Severe acute respiratory syndrome (SARS) in elders.

In the era of SARS, there have been much concern about the atypical features of SARS in elders, and they have even been described as “invisible SARS.” The Hong Kong Geriatrics Society (HKGS) advocates the need to approach elders in the era of SARS with appropriate attitude, knowledge and skills. The HKGS has formed a Special Interest Groups (SIG) on “SARS in Elders” in April 2003. The aim is to further research and understanding of this new illness, promote links with the HKGS and other medical specialist societies, and unmask the prevailing myths, misconceptions, and fears surrounding “SARS in Elders”and “invisible SARS.” While fit elders can report the typical symptoms of SARS, just like their younger counterpart, this is often not the case for frail elders, who tend to present more typically as the geriatric syndromes (the socalled “atypical” presentations): falls, confusion, incontinence and poor feeding. Instead of a fever of over 38°C, a “fever pattern” may be observed. A diagnosis of SARS in old age requires a high index of suspicion, knowledge of the geriatric presentations of infections in old age, sensitivity to a frail elder with change in physical and functional state, alertness to any contact history of SARS, and an updated knowledge of the current prevalence of SARS in the locality. It is equally important not to over-diagnose SARS in elders as not to underdiagnose SARS in elders. Elders with SARS often have an apparently lengthened incubation period (14 days or more) because of delayed detection of onset and inexact day of contact due to multiple exposures. This has important clinical implications on diagnosis, contact tracing duration of surveillance and cohort, as well as infection control measures during high risk nursing and personal care for these frail elders. This long incubation period also calls for an adequate period of careful observation of hospitalized elders at risk of SARS, and when such patients are moved POSITION STATEMENT SEVERE ACUTE RESPIRATORY SYNDROME (SARS) IN ELDERS