Lyme Disease in the Elderly: Often Overlooked

Lyme disease may be more common in older adults than previously recognized, yet it is often overlooked or misattributed to aging or other conditions.

This has important implications for diagnosis and management in this population.

Study Findings in Older Adults

In a Netherlands study of 1,454 patients referred to a Lyme center, 255 (17.5%) were aged 65 years or older.

The average age was 79 years (range 65–87), with 45% male.

One-third (33%) of older patients had clinical Lyme borreliosis with positive serologic tests—compared with 18% in younger patients.

Evidence of Disseminated Disease

Among the elderly patients:

45 had disseminated Lyme disease
5 had active infection at the time of evaluation

This suggests that Lyme disease in older adults may present later or be diagnosed at a more advanced stage.

Depression Less Common Than Expected

Interestingly, depressive symptoms were less common in older patients:

9.8% in patients ≥65 years
24.7% in patients aged 18–64 years

This challenges assumptions that symptoms in older adults are primarily psychiatric.

Why Lyme Disease Is Missed in Older Adults

Lyme disease may be underdiagnosed in the elderly because symptoms overlap with common age-related conditions, including:

Fatigue and reduced mobility
Cognitive decline or memory problems
Joint pain attributed to osteoarthritis
General frailty or deconditioning

These overlaps can delay recognition and treatment.

Clinical Takeaway

Lyme disease should be considered in older adults presenting with unexplained fatigue, cognitive changes, or joint symptoms—particularly in endemic areas. Age alone should not exclude Lyme disease from the differential diagnosis.

Related Articles:

Lyme encephalopathy mistaken for dementia

Emotional effects in Lyme disease

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