When Cold Means More: Understanding Hypothermia as a Sign of Infection in the Elderly

If you’ve ever touched your elderly loved one’s hand and thought, “They feel a little colder than usual today,” you probably chalked it up to chilly weather or a drafty room. But did you know that, in older adults, a low body temperature can sometimes signal something far more serious—like an infection?

For many caregivers, the word “hypothermia” brings to mind freezing temperatures and outdoor exposure, but in elderly individuals, even a subtle drop in body temperature can serve as an early warning sign of sepsis or another underlying issue.

Unlike younger people, who often spike a fever when fighting off an infection, older adults may struggle to regulate their body temperature, making it harder for caregivers to spot a problem. Instead of a fever, you might see a reading of 96°F or lower—and this could be your first clue that something is wrong.

In this post, we’ll explore why hypothermia in older adults isn’t just about feeling cold. We’ll dive into the connection between low body temperature and infections like sepsis, share common signs to watch for, and give you practical tips for responding effectively. Because when it comes to caregiving, understanding the little things can make all the difference.

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Why the Elderly Don’t Always Present with a Fever

When we think of infections, we usually associate them with fevers, but for older adults, the story can look very different. As we age, our bodies undergo changes that affect the way we respond to illness, which makes it harder to mount a fever even when fighting off a serious infection.

Another factor is the body’s reduced ability to regulate temperature. Conditions like diabetes, hypothyroidism, poor circulation, and anemia can make it harder for your loved one to maintain a normal body temperature.

The takeaway? While a fever might grab your attention immediately, a low temperature in an older adult should be treated just as seriously, especially if other symptoms are present like lethargy and new onset confusion or disorientation. Sometimes, you just “know” when something is off, but you can’t put our finger on it.

Recognizing the Signs of Trouble

Caregivers are often the first to notice subtle changes in their loved ones, and when it comes to low body temperature, small signs can mean a lot. While a thermometer reading below 96.8°F is concerning on its own, it’s rarely the only clue. If your loved one’s temperature is below 96, please take this seriously. Pay close attention to how your loved one is acting and feeling.

Here are some signs to watch for:

• Confusion or disorientation: If they seem unusually forgetful, confused, or “foggy,” it could be an early sign of something serious.
• Cold or pale skin: A drop in skin temperature or a noticeable paleness can indicate poor circulation.
• Fatigue or sluggishness: If they’re more tired than usual or having trouble staying awake, don’t dismiss it as “just being tired.”
• Shivering: Shivering is a natural response to feeling cold, but its absence during a low-temperature episode can signal worsening hypothermia.
• Changes in breathing or heart rate: Rapid breathing or a fast heartbeat can accompany a systemic infection like sepsis.

Being attuned to these signs can help you take action before the situation escalates.

What to Do If You Suspect a Problem

If you notice a low temperature or other unusual symptoms, staying calm but acting quickly is key. Here’s what you can do to protect your loved one:

1. Take the Temperature: Use a reliable thermometer to confirm the reading. If their temperature is consistently below 96.8°F, continue monitoring and consider other symptoms.

2. Look for Other Signs: Check for skin changes, disorientation, shivering, or signs of infection, such as redness, swelling, or unusual odors.

3. Warm Them Gently: Move your loved one to a warm, draft-free space. Use blankets, warm (but not hot) compresses on the chest and neck and encourage warm drinks if they’re alert.

4. Call a Healthcare Provider: If the low temperature persists or is accompanied by other symptoms, contact your doctor or seek emergency care immediately.

5. Be an Advocate: Share all symptoms with the medical team, and don’t hesitate to call 911 if your gut is telling you something is really wrong. 

Understanding When and How to Check a Temperature

As a caregiver, it’s important to remember that you don’t need to take your loved one’s temperature daily unless instructed by a healthcare provider. Instead, focus on the bigger picture—if something seems off, such as confusion, fatigue, or unusual behavior, checking their temperature can provide valuable insight into their overall condition.

If you do find a low reading, resist the urge to assume the thermometer is broken. Instead:

1. Verify the Thermometer’s Functionality: Test the thermometer by checking your own temperature or using it on someone else in the household.

2. Retake Their Temperature: Ensure the thermometer is placed correctly for the most accurate reading.

Where and How to Check a Temperature

The accuracy of a temperature reading depends on the method and the type of thermometer you’re using. While forehead thermometers are convenient, certain methods are more reliable, particularly for elderly individuals who may have thinner skin or other challenges.

Here’s a quick breakdown of common methods:

1. Oral Temperature:

o Accuracy: Highly accurate when the thermometer is placed correctly under the tongue.

o Best for: Older adults who can keep their mouth closed for the required time.

o Tips: Wait 15 minutes after eating or drinking to avoid skewed readings.

2. Ear (Tympanic) Temperature:

o Accuracy: Reliable when positioned properly in the ear canal.

o Best for: Adults without excessive earwax or ear infections.

o Tips: Pull the ear gently upward and back to straighten the canal for a clear reading.

3. Forehead (Temporal Artery) Thermometers:

o Accuracy: Convenient but can be less reliable in cold environments or if used incorrectly.

o Best for: Quick readings, especially if oral or ear methods aren’t an option.

o Tips: Follow the manufacturer’s instructions for proper scanning technique.

4. Axillary (Underarm) Temperature:

o Accuracy: Least reliable, as readings can be 1°F lower than core body temperature.

o Best for: A quick, preliminary check when other methods aren’t feasible.

o Tips: Ensure the thermometer is snug against dry skin for the best result.

How to Prevent Hypothermia

Prevention is the best defense, especially during colder months. Remember: if hypothermia is related to an infection, bundling up your loved one will not address the core issue. 

Maintain a warm home environment: Keep the thermostat at 68–70°F and ensure drafty windows and doors are sealed.

• Encourage warm clothing: Layers are key, especially for those who get cold easily. Don’t forget non-slip socks and cozy slippers.
• Offer warm drinks and meals: Soups, teas, and other warm foods can provide comfort while helping maintain body temperature.
• Limit exposure to cold: Avoid extended time outdoors or near cold drafts, and always bundle up for trips outside.
• Address health conditions: Treat underlying issues like hypothyroidism, anemia, or circulatory problems that could worsen their temperature regulation.

Wrapping Things Up:

It’s not about obsessively checking temperatures; it’s about being aware of changes. If you find a low reading, don’t ignore it—double-check and consider the bigger picture. Is there anything else unusual right now? These small steps can make a significant difference in catching potential problems early. You’ll always feel better erring on the side of caution. Sometimes, it’s as simple as calling their doctor and speaking to the triage nurse, if that’s an option.

You know your loved one best and are familiar with their baseline. We all have off days—maybe they had trouble sleeping or are taking medications affecting their appetite. But a persistent lower-than-normal temperature, especially when combined with symptoms like confusion or lethargy, can signal that something more serious is brewing. A low body temperature might seem minor, but in the elderly, it can be an important clue that their body is under stress.

By staying aware, recognizing warning signs, and acting quickly, you can make all the difference in keeping your loved one safe and healthy. While these tips are meant to help you stay informed and proactive, they’re no substitute for professional medical advice. If you have concerns, don’t hesitate to reach out to your doctor or healthcare provider for guidance. And of course, if you feel something is truly wrong or notice severe symptoms like a temperature below 96, difficulty breathing, or your loved one is not arousable, don’t wait—seek medical attention immediately.

If you found this information helpful, share it with other caregivers who might need it. Together, we can create a community of support and shared knowledge. For more information, check out these valuable resources from Sepsis.org and the National Institute on Aging. And don’t forget to follow Caregivers Coffee for more practical tips and insights designed to help multi-generational caregivers navigate these challenges with confidence.