In older patients, the first indicator of nontraumatic internal bleeding may be:

• A. a heart rate over 120 beats/min.
• B. a low blood pressure.
• C. weakness or dizziness.
• D. diaphoresis and pale skin.

Answer: (C)

In older adults, the first sign of nontraumatic internal bleeding is often a nonspecific change like weakness or dizziness. As people age, their ability to mount a rapid heart-rate response to blood loss and to maintain blood pressure can be blunted by medications (such as beta-blockers) and age-related autonomic changes. Because of this, vital signs like a rapid pulse or dropping blood pressure may not appear immediately, while reduced brain perfusion tends to manifest as feeling faint, lightheaded, or weak. These subjective symptoms can precede more dramatic signs, making weakness or dizziness the earliest clue to covert bleeding in the elderly. If you see sudden weakness or dizziness in an older patient with bleeding risk factors, prompt assessment is important.