Which statement is true about fever in elderly patients with meningitis?

• A. Fever is almost always present
• B. Neck stiffness is never present
• C. Altered mental status is rare
• D. Fever is very common but often missed in elderly patients

Answer: (D)

In older adults, fever from meningitis isn’t as reliable a sign as it is in younger people because the aging immune system often mounts a blunted febrile response. That means fever may be absent or only very subtle in elderly patients, even when meningitis is present. Because of this, clinicians can miss meningitis if they rely on temperature alone and don’t consider other clues. In this population, altered mental status, confusion, lethargy, poor appetite, or falls may be the more prominent clues, and a normal or only mildly elevated fever does not rule out meningitis. The statement that fever is very common but often missed captures this reality: fever can occur, but it is often not obvious and may be overlooked, so a high index of suspicion is needed.

The other options don’t fit because neck stiffness is not guaranteed to be present in elderly meningitis, altered mental status is not rare in this group, and fever is not almost always present in elderly patients with meningitis.