Lyme Disease in the Elderly: Symptoms, Treatment, and Outcomes
Older adults may recover more slowly from Lyme disease.
Age can influence symptom resolution and treatment outcomes.
Early diagnosis and treatment remain important.
Lyme disease in the elderly can be more difficult to recognize because fatigue, joint pain, balance problems, and memory changes often overlap with other medical conditions associated with aging. A large study from Slovenia found that although most older adults recovered after treatment for early Lyme disease, they experienced slower resolution of their erythema migrans (EM) rash and were somewhat more likely to have an incomplete treatment response than younger patients.
Because early Lyme disease may resemble common age-related illnesses, clinicians should maintain a high index of suspicion when older adults develop new symptoms following possible tick exposure.
The findings highlight the importance of recognizing Lyme disease promptly in older adults and beginning appropriate treatment early. For a broader overview of diagnosis and symptoms, see the Lyme Disease Symptoms Guide.
The authors reviewed the records of 1,220 young, middle-aged, and elderly patients, comparing disease course and long-term outcomes for each group.
The patients had been treated at an outpatient clinic at the University Medical Center Ljubljana in Slovenia. The study included 224 elderly patients, with 173 between 65–74 years old, 48 between 75–84 years old, and 3 patients who were 85 years or older.
Patients with an erythema migrans (EM) rash were treated for up to 14 days with doxycycline, amoxicillin, or cefuroxime, consistent with common treatment approaches for early Lyme disease. Individuals with multiple EM lesions received a 14-day course of intravenous ceftriaxone or doxycycline.
The outcomes for elderly patients were compared with those for middle-aged (45–64 years) and younger adults (18–44 years).
The investigators then compared treatment responses across the three age groups.
The investigators found that older patients had slower resolution of erythema migrans and higher odds of an unfavorable treatment outcome.
At the 12-month follow-up visit, 7.8% of elderly patients had an incomplete treatment response, compared with 6.6% of middle-aged patients (n=627) and 3.7% of younger adults (n=369).
“Up until now, information on the impact of age on the clinical course and outcome of early Lyme borreliosis was limited to one report from the U.S.,” the authors noted.
The study also found that the odds of an incomplete response were higher among older adults, women, patients with multiple erythema migrans lesions, and those presenting with Lyme borreliosis-associated constitutional symptoms.
Older adults often present unique diagnostic challenges because fatigue, muscle aches, balance problems, memory concerns, or joint pain may initially be attributed to aging or other chronic illnesses. These overlapping symptoms may contribute to delayed diagnosis in some patients. Learn more about the importance of early diagnosis and delayed Lyme treatment.
None of the elderly subjects with persistent post-treatment symptoms met the study’s definition of post-Lyme disease syndrome because their symptoms did not reduce their previous activity levels.
In other words, some elderly subjects continued to experience symptoms after treatment but remained functionally independent. This finding illustrates that recovery exists along a spectrum and that persistent symptoms do not always result in significant disability. Learn more about persistent Lyme disease and Recovery From Lyme Disease.
Frequently Asked Questions
Can Lyme disease be harder to recover from in older adults?
Most older adults recover after appropriate antibiotic treatment, but some studies suggest they may experience slower resolution of symptoms and a slightly higher likelihood of incomplete recovery than younger patients.
Can Lyme disease be mistaken for normal aging?
Yes. Fatigue, joint pain, balance problems, and cognitive changes may overlap with other medical conditions common in older adults, making Lyme disease more difficult to recognize.
Does age affect recovery from Lyme disease?
The Slovenian study found that elderly patients were more likely to have slower resolution of erythema migrans and somewhat higher rates of incomplete treatment response than younger adults.
Should older adults be treated differently for Lyme disease?
Current treatment recommendations generally use the same antibiotics as in younger adults, although clinicians should consider other medical conditions, medication interactions, and kidney or liver function when selecting therapy.
Clinical Takeaway
Most older adults with Lyme disease recover following appropriate antibiotic treatment, although recovery may take longer than in younger adults. This large observational study suggests that incomplete responses occur somewhat more often in elderly patients. Clinicians should maintain a high index of suspicion because Lyme disease symptoms in older adults can resemble many other age-related conditions.
Prompt diagnosis and treatment may improve outcomes while reducing the risk of prolonged symptoms.
Related Articles
Lyme Disease Symptoms Guide
Delayed Lyme Treatment
Lyme Disease Mimics Autoimmune Disorder in an Elderly Woman
References:
- Borsic K, Blagus R, Cerar T, Strle F, Stupica D. Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis. J Clin Med. 2018;7(12).
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I am in my mid seventies. I was diagnosed when I was about 64. I am still struggling with problems probably connected to Lyme.
You are not alone.
My 89 year old mother in law was diagnosed with Lyme disease about 2-3 weeks ago. She has been taking doxycycline/Hiclate 100 mg since July 30th. She is not eating at all. Does anyone know how long she can go without eating.
Should we take her off the medicine? To compound the problem she also has medium Alzheimers (or more).
There are other antibiotics that are easier on the stomach. I typically advise a reassessment to reexamine the plan to include an assessment of the risk of weight loss.
I have had Lyme for 4 yrs. Severe neuropathy was resolved as well as all but gastro symptoms which are intense. I am 77 yrs old.
I’ve had Lyme’s symptoms and physical limitations for over 30 years. Although I enjoy walking daily, limitations are increasing. Taking herbal remedies for babesia but have to wonder if it’s worth it.
I have found Malarone or Mepron quite helpful.
Healthy early senior collapses goes to ER. Double Pneumonia. Enlarged Heart. Lung nodule.
Active Lyme. Four months later aching joints, headaches, bones, memory loss, declining in health. Repeat in pneumonia. Internist says old age. Arthritis. Of course you feel bad. Why can’t I get my husband’s dr to hear us here in VA? It’s Lyme! Help?!
I have had lyme for 6 yrs & only recently learned I have Bartonella & Babesia