Detecting Infections in Terminally Ill Geriatric Patients with Dementia

Published on May 19, 2023

Updated on February 7, 2024

One of the most important roles is to detect and manage in terminally ill geriatric patients with dementia. These patients are often at higher risk for due to their weakened immune systems, underlying health conditions, and limited mobility. Detecting infections in these patients can be challenging due to their limited communication abilities and other cognitive and physical impairments. However, early detection and management of infections can significantly improve the patient's quality of life and potentially prolong their life.

Signs and Symptoms of Infection

Sometimes, older people who have dementia get sick from germs that make them have an infection. An infection is when germs get inside your body and make you feel bad. It is important to know when someone has an infection, so they can get the appropriate medicine and feel better. But it is not easy to tell when someone with dementia has an infection, because they may not act like other people who are sick. They may not have a fever or say they are in pain. Here are some things to look for that may mean someone with dementia has an infection:

  • They act differently than usual. They may be more angry, sad, scared, or quiet than normal. They may not remember things well or get confused easily. They may not know where they are or what time it is. This is called a change in behavior or mental status.
  • They have trouble eating or drinking. They may not feel hungry or thirsty, or they may forget to eat or drink. They may lose weight or get dehydrated. This is called a loss of appetite.
  • They feel very tired or weak. They may not have energy to do things they usually do, like walking, talking, or playing. They may sleep more or have trouble staying awake. This is called increased fatigue or weakness.
  • They have trouble moving or walking. They may not be able to stand up, sit down, or balance well. They may fall down or hurt themselves. They may need help to move around or use a wheelchair. This is called decreased mobility or difficulty walking.
  • They feel hot or cold. They may have a high or low temperature that is not normal for them. They may sweat a lot or shiver. They may need more or less clothes or blankets than usual. This is called a fever or chills.
  • They breathe fast or hard. They may have trouble breathing or feel like they can't get enough air. They may cough or wheeze. They may have pain in their chest or throat. This is called rapid heart rate or breathing.
  • They have red, swollen, or warm skin. They may have a rash or a sore on their skin that looks infected. They may have pus or blood coming out of the sore. They may have pain or itching in the area. This is called skin redness, swelling, or warmth.
  • They have pain or in a specific area. They may have a headache, a stomachache, a toothache, or an earache. They may have pain in their back, joints, or muscles. They may have trouble peeing or pooping. They may cry, moan, or groan when they are touched or moved. This is called pain or in a specific area.
  • They have changes in urine color, smell, or frequency. They may pee more or less than usual, or at different times of the day or night. They may have trouble peeing or holding it in. They may have blood or pus in their pee. They may have pee that is dark, cloudy, or smelly. This is called changes in urine color, smell, or frequency.

It is important to note that not all patients may display all these symptoms, and some may not display any symptoms at all. Therefore, it is crucial to monitor these patients closely and look for any changes in their behavior or physical condition.

Preventing Infections

Prevention is key in managing infections in geriatric patients with dementia. Some simple measures can be taken to reduce the risk of infection, such as:

  • Washing hands regularly and using hand sanitizer. This can help get rid of germs that can make you or the person you are caring for sick. You should wash your hands before and after touching the person, before and after eating, and after using the bathroom. You should also use hand sanitizer when you can't wash your hands with soap and water.
  • Thoroughly cleaning and sanitizing equipment and surfaces. This can help prevent germs from spreading to other people or things. You should clean and sanitize any equipment or tools that you use to care for the person, such as thermometers, blood pressure cuffs, or stethoscopes. You should also clean and sanitize any surfaces that the person touches, such as tables, chairs, bed rails, or doorknobs.
  • Encouraging the patient to drink plenty of fluids. This can help keep the person hydrated and flush out toxins from their body. You should offer the person water, juice, soup, or other drinks that they like. You should also watch for signs of dehydration, such as dry mouth, sunken eyes, or dark urine.
  • Ensuring proper hygiene and cleanliness during toileting and incontinence care. This can help prevent infections in the urinary tract or the skin. You should help the person use the toilet or change their diapers as often as needed. You should also clean their genital and anal areas with warm water and soap, and dry them gently. You should use gloves and disposable wipes when handling urine or feces, and throw them away in a sealed bag.
  • Providing adequate nutrition and hydration. This can help boost the person's immune system and fight off infections. You should give the person healthy and balanced meals that include fruits, vegetables, grains, protein, and dairy. You should also avoid giving them foods that are too spicy, salty, or sugary, as they may irritate their stomach or mouth. You should also make sure the person has enough water or other fluids to drink with their meals.
  • Ensuring that wounds are meticulously cleaned and dressed. This can help prevent infections in the skin or the blood. You should clean any cuts, scrapes, or sores that the person has with warm water and soap, and apply an antibiotic ointment. You should also cover the wound with a clean bandage and change it every day or as directed by a doctor. You should also watch for signs of infection, such as redness, swelling, pus, or fever.
  • Encouraging mobility and exercise to maintain strength and mobility. This can help prevent infections in the lungs or the muscles. You should help the person move around and do some physical activities that they enjoy, such as walking, stretching, or dancing. You should also help them breathe deeply and cough to clear their lungs. You should also avoid letting them sit or lie down for too long, as this may cause fluid to build up in their lungs or legs.
  • It is also essential to ensure that no visitors or caregivers are showing any signs of illness and are following proper infection control measures. This can help prevent infections from spreading to the person or others. You should ask anyone who wants to visit the person to stay away if they have a fever, cough, sore throat, or other symptoms of illness. You should also ask them to wear a mask, wash their hands, and avoid touching the person or their belongings. You should also follow the same rules if you are feeling sick or have been exposed to someone who is sick.

Managing Infections

If an infection is suspected, prompt management is essential. This may involve collecting samples for cultures and starting appropriate antibiotic treatment if necessary. It is important to work closely with the patient's physician to determine the best course of treatment based on the patient's overall health and medical history. In some cases, it may be necessary to hospitalize the patient for more intensive treatment.

It is also important to manage any pain or discomfort associated with the infection. This may involve using interventions, such as positioning or massage, or medications such as acetaminophen or opioids.


Infections are a common and serious problem for older people who have dementia. They can make them feel very bad and cause more health issues. It is not easy to tell when someone with dementia has an infection, because they may not act like other people who are sick. They may not have a fever or say they are in pain. That is why it is important to know the signs and symptoms of infection in older people with dementia, such as changes in behavior, appetite, mobility, skin, urine, or pain. If you notice any of these signs, you should tell a doctor or a nurse right away. They can check if the person has an infection and give them the right medicine. This can help them feel better and prevent more serious problems.

It is also important to prevent infections in older people with dementia. This can help them stay healthy and happy. You can prevent infections by washing your hands, cleaning and sanitizing things, giving the person enough fluids and food, taking care of their hygiene and wounds, helping them move and exercise, and keeping away from sick people. You can also help the person feel better and less pain from the infection by doing some things to make them comfortable, such as moving them or rubbing them gently, or giving them some medicine to ease their pain.

Infections are a big challenge for older people who have dementia, but they can be detected and treated with proper care and attention. By knowing the signs and symptoms of infection, preventing infection, and managing infection, you can help the person with dementia live a better and longer life.


For more information on detecting and managing infections in terminally ill geriatric patients with dementia, please visit:

Infection Control in Hospice and Palliative Care from the National Hospice and Palliative Care Organization

Infections in the Elderly Critically Ill Patients

Urinary tract infections in long-term care: Improving outcomes through evidence-based practice

My Loved One with Dementia

Understanding Dementia (Alzheimer's & Vascular & Frontotemporal & Lewy Body Dementia) (Video)

How Do I Know Which Dementia I'm Looking At? (Video)

Dementia Training material (Free)

Promoting Meaningful Relationships with Dementia Patients through Validation Therapy

Unlocking the Power of Validation Therapy in Compassionate End-of-Life Care

Validation Therapy: A Valuable Tool for Families and Healthcare Teams

Best Practices for Approaching Combative Dementia Patients

The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer's Disease and Other Dementias

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How Do I Know You? Dementia at the End of Life

The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer's Disease and Other Neurocognitive Disorders (Guides to Caregiving)

Sundown Dementia, Vascular Dementia and Lewy Body Dementia Explained

The Caregiver's Guide to Dementia: Practical Advice for Caring for Yourself and Your Loved One (Caregiver's Guides)

Ahead of Dementia: A Real-World, Upfront, Straightforward, Step-by-Step Guide for Family Caregivers

The Dementia Caregiver's Survival Guide: An 11-Step Plan to Understand the Disease and How To Cope with Financial Challenges, Patient Aggression, and Depression Without Guilt, Overwhelm, or Burnout

Dementia Care Companion: The Complete Handbook of Practical Care from Early to Late Stage

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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