Norovirus in Older Adults: What to Do at Home This Fall

The belief you'll hear most often is that a squirt of hand sanitizer protects you from a stomach bug. For norovirus it doesn't do the job well, and that matters this season. Norovirus is circulating again, and norovirus in older adults is more likely to lead to dehydration and a hospital stay. This post goes through five common beliefs, what the evidence says about each, and what you can do at home.

Belief: Hand sanitizer is enough

CDC's norovirus prevention guidance says to wash your hands thoroughly with soap and water, especially after using the toilet or changing diapers and before preparing food or eating. It also says hand sanitizers are not a substitute for handwashing. CDC's healthcare outbreak guideline adds that alcohol-based sanitizers are less reliable against norovirus, and it recommends soap and water as the standard for hand hygiene.

Use sanitizer when a sink isn't available, but wash with soap and water as soon as you can. Scrub all surfaces of your hands, including thumbs and under the nails, and rinse under running water. Do this after the bathroom, after handling soiled laundry, and before you cook or eat.

Belief: If most states look quiet, there's nothing to worry about

National numbers can look calm while one building has a large outbreak. In October, the Johnson County Health Department in Kansas counted 97 cases in an outbreak at an Overland Park elementary school, 95 of them students and staff, before declaring it over (KCTV5). A cluster like that can reach grandparents who help with pickup, babysitting or family meals, even when the state-level map looks calm.

CDC tracks norovirus outbreaks in 12 states through its NoroSTAT network, which posts updated counts each month. Look at your own state or county health department for local notices, and pay attention to news from nearby schools, child care centers, senior living communities and cruise lines. Low statewide levels are a reason to stay calm, and a nearby outbreak is a reason to tighten your habits for a couple of weeks.

Belief: Norovirus in older adults is the same 24-hour bug everyone gets

Norovirus causes vomiting and diarrhea, and in healthy younger people it often passes in a day or two. CDC's overview of norovirus names dehydration as the main complication and says it is most serious in older adults, young children and people with other health conditions.

Several age-related changes explain why. Thirst signals weaken with age, so you may not feel dehydrated until you already are. Kidneys concentrate urine less efficiently, and the body holds a smaller share of water than it did earlier in life. Many adults over 65 also take medications that change fluid balance, such as diuretics, blood pressure drugs or diabetes medicines. When fluid loss is fast, low blood pressure, dizziness and falls can follow, along with kidney strain, and those are the problems that lead to hospital care. Heart disease, diabetes and kidney disease make this more likely.

If you take a water pill or a blood pressure medicine and you're vomiting or have diarrhea, call your doctor or pharmacist the same day and ask whether to adjust it. Don't stop a prescribed medicine on your own.

Belief: You should wait it out at home no matter what

Most cases can be managed at home, but some symptoms call for medical care. Contact your doctor promptly, or seek urgent care, if you notice any of these:

• You can't keep liquids down for more than about a day.
• You pass little or no urine, or it is very dark.
• You feel dizzy or faint when you stand, or your heart is racing.
• Your mouth is very dry, or you feel unusually weak or confused.
• There is blood in your vomit or stool, or you have a high fever.
• Severe belly pain develops, or diarrhea lasts more than a few days.

Confusion or fainting in an older adult is a reason to call 911 or go to the emergency department, not to wait for a callback. If someone you care for becomes unusually sleepy or hard to wake, treat it the same way.

Belief: Any household cleaner will handle it

Norovirus spreads through contaminated surfaces, food and close contact, and CDC's prevention guidance says contaminated surfaces should be cleaned and disinfected. Its healthcare guideline pairs that with contact precautions and environmental cleaning. Many everyday cleaners are not made for this virus, so check the label for norovirus claims, or use a bleach-based product and follow its directions for mixing, contact time and ventilation.

A practical routine for a sick household:

• Wear disposable gloves and clean up vomit and stool promptly with paper towels, then bag them.
• Disinfect toilets, faucet handles, doorknobs, light switches, phones and the kitchen counters.
• Wash soiled clothes and linens in hot water and dry them on a hot setting.
• Have the sick person use a separate bathroom if you can, and stay out of the kitchen.
• Don't prepare food for others until you've felt well for at least two days (CDC advises waiting after symptoms stop, since the virus can still be shed).

Rinse food-contact surfaces after disinfecting and keep bleach away from other cleaning products, since mixing them can release harmful gases.

Belief: Sports drinks and plain water will cover it

Plain water helps, but vomiting and diarrhea also drain salts such as sodium and potassium. Oral rehydration solutions sold at pharmacies are designed to replace both water and salts. Broth, diluted juice and electrolyte drinks can also help, though some sports drinks are high in sugar. If you have heart failure, kidney disease or a fluid restriction, ask your doctor which drinks and how much are right for you before an illness hits. (For background on how salt fits into a heart-healthy day, see Sodium and Your Heart: How Much Is Too Much?)

Take small, frequent sips, such as a few spoonfuls every few minutes, rather than large gulps that can trigger more vomiting. Once you can keep fluids down, add bland foods like toast, rice or bananas. After recovery, gut-friendly foods can come back gradually.

Your Best Next Step: Set Up a Plan Before Anyone Gets Sick

Stock your home now with soap at every sink, a bleach-based disinfectant, disposable gloves, an oral rehydration solution and a thermometer. Write down your medication list and your doctor's phone number, and keep them where you can find them quickly. Check which vaccines you're due for this season as well, using our fall vaccine guide for adults over 65, since norovirus has no vaccine and other respiratory illnesses do.

If you do get sick, SteadiDay's Daily check-ins (available on the free plan) give you a quick way to log how you feel each day, including fluids, dizziness and energy. That record makes it easier to notice a decline and to describe your symptoms clearly if you call your doctor. Today, wash your hands with soap and water for 20 seconds before your next meal.

Common Questions

Does hand sanitizer kill norovirus?

Alcohol-based sanitizers are less reliable against norovirus, according to CDC's healthcare guideline. CDC advises washing with soap and water, especially after using the toilet and before eating or preparing food. Use sanitizer only when you can't get to a sink, then wash as soon as you can.

Why are adults over 65 more likely to get dehydrated from a stomach virus?

Thirst signals weaken with age, kidneys conserve water less efficiently, and some common medications affect fluid balance. Fluid loss from vomiting and diarrhea can therefore build up faster than you notice. CDC lists older adults among the groups at highest risk for serious dehydration from norovirus.

How long should I wait before seeing a doctor for vomiting and diarrhea?

Call your doctor if you can't keep liquids down for about a day, if you pass little urine, or if you feel dizzy, confused or very weak. Blood in vomit or stool, high fever, severe belly pain or diarrhea lasting more than a few days also need a medical visit. Fainting or confusion calls for emergency care.

What cleaner should I use after someone in my home has norovirus?

Use a bleach-based product or a disinfectant labeled for norovirus, and follow the directions on the label. Clean up vomit and stool first with disposable towels, then disinfect toilets, handles, counters and other high-touch surfaces. Wash soiled laundry in hot water.