antiviral medications interact with many drugs commonly prescribed to older adults. Certain cholesterol-lowering statins, including lovastatin and simvastatin, need to be stopped at least 12 hours before starting treatment and held for five days after finishing it. Atorvastatin should also be temporarily paused. Blood thinners are another concern: rivaroxaban should be avoided entirely during treatment, and warfarin requires close monitoring. If your parent takes apixaban or dabigatran, their doctor will need to adjust the dose or stop it depending on the situation.
This is why the very first call should go to your parent’s primary care provider or a telehealth service that can prescribe antivirals. Have a full list of their current medications ready. The doctor needs that list to determine which antiviral is safe or whether any of their regular medications need to be paused. Don’t wait to see if symptoms get worse. By the time they do, the treatment window may have closed.
Watch for Emergency Warning Signs
Most of the time, COVID in older adults looks like a bad cold or flu. But certain symptoms signal that the body is in trouble and needs emergency care. The CDC lists these as emergency warning signs:
- Trouble breathing (not just congestion, but visible effort to get air)
- Persistent pain or pressure in the chest
- New confusion or sudden difficulty thinking clearly
- Inability to wake up or stay awake
- Pale, gray, or blue color in the lips, nail beds, or skin
If you see any of these, call 911 and tell the dispatcher your parent has or may have COVID-19. Don’t drive them yourself unless there’s no other option, because paramedics can begin treatment on the way.
Confusion Can Be the Only Symptom
One of the trickiest things about COVID in elderly patients is that it sometimes shows up as confusion rather than cough or fever. Research published in Cognitive and Behavioral Neurology found that 9% of COVID patients with delirium had confusion as their only presenting symptom, with no respiratory symptoms at all. The most common form was hypoactive delirium, seen in 62% of cases. That means your parent may not be agitated or obviously distressed. Instead, they might seem unusually drowsy, withdrawn, or “just not themselves.” About 29% showed agitation, and a small number experienced hallucinations.
If your parent has baseline dementia, this can be especially hard to spot. The key difference is that delirium represents an acute change, a noticeable shift from their usual behavior over hours or a day or two. If they’re suddenly more confused than their normal baseline, that’s a red flag worth a call to their doctor or a trip to the ER.
Monitor Oxygen Levels at Home
A pulse oximeter is one of the most useful tools you can have during this time. It clips onto a finger and reads blood oxygen saturation. A normal reading is 95% or higher. Some people with chronic lung conditions may normally sit around 90%, but if you don’t know your parent’s baseline, treat anything below 95% as a reason to call their healthcare provider.
Check readings two to three times a day, and more often if symptoms seem to be worsening. Keep in mind that oxygen levels can drop before a person feels noticeably short of breath. If your parent is breathing faster than usual, feels too sick to get out of bed, or seems winded doing things they normally handle easily, call their doctor even if the oximeter reads normal. The device isn’t perfect, especially if fingers are cold or circulation is poor.
Keep Them Hydrated and Comfortable
Fever, sweating, and reduced appetite can quickly lead to dehydration in older adults, and dehydration makes everything worse. General guidelines recommend about 1.6 liters (roughly 54 ounces) of daily fluid intake for women and 2.0 liters (about 68 ounces) for men, not counting water from food. During a fever, the body loses more fluid than usual, so aim for the higher end or above.
Water is fine, but if your parent isn’t eating much, drinks with some electrolytes and calories are better. Broth, diluted juice, oral rehydration solutions, and even popsicles all count. Small, frequent sips work better than trying to drink a full glass at once, especially if nausea is an issue. Watch for signs of dehydration: dark urine, dry mouth, dizziness when standing, and reduced urination. These warrant a call to the doctor because severe dehydration in an older adult can spiral quickly.
For fever and body aches, acetaminophen (Tylenol) is the most commonly recommended option. Stick to the dosing instructions on the package and be careful about overlap. Many combination cold medicines already contain acetaminophen, so check every label to avoid doubling up.
Watch for Pneumonia and Worsening Symptoms
The typical trajectory of COVID is that symptoms peak around days five through seven and then gradually improve. If your parent is getting worse after the first week instead of better, that’s concerning. The biggest risk is pneumonia, either from the virus itself or from a secondary bacterial infection.
Aspiration pneumonia is a particular concern in elderly patients. Research in the Journal of the American Geriatrics Society found that aspiration pneumonia cases surged from 4% to 41% among older COVID patients during certain pandemic periods. This type of pneumonia happens when food, liquid, or saliva enters the lungs instead of the stomach, and it’s more common in people with swallowing difficulties. If your parent has a history of swallowing problems, stroke, or Parkinson’s disease, watch for a worsening cough, new fever after initial improvement, or increased difficulty breathing.
Even with milder variants, severe complications including an overactive immune response can still occur in people with underlying health conditions or weakened immune systems. A pattern to watch for: your parent seems to be improving, then suddenly gets worse. A new fever, increasing shortness of breath, or a sharp decline in energy after a few days of stability all warrant an immediate call to their doctor.
Protect Yourself While Caregiving
You can’t help your parent if you get sick too, so take precautions seriously. An N95 respirator provides the best protection available for home use. Regular cloth masks are not sufficient for close caregiving contact. If N95s aren’t available, a well-fitting KN95 or a mask meeting ASTM F3502-21 standards (sometimes labeled “Workplace Performance”) is the next best option.
Ideally, your parent should stay in a separate room with the door closed and use a separate bathroom if one is available. Open windows in their room when weather permits, or run a portable air purifier with a HEPA filter. When you enter their room to bring food, check vitals, or help with care, wear your respirator. Wash your hands thoroughly before and after every interaction. If you’re sharing a bathroom, clean high-touch surfaces after each use.
Keep the sick room well-ventilated. Even cracking a window a few inches creates airflow that reduces the concentration of virus in the room. If your home has a central HVAC system, running the fan continuously (not just when heating or cooling) helps cycle air through the filter more frequently.
Create a Simple Daily Checklist
When you’re managing care for a sick parent, it helps to track things consistently so you can spot trends. A few times a day, check and note:
- Temperature: Is fever staying stable, improving, or climbing?
- Oxygen saturation: Is it holding above 95%?
- Fluid intake: Have they had enough to drink today?
- Mental status: Are they alert and oriented at their usual baseline?
- Breathing: Is their breathing rate or effort increasing?
Writing these down gives you something concrete to share with their doctor during a phone call or telehealth visit. It also helps you notice gradual changes you might miss in the moment. A slow downward trend over 24 to 48 hours can be just as important as a sudden crisis.