Treating Lyme disease in elderly patients is one of the most complex challenges I see in my practice.

Unlike younger adults, older patients often live with multiple health conditions. They may be taking many medications, which raises the risk of drug interactions. Kidney or liver function may be reduced, making it harder to clear antibiotics. And neurological symptoms from Lyme can increase the risk of falls, which can have devastating consequences in this age group.

Standard guidelines don’t always address these realities. What works well for a younger patient may not be safe—or effective—for someone in their eighties. That’s why Lyme disease treatment in elderly patients requires individualized care.

Every decision has to balance infection control with age-related vulnerabilities. Antibiotics may be necessary, but they can also increase risks like dehydration, C. difficile infection, or secondary complications. Medications for neuropathy may relieve pain but could also cause sedation and falls. And we can’t overlook the role of co-infections like Babesia or Bartonella, which make recovery even more complicated.

As an ILADS guideline author, I’ve emphasized the importance of clinical judgment and patient-centered care. For elderly patients, that means more frequent monitoring, lower starting doses, and close coordination with family and caregivers. The goal isn’t just to fight infection—it’s to preserve function, independence, and quality of life.

So here’s the bottom line: elderly Lyme disease patients need more than standard protocols. They need individualized care that takes into account the whole person, not just the infection.”