Choice A rationale:

Nuchal rigidity (stiff neck) is a classic symptom of meningitis, but it is not particularly concerning in older adults as it is in younger individuals. Older adults may have a less pronounced neck stiffness due to age-related changes.

Choice B rationale:

Rash can be a symptom of certain types of meningitis, such as meningococcal meningitis, but it is not specific to older adults. Moreover, older adults may not exhibit a rash even in cases of meningococcal meningitis.

Choice C rationale:

Irritability is a vague symptom and may not be specific to meningitis in older adults. It can be caused by various factors and does not raise significant concern for meningitis.

Choice D rationale:

Altered mental status, such as confusion, delirium, or decreased level of consciousness, is particularly concerning in older adults with suspected meningitis. Older adults may not always present with classic symptoms like neck stiffness, and altered mental status may be the primary indicator of central nervous system involvement.

Choice E rationale:

Photophobia is a common symptom of meningitis, but it is not specific to older adults. It may be present in both younger and older patients with meningitis.