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Understanding monitoring and vital sign ranges for older adults
Vital signs are named so for good reason; they are some of the most important factors medical professionals take into account when predicting the health of anyone based on their bodily functions, and especially so for older adults. Here, we are taking a look at what these are, what vital sign monitoring does, how it is done, why vital signs are so important for older people, what the ‘normal’ ranges are and how to know if there is a problem, how vital signs change over time, and how a home carer can support you in monitoring vital signs and alerting medical professionals of any potential issues.
At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about vital sign monitoring, we can help
What are vital signs and why are they important?
Vital signsare important measurements taken of key physiological functions within the body that indicate a person’s overall health status. Four main vital signs are taken into account:
- Body temperature – This is the internal temperature of a person’s body, which can be an indicator of general illness, infection, or a more serious condition
- Pulse rate – A person’s pulse rate is the number of times their heart beats per minute, which can give a clearer idea of how their heart is functioning
- Blood pressure – Another indicator of heart function is blood pressure, which refers to the pressure of circulating blood against blood vessel walls
- Respiratory rate – This is a sign of how fast and well a person is breathing, and can show the need for swift intervention if someone is not breathing in enough oxygen
- Blood oxygen saturation – This measures the percentage of oxygen in a person’s blood, and can be found using pulse oximetry, a non-invasive monitoring technique that shines light at specific wavelengths through tissue, usually in the fingernail
What is vital sign monitoring?
All four of the above vital signs are crucial to a person’s health, and offer valuable insights into how their body is functioning. In many cases, the first thing a healthcare professional will do is assess a person’s vital signs and continue to monitor any changes.
Usually vital sign monitoring involves tasks like recording blood pressure, oxygen saturation levels, pulse rate, respiration rate, temperature and more. This will be done by a healthcare assistant if a person is situated in a nursing home or hospital, but can also be done by a family caregiver at home, or by a visiting home carer.
If a person is in hospital, their vital signs will often be monitored continuously for real-time data so interventions can be made immediately if needed. In non-urgent cases, vital signs may be taken on a semi-regular basis and any changes recorded over time to give an overall picture of whether someone’s health is declining or they are getting better.
How are vital signs monitored in older adults?
In older adults,vital signsmay be monitored more frequently as age-related changes and comorbidities often create more fluctuations. Nowadays, this is often done usingelectronic equipment, virtual ward systems, or non-invasive methods such as wireless sensors.
For each vital sign, there will be a different method of data collection. For example:
Temperature
Temperature varies from person to person. This is usually measured using a tympanic thermometer inside of the ear, but it can also be measured with other types of thermometer orally (under the tongue) or in the armpit. This should be checked regularly in order to spot any problems early; if it is too high, the person may have an infection or another issue, or if it is too low, the person may have a health condition such as hypothermia.
Pulse Rate
Pulse rate can be taken using the wrist in some cases, but medical professionals typically assess this at the artery in the neck. You may hear it referred to as heart rate instead of pulse rate, but in any case, this can be checked by pressing two fingers against the side of the neck just under the jawline.
You can set a timer for 30 seconds, and monitor both the rate of the pulse and the rhythm, which is especially important in older adults as this could indicate any heart issues such as atrial fibrillation. It is important to know that pulse rate can be influenced by a number of elements, such as how the person is feeling, any physical activity they have recently undertaken, the medication they take, and more.
Blood Pressure
Blood pressure monitoring is important for detecting conditions like hypertension and more. Using a reliable blood pressure monitor cuff – which looks like a strap that sits around the upper arm and is inflated by a qualified healthcare professional – you can tell what the person’s blood pressure is and any fluctuations that could be cause for concern.
Respiratory Rate
Respiratory rate is likely the simplest vital sign to check, as most people can see this visually; if the person’s chest or abdomen is rising up and sinking down again, they are breathing. Look out for chest or abdomen movement, feel the person’s chest, and count how many breaths the person takes within one minute. Like other vital signs, this too can be affected by things like illness, stress and more.
Regular monitoring in older adults can help with the early detection of health issues. Have the appropriate equipment handy for the above checks, create a regular routine, take care and time to measure accurate readings of each vital sign, and ensure the person’s environment is stress-free and calming so it does not impact results.
While some of these can be monitored by family caregivers at home, and other care organisations or individuals may offer these services, remember that vital sign monitoring is an important element of healthcare for someone with particular needs, such as an older adult. This should always be done with the permission of the doctor in charge of the person’s care, in accordance with the Care Plan they have put together, to make sure it is done regularly and accurately. If you have any concerns, don’t be afraid to ask your care provider questions about how they plan to do this.
Why is it important for older people to have their vital signs monitored?
Vital signs are important for anyone, but older adults moreso. This is because early detection of vital sign fluctuations usually corresponds with quicker detection of changes in health status, and can help to pick up early signs of things like infections and other health issues in older adults who are more susceptible to things like this, and may recover less easily.
Vital sign monitoring can also help to prevent misdiagnosis, detect medical issues with no obvious symptoms, and see if lifestyle modifications are helping. Plus, studies have found changes in vital signs impacted the prognosis of older patients more than other age groups.
Older people with ongoing health conditions – like hypertension, heart disease, chronic obstructive pulmonary disease (COPD), and more – can benefit from regular vital sign checks. Conditions like these can result in the need for certain medications which could alter a person’s vital signs. This is why it is so important to let your GP or hospital doctor know if you are on any medication that they may not know about.
What are ‘normal’ vital sign ranges for older adults, and what might be cause for concern?
Normal ranges for vital signs in older adults can vary slightly from younger people, so knowing both the typical ranges for health and thevital sign abnormalities that can predict any underlying issues are so important.
Temperature
For temperature, the range forpeople older than 65typically falls between 96.4°F (35.8°C) to 98.5°F (36.9°C). Anything lower than this could indicate hypothermia, and anything higher could be a sign of an infection or inflammation of some sort. Remember that each person is different, so these are approximate figures – if you have any concerns about the temperature of someone you are caring for, speak to their GP.
Pulse Rate
A normal resting heart rate for an adult could be anywhere from 60 to 100 beats per minute (BPM), however older adults are likely to be on the higher end of this spectrum. A pulse rate that is lower than 60 BPM or higher than 100 BPM could be a sign that something is wrong, and you should seek medical assistance. Keep in mind that pulse rates will vary from person to person, and could be different due to emotions, exercise, medications they are taking, or if someone is ill or injured.
Blood Pressure
Blood pressure is measured in millimetres of mercury (mm Hg), and according to the NHS, adults should have an approximate blood pressure reading of over 90/60 mm Hg and under 120/80 mm Hg.
For context, high blood pressure (hypertension) is thought to be any reading higher than 135/85 mm Hg if your reading was taken at home, and 140/90 mm Hg if your reading was taken in a pharmacy, GP surgery or clinical setting. Low blood pressure (hypotension) is any reading of 89/59 mm Hg or lower, regardless of where this is taken. It is important to remember that certain factors can influence blood pressure readings, such as stress, smoking, temperature, exercise, and more.
Respiratory Rate
Generally, respiratory ratesin healthy adults range from 12 to 18 breaths per minute, which indicates the level of oxygen in a person’s blood, however this could be higher for older people. Doctors will look for breathing to be within this range, and may also listen for things like wheezing or other atypical sounds, as well as check for muscle tightening or pain while breathing.
How do vital sign ranges change over time?
As people age and life is lived, bodily changes can influencevital signranges, which is why older adults usually require more vital sign monitoring than younger people in order to pick up on subtle alterations. For example, core body temperature is lower, and pulse rate may slightly increase due to decreased cardiac efficiency and loss of elasticity in blood vessels, leading to higher blood pressure readings. Also, respiratory rates tend to stay relatively stable but can decrease slightly as lung elasticity and function changes with age.
Studies have found several physiological changes may occur with age which can adapt vital signs, and make older people less able to adapt to physiological stressors. Regular monitoring will help to detect any deviations from typical ranges as they occur, providing adequate time for appropriate interventions.
How can home carers support older adults with vital sign monitoring and alerting?
Home carers are usually necessary for supporting older adults with vital sign monitoring and alerting at home if their familial caregivers are not able to provide adequate checks each day. They can assist in regular monitoring of temperature, pulse rate, blood pressure and respiratory rate using appropriate devices, ensure these measurements are taken at the right time each day or week, and even encourage older people to become proactive in their own healthcare by involving them in the process so they understand the signs to look out for.
If a client requires this service, home carers will be trained to identify what normal ranges should be and detect any deviations from these or concerning trends that need to be checked, in accordance with the Care Plan provided by the person’s GP or the healthcare professional in charge of their care. This should include upper and lower limits, and details of who to call if they have any concerns or questions. Through maintaining records of vital signs over time and noting any changes or patterns, early intervention can help with a number of medical issues and underlying conditions. Carers should quickly alert healthcare professionals or family members if further assessment is needed.
At Home Instead, our Care Professionals are fully trained in your care needs and vital sign monitoring, which can help to reduce the number of infections and the need for hospital admissions. Having our Care Professionals visit your home allows you to maintain your independence, routine and lifestyle, while feeling safe in the knowledge that your healthcare is being carefully monitored by a familiar, friendly face, and your clinical team can intervene if ever your vital signs change.
Reach out to the Home Instead team to discuss your needs and allow us to create a personalised home care package to support you.
Michelle Tennant, Clinical Governance Lead
I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 4 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.
