What causes shivering in the elderly? Understanding the underlying health issues

The human body's ability to regulate temperature changes with age, and many older adults experience increased sensitivity to cold. Understanding what causes shivering in the elderly is crucial, as it can range from harmless age-related changes to serious underlying health conditions.

Quick Summary

Elderly shivering can result from age-related factors like slower metabolism and poor circulation, or be a sign of underlying conditions such as infections, thyroid issues, or diabetes.

Key Points

• Aging's Impact: Slower metabolism and thinner skin make seniors more sensitive to cold, often leading to shivering.

• Check for Infection: Shivering can be a sign of infection like a UTI or pneumonia in older adults, even without a fever.

• Poor Circulation: Conditions like peripheral artery disease or heart failure can cause cold extremities and shivering.

• Medication Effects: Certain drugs for blood pressure, mood disorders, and seizures can induce tremors or cause cold sensitivity.

• Hypothermia Risk: Elderly adults are more susceptible to dangerously low body temperatures (hypothermia), even in moderately cool indoor environments.

• Know Emergency Signs: Shivering accompanied by confusion, slurred speech, a weak pulse, or shallow breathing requires immediate medical help.

As we age, our bodies undergo numerous physiological changes that can affect how we perceive and regulate temperature. For many elderly individuals, shivering is not simply a reaction to a cold room but a signal of a more complex issue. While some causes are benign, others require immediate medical attention. Recognizing the signs and understanding the potential causes is vital for proper care and prevention of complications.

The Normal Aging Process and Temperature Regulation

Several natural, age-related changes contribute to an older person's increased sensitivity to cold and a reduced ability to maintain core body temperature. These factors can lead to shivering even in what younger people consider mild temperatures.

• Decreased Metabolic Rate: An older person's metabolism slows down, generating less heat to keep the body warm.
• Reduced Subcutaneous Fat: The layer of insulating fat just under the skin thins with age, making it more difficult to conserve body heat.
• Slower Circulation: Aging can lead to changes in blood circulation, resulting in decreased blood flow to extremities like hands and feet. This is why cold hands and feet are a common complaint.
• Challenges in Sensing Temperature: The body's ability to sense changes in temperature can diminish, meaning an older person may not realize they are becoming dangerously cold until it is too late.

Underlying Medical Conditions Causing Shivering

Beyond the natural aging process, shivering in the elderly can be a sign of a more serious health problem that requires diagnosis and treatment. Medical conditions are a significant category of what causes shivering in the elderly.

Infections and Sepsis

An infection is a common cause of shivering, as the body generates heat to fight off invaders. However, older adults may not exhibit the typical fever response due to their weakened immune systems, making shivering a key symptom to watch for.

• Pneumonia: A lung infection that can cause shivering, along with symptoms like a bad cough and difficulty breathing.
• Urinary Tract Infections (UTIs): A bacterial infection common in the elderly, sometimes presenting with chills or shivering without a high fever.
• Sepsis: A life-threatening complication of an infection. In the elderly, sepsis may cause shivering, confusion, and a fast heartbeat.

Endocrine and Metabolic Issues

Hormonal imbalances and metabolic problems can also interfere with the body's temperature regulation.

• Hypothyroidism: An underactive thyroid gland slows down the body's metabolism and can lead to constant cold intolerance and shivering.
• Diabetes and Hypoglycemia: Uncontrolled diabetes and low blood sugar can trigger episodes of shivering, trembling, weakness, and dizziness.

Circulatory Problems

Conditions that affect blood flow can cause cold sensations and shivering, especially in the extremities.

• Cardiovascular Disease: Heart failure, coronary artery disease, and peripheral artery disease (PAD) can all impede blood flow, making it harder to retain heat.
• Anemia: A lack of red blood cells or hemoglobin impairs oxygen transport, affecting heat distribution and causing a person to feel cold.

Neurological Disorders

Some neurological conditions can cause involuntary shaking that can be mistaken for shivering, and may worsen with age.

• Essential Tremor: A common neurological disorder that causes involuntary, rhythmic shaking, most often in the hands.
• Parkinson's Disease: This neurodegenerative condition is known for causing resting tremors, which are most noticeable when the affected body part is at rest.

Medication Side Effects

Certain medications commonly prescribed to older adults can have side effects that include tremors or sensitivity to cold. These side effects should be discussed with a doctor to evaluate whether a dosage adjustment or different medication is needed.

Common medications include:

• Beta-blockers: Used to treat high blood pressure and other heart conditions.
• Certain Antidepressants: SSRIs and other mood-regulating drugs.
• Antipsychotics: Medications for treating behavioral issues.
• Lithium: Used for bipolar disorder.

Environmental and Lifestyle Factors

Beyond medical conditions, external factors can also contribute to shivering episodes.

• Hypothermia: A serious medical emergency where the body's temperature drops dangerously low (below 95°F/35°C). In the elderly, this can occur even in moderately cool indoor temperatures.
• Dehydration: Not drinking enough fluids can disrupt the body's fluid balance, which is necessary for temperature regulation.

Comparison Table: Causes of Shivering in the Elderly

Cause Type	Specific Cause	Key Features
Age-related Changes	Slower metabolism	Reduced heat production; persistent cold feeling
	Reduced subcutaneous fat	Less insulation, more heat loss
	Poor circulation	Cold hands and feet, numb or tingling extremities
Infections	Pneumonia, UTI, etc.	Shivering, sometimes without a high fever; potential confusion
	Sepsis (Severe infection)	Shivering, fast heartbeat, confusion, low body temperature
Metabolic/Endocrine	Hypothyroidism	Cold intolerance, fatigue, low body temperature
	Hypoglycemia (Low blood sugar)	Shaking, weakness, dizziness, sweating
Neurological Disorders	Essential Tremor	Rhythmic shaking, often in the hands, worsens with movement
	Parkinson's Disease	Resting tremors, noticeable when affected limb is at rest
Medication Side Effects	Beta-blockers, Antidepressants, etc.	Tremors as a potential side effect, can worsen with dose
Environmental Factors	Hypothermia	Shivering, confusion, drowsiness, slurred speech
Other	Dehydration	Shaking or cramping due to fluid imbalance

Conclusion

Shivering in the elderly is a symptom that should never be ignored. While it can be an expected result of the natural aging process, it often points to an underlying medical condition that requires attention. From common infections and medication side effects to more serious issues like hypothermia or neurodegenerative disorders, a comprehensive medical evaluation is necessary to determine the root cause. Caregivers and family members should be vigilant in monitoring an older person's symptoms and seek professional medical advice promptly, especially if confusion, slurred speech, or unusual weakness accompanies the shivering. By being proactive, you can ensure a correct diagnosis and a safer, more comfortable life for the senior in your care.

This information is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment.

Frequently Asked Questions

When should I be concerned about an elderly person shivering?

You should be concerned and seek prompt medical attention if shivering is accompanied by other serious symptoms such as confusion, slurred speech, drowsiness, a weak pulse, or shallow breathing.

Can common medications cause shivering in older adults?

Yes, several medications can have tremors or increased cold sensitivity as a side effect. These include beta-blockers for high blood pressure, certain antidepressants, and antipsychotics. You should always discuss potential side effects with a doctor.

Is it normal for older adults to feel colder than younger people?

Yes, it is common for older adults to feel colder. Age-related changes like a slower metabolism, reduced body fat, and less efficient blood circulation can decrease the body's ability to regulate its temperature effectively.

What infections can cause shivering in the elderly?

Bacterial and viral infections like pneumonia, urinary tract infections (UTIs), and influenza are common culprits. It's important to note that older adults may not develop a fever in response to infection, making shivering a key sign.

Can poor circulation cause shivering?

Yes, poor circulation can cause cold hands and feet and lead to shivering. Conditions such as heart failure and peripheral artery disease (PAD) can impede blood flow, which in turn reduces heat retention in the body's extremities.

What can caregivers do to help an elderly person who is shivering?

Caregivers can help by ensuring the living space is warm and draft-free, dressing the person in layers, and offering warm beverages like tea or broth. If an underlying medical cause is suspected, a doctor should be consulted.

How can I tell the difference between shivering and a tremor?

Shivering is the body's involuntary, rapid muscle contraction to generate heat, usually triggered by cold or infection. A tremor is a rhythmic, involuntary shaking caused by a neurological or medication-related issue, which may occur at rest or with movement. A doctor can provide an accurate diagnosis.

Can low blood sugar cause shaking in the elderly?

Yes, a rapid decrease in blood sugar (hypoglycemia), especially in diabetic patients, can cause symptoms that include shaking, weakness, sweating, and feeling cold.

How does hypothyroidism relate to shivering in seniors?

Hypothyroidism, or an underactive thyroid, slows the body's metabolic processes. This can reduce the amount of heat the body produces, leading to an increased intolerance to cold and episodes of shivering.