Even with advancements in antibiotic treatments, infections remain a significant contributor to mortality among older adults. Managing infections in this population poses unique challenges, necessitating early detection and treatment due to the increased risk of morbidity and mortality. This article will delve into common infections in geriatric patients, encompassing early, middle, and late-stage symptoms, preventive measures, and prevalent treatment approaches, particularly for patients facing a terminal illness prognosis of six months or less.
Epidemiology and Risk Factors of Infections in the Elderly
Do you know what epidemiology means? It is the study of how often and why diseases occur in diverse groups of people. This section will discuss the epidemiology and risk factors of infections in older people.
Common Types and Sources of Infections in Older Adults
Older people can get many infections, but some are more common. Here are some of the most common types and sources of infections in older adults:
Pneumonia is an infection that affects the lungs. It can make breathing difficult and cause coughing, chest pain, and fever. Bacteria, viruses, fungi, or other germs can cause pneumonia. Some of the familiar sources of pneumonia in older people are influenza (the flu), aspiration (when food or saliva goes into the lungs), and hospital-acquired infections (when germs spread in the hospital).
Urinary tract infections (UTIs): These infections affect the bladder, kidneys, or other parts of the urinary system. They can cause pain or burning when urinating, frequent or urgent urination, blood in the urine, and fever. Bacteria, fungi, or other germs can cause UTIs. Some of the common sources of UTIs in older people are catheters (tubes that drain urine from the bladder), sexual activity, and diabetes.
Skin and soft tissue infections (SSTIs) affect theskin or tissues under the skin. They can cause redness, swelling, pain, warmth, and pus. SSTIs can be caused by bacteria, fungi, or other germs. Some common sources of SSTIs in older people are wounds, ulcers, insect bites, and surgical sites.
Factors that Increase the Susceptibility and Severity of Infections in the Elderly
Why do older people get more infections than younger people? And why are their infections more serious? Many factors make older people more vulnerable and less able to fight infections. Here are some of them:
Immune senescence: This means that the immune system, the body’s defense against germs, gets weaker as people age. The immune system has two parts: the innate immune system, which is the first line of defense, and the adaptive immune system, which is the second line of defense. Both parts of the immune system become less effective in older people. They produce fewer and less diverse antibodies, proteins that recognize and attack germs. They also have fewer and less active white blood cells, which are cells that fight germs. This makes it harder for older people to prevent and clear infections.
Comorbidities: Older people often have other health problems besides infections. These health problems can make infections worse or harder to treat. For example, diabetes can impair blood flow and wound healing, leading to more infections. Heart disease can reduce the oxygen supply to the tissues, making infections more severe. Kidney disease can affect drug elimination, affecting the dosage and effectiveness of antibiotics.
Invasive procedures: Older people often need medical devices or surgeries that can introduce germs into the body. For example, catheters, ventilators, pacemakers, and artificial joints can all be sources of infection. Surgeries can also cause wounds that can get infected. These infections can be harder to treat because they involve antibiotic-resistant germs.
Emerging and Resistant Pathogens that Pose a Threat to the Geriatric Population
What are pathogens? They are germs that can cause diseases. Some pathogens are more dangerous than others. They can be emerging or resistant. Emerging pathogens are new or rare germs that can cause outbreaks or epidemics. Resistant pathogens are germs that can survive or grow despite antibiotics. Both types of pathogens can pose a threat to the geriatric population. Here are some examples of them:
Methicillin-resistant Staphylococcus aureus (MRSA): This is a type of bacteria that can cause SSTIs, pneumonia, blood infections, and bone infections. It is resistant to many antibiotics, especially methicillin, a common drug used to treat staph infections. MRSA can be spread by contact with infected people or surfaces. It can cause severe and sometimes fatal infections in older people, especially those who have weak immune systems, wounds, or medical devices.
Vancomycin-resistant enterococcus (VRE): This type of bacteria can cause UTIs, blood infections, and wound infections. It is resistant to many antibiotics, especially vancomycin, a powerful drug used to treat serious infections. VRE can be spread by contact with infected people or surfaces. It can cause severe and sometimes fatal infections in older people, especially those who have weak immune systems, catheters, or surgeries.
Clinical Presentation and Diagnosis of Infections in the Elderly
How do you know if you or someone else has an infection? Usually, you look for signs and symptoms. You can see or measure signs like fever, rash, or blood pressure. You can feel or describe symptoms, such as pain, nausea, or fatigue. Signs and symptoms can help doctors diagnose infections and determine the best treatment.
But what if the signs and symptoms are not clear or typical? This can happen in older people, who may have different or fewer signs and symptoms of infections than younger people. This can make it harder to diagnose and treat infections in older people. This section will discuss the typical and atypical signs and symptoms of infections in older people and how they can be diagnosed using laboratory tests, imaging studies, and microbiologic cultures.
Typical and Atypical Signs and Symptoms of Infections in Older Adults
Some of the typical signs and symptoms of infections in older adults are:
Fever: This is when the body temperature is higher than normal, usually above 37.8°C (100°F). Fever is a sign that the body is fighting an infection. However, not all older people with infections have a fever. Some may have a low-grade fever below 38°C (100.4°F) or none. This can be due to the weakened immune system, the use of anti-inflammatory drugs, or the type of infection. Please remember that in most elderly patients, fever is a late sign that may not even show up.
Leukocytosis: This is when the number of white blood cells, which are part of the immune system, is higher than normal. Leukocytosis is a sign that the body is responding to an infection. However, not all older people with infections have leukocytosis. Some may have a normal or small number of white blood cells. This can be due to the weakened immune system, the use of steroids, or the type of infection.
Cognitive impairment: This is when mental abilities, such as memory, attention, or reasoning, are reduced or impaired. Cognitive impairment can be a symptom of an infection, especially in older people with dementia or delirium. However, not all older people with infections have cognitive impairment. Some may have normal or mild cognitive changes. This can depend on the severity and location of the infection, the presence of other health problems, or the use of medications.
Some of the atypical signs and symptoms of infections in older adults are:
Functional decline: This is when the ability to perform daily activities, such as walking, dressing, or eating, is reduced or impaired. Functional decline can be a symptom of an infection, especially in older people with frailty or disability. However, functional decline can also be caused by other factors, such as aging, chronic diseases, or depression. Therefore, it is important to rule out other causes before attributing functional decline to an infection.
Anorexia: This is when the appetite or desire to eat is reduced or lost. Anorexia can be a symptom of an infection, especially in older people with malnutrition or dehydration. However, anorexia can also be caused by other factors, such as medications, taste changes, or social isolation. Therefore, it is important to rule out other causes before attributing anorexia to an infection.
Pain is a sensation of discomfort or distress in a part of the body. It can be a symptom of an infection, especially in older people with arthritis or neuropathy. However, pain can also be caused by other factors, such as injury, inflammation, or cancer. Therefore, it is important to rule out other causes before attributing pain to an infection.
Role and Limitations of Laboratory Tests, Imaging Studies, and Microbiologic Cultures in the Diagnosis of Infections in the Elderly
How can doctors confirm if an older person has an infection? Besides looking for signs and symptoms, they can also use laboratory tests, imaging studies, and microbiologic cultures. These methods can help identify the type and source of the infection and guide the treatment. However, these methods also have some limitations and challenges for older people. Here are some of them:
Laboratory tests: These are tests that measure the levels of certain substances in the blood, urine, or other body fluids. Some of the standard laboratory tests for infections are complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and lactate. These tests can help indicate the presence and severity of an infection, but they are not specific or sensitive enough to diagnose the exact type of infection. They can also be affected by other factors, such as age, medications, or chronic diseases, which can alter the normal ranges or values in older people.
Imaging studies: These tests use machines to create pictures of the inside of the body. Standard imaging studies for infections include chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), and ultrasound. These tests can help locate and visualize the infection but are not always available or accessible in older people. They can also be costly, time-consuming, or invasive and expose older people to radiation or contrast agents, which can have side effects or complications.
Microbiologic cultures: These are tests that grow and identify the germs that cause the infection, such as bacteria, viruses, fungi, or parasites. Some common microbiologic cultures for infections are blood culture, urine culture, sputum culture, wound culture, and cerebrospinal fluid culture. These tests can help determine the type and sensitivity of the infection, but they are not always feasible or reliable in older people. They can also take a long time to produce results, delaying the treatment.
Need for Early Detection and Prompt Initiation of Treatment in Older Patients with Infections
Why is it essential to diagnose and treat infections in older people as soon as possible? Infections can have severe and sometimes fatal consequences. They can worsen existing health problems, cause new complications, or lead to sepsis, a life-threatening condition that occurs when the body’s response to an infection damages its organs. Therefore, detecting and treating infections in older people early and promptly is crucial.
How can we do that? By being aware and alert of the signs and symptoms of infections in older people and seeking medical attention when they occur. Using laboratory tests, imaging studies, and microbiologic cultures appropriately and judiciously and interpreting the results carefully and accurately. By starting the antibiotic therapy as soon as possible and adjusting the dose and duration according to the type and severity of the infection. By monitoring the response and outcome of the treatment and changing the strategy if needed. By preventing infections first, following the hygiene recommendations, and avoiding the risk factors and sources of infection.
Common Infections in Older Adults
Urinary Tract Infections (UTIs)
UTIs stand as the most prevalent bacterial infections among older adults. Symptoms may encompass fever, chills, confusion, agitation, and incontinence. Yet, pinpointing UTIs early in the elderly proves challenging, as typical signs like fever and leukocytosis are often absent. In older adults, a change in mental status, such as confusion or agitation, might be the sole indicator of a UTI.
Pneumonia
Pneumonia is a common respiratory infection in the elderly. Symptoms may involve cough, fever, chills, shortness of breath, chest pain, and confusion. Nonetheless, older adults might lack fever or cough, with confusion or a decline in functional status as their primary symptom.
Skin and Soft Tissue Infections
Skin and soft tissue infections, like cellulitis, are frequent in older adults. Symptoms may manifest as redness, warmth, swelling, and pain at the infection site. Cellulitis necessitates systemic antibiotic therapy, especially in patients displaying signs of systemic infection alongside bedsores.
Sepsis
Sepsis is a life-threatening condition caused by the body’s response to infection, which harms its tissues and organs. Symptoms in older adults may include lethargy, rapid breathing (tachypnea), appetite loss, dehydration, weakness, and confusion. Unique symptoms of infection in older patients encompass dehydration, weakness, and appetite loss.
Best Practices to Prevent Infections in Older Adults
Do you want to stay healthy and avoid getting sick? Of course you do! Nobody likes to have infections, illnesses caused by tiny germs that can make you ill. Infections can be quite common and severe in older people, who have a more challenging time fighting off germs than younger people. That is why it is essential to prevent infections in older people.
How can you do that? Following some simple tips can help you keep germs away from your body. Here are some of the best practices to prevent infections in older adults:
Hand hygiene: You should wash your hands often with soap and water or use alcohol-based hand sanitizers. Your hands can touch many things that have germs on them, such as doorknobs, faucets, phones, or keyboards. If you don’t wash your hands, you can transfer the germs to your mouth, nose, eyes, or other body parts and get sick. It would be best to wash your hands before and after eating, after using the bathroom, after coughing or sneezing, after touching animals, and after visiting someone sick. Washing your hands whenever they look dirty or sticky would be best.
Avoid close contact: This means that you should stay away from people who are sick or who have symptoms of an infection, such as fever, cough, or sore throat. It would be best to avoid crowded places where germs can spread quickly. If you must be near someone sick, wear a mask or ask them to wear one to prevent the germs from entering your airways. You should also avoid sharing personal items, such as cups, utensils, towels, or toothbrushes, with anyone who is sick or who may have germs on them.
Respiratory etiquette: Cover your mouth and nose with a tissue or sleeve when coughing or sneezing. This can help prevent germs from flying out of your mouth or nose and landing on other people or surfaces. Throw away the tissue, wash your hands, or use hand sanitizer afterward. You should also avoid coughing or sneezing into your hands because you can spread the germs to other things you touch.
Face touching: You should avoid touching your face, especially your eyes, nose, and mouth, with your hands. Your face has openings that can let germs into your body and make you sick. If you touch your face with your hands, you can transfer the germs from your hands to your face and increase the risk of infection. You should also avoid rubbing your eyes, picking your nose, or biting your nails because these habits can also introduce germs into your body.
Oral hygiene: You should take diligent care of your teeth and gums to prevent oral infections, such as tooth decay, gum disease, or thrush. Oral infections can cause pain, swelling, bleeding, or bad breath and affect overall health. Brushing your teeth at least twice daily using a soft-bristled toothbrush and fluoride toothpaste would be best. It would be best to floss your teeth at least once daily to remove the food and plaque that can cause cavities and gum problems. It would be best to visit your dentist regularly for check-ups and cleanings and to treat any oral issues you may have.
These are some of the best practices for preventing infections in older adults. Following these tips can reduce your chances of getting sick and improve your health and well-being. Remember, prevention is better than cure!
Treatment Approaches for Infections in Older Adults
How can you get better if you have an infection? The best thing is to get the proper treatment. Treatment helps your body fight off the germs that make you sick, can help you feel better, and can prevent complications.
But not all infections are the same. Germs, such as bacteria, viruses, fungi, or parasites, can cause them. They can also affect different parts of your body, such as your lungs, bladder, skin, or blood. They can also be mild, moderate, or severe, depending on how sick you are and how much the infection affects your health.
That is why the treatment for infections depends on the type and severity of the infection. In this section, we will talk about the standard treatment approaches for infections in older people.
Antibiotics for Bacterial Infections
Bacterial infections are infections caused by bacteria, which are tiny living things that can multiply and cause diseases. Some examples of bacterial infections are urinary tract infections (UTIs), pneumonia, and skin infections.
Antibiotics are the most common treatment for bacterial infections. They are drugs that can kill or stop the growth of bacteria. There are many antibiotics, each one against a specific type of bacteria. For example, penicillin is an antibiotic that can treat strep throat caused by streptococcus bacteria.
However, antibiotics are not always practical or safe. Some bacteria can become resistant to antibiotics, which means that the antibiotics cannot kill them anymore. This can make the infection harder to treat and more dangerous. Some antibiotics can also cause side effects or interactions with other drugs, harming your health. Therefore, you should only take antibiotics when your doctor prescribes them and follow the instructions carefully. It would be best not to take antibiotics for viral infections, such as the flu or the common cold, because they will not work and may cause harm.
Antiviral Medications for Viral Infections
Viral infections are caused by viruses, tiny particles that can infect and damage cells. Some examples of viral infections are influenza (the flu), herpes, and shingles.
The most common treatment for viral infections is antiviral medications. Antiviral medications can interfere with viruses’ life cycles and prevent them from multiplying and spreading. There are many kinds of antiviral medicines, each working against a specific type of virus. For example, oseltamivir is an antiviral medication that can treat influenza caused by a virus called influenza.
However, antiviral medications are not always practical or safe. Some viruses can become resistant to antiviral drugs, meaning the medicines cannot stop them anymore. This can make the infection harder to treat and more dangerous. Some antiviral medications can also cause side effects or interactions with other drugs, which can harm your health. Therefore, you should only take antiviral medications when your doctor prescribes them and follow the instructions carefully.
Hospitalization for Severe Infections
Severe infections are profoundly serious and can threaten life. Some examples are sepsis, meningitis, and endocarditis.
The most common treatment for severe infections is hospitalization. Hospitalization is when you stay in the hospital for medical care and monitoring. You can get the best treatment for your infection in the hospital, such as intravenous (IV) antibiotics or antiviral medications, fluids, oxygen, or surgery. You can also get the best support for your health, such as pain relief, nutrition, or physiotherapy. You can also get the best protection from complications, such as organ failure, shock, or death.
However, hospitalization is not always easy or pleasant. It can be stressful, uncomfortable, or lonely. It can also expose you to other infections, such as hospital-acquired infections, which you get while in the hospital. Therefore, you should only go to the hospital when necessary and follow the advice of your doctor and the hospital staff. It would be best if you also tried to stay positive, calm, hopeful, and connected with your family and friends. It would help if you also tried to recover and return to your home and normal activities as soon as possible.
Treatment for Terminal Illnesses
What if you have an infection and are very old and extremely sick? What if the doctors say that you have only a few months or weeks to live? What kind of treatment can you get?
When you have a terminal illness, it means that you have a disease that cannot be cured and will cause your death. When you have a terminal prognosis, it means that the doctors estimate how much time you have left to live. If you have a terminal prognosis of six months or less, you may want to change the focus of your treatment.
Instead of trying to cure your infection or prolong your life, you may want to focus on your comfort and quality of life. This is called palliative care. Palliative care is a type of care that helps you and your family cope with your illness and your symptoms. Palliative care can help you with things like:
Pain is when you feel hurt or sore in your body. It can make you unhappy. Palliative care can help you with pain by giving you medicines or other treatments that can make you feel better.
Nausea: This is when you feel sick and want to throw up. It can also make you lose your appetite and weight. Palliative care can help you with nausea by giving you medicines or other treatments that can make you feel better.
Breathlessness occurs when you have trouble breathing or feel you can’t get enough air. It can make you feel scared and anxious. Palliative care can help you with breathlessness by giving you oxygen or other treatments that can make you feel better.
Palliative care can also help you with other symptoms, such as fatigue, anxiety, depression, or insomnia. Palliative care can also help you with your emotional, spiritual, and social needs. Palliative care can help you express your feelings, find meaning and purpose, and connect with your loved ones.
One form of palliative care is hospice care. Hospice care is a type of care you can get in the final stages of your life. Hospice care can offer you comfort and support in your home, in a hospital, or in a particular facility. Hospice care can provide a team of professionals, such as doctors, nurses, social workers, chaplains, and volunteers, who can help you and your family with your physical, emotional, and spiritual needs. Hospice care can also provide you with equipment, supplies, and medicines that you may need.
When you have a terminal illness, you and your family can decide what kind of treatment you want for your infection. You can ask your doctor, your power of attorney (if you cannot make your own decisions), and your family to help you. You can get treatment for your infection, such as antibiotics or antiviral medications, or you can only get comfort care, such as pain relief or oxygen.
However, you should also be aware that if you are in the last week or two of your life, treatment for your infection may not help you much. It may not make you live longer or feel better. It may even make you feel worse or cause you more problems. Your body is too weak to fight or treat the infection. This is called futility. Futility means that the treatment is useless or harmful.
Therefore, you should think carefully about what kind of treatment you want for your infection when you have a terminal illness. You should weigh the benefits and risks of the treatment and consider your goals and values. It would be best to talk to your doctor, your power of attorney, and your family about your wishes and preferences. Writing your wishes and preferences in an advance directive document would be best. An advance directive is a way to tell your doctor and your family what kind of care you want or don’t want when you cannot speak for yourself. An advance directive can help you get the care that you want and avoid the care that you don’t want.
Conclusion
In conclusion, managing infections in the geriatric population is crucial due to the increased risk of morbidity and mortality. The unique challenges in diagnosing and treating infections in older adults, including the atypical presentation of symptoms and the limitations of diagnostic methods, necessitate a proactive approach to early detection and prompt initiation of treatment. Common infections such as urinary tract infections (UTIs), pneumonia, and skin and soft tissue infections pose significant risks to older adults, often presenting with atypical symptoms, making early identification challenging. Furthermore, the emergence of resistant pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococcus (VRE), underscores the importance of vigilance in infection prevention and control.
Emphasizing hand and oral hygiene is essential to preventing infections in older adults. Additionally, it is crucial to understand the treatment approaches for different types of infections, including the appropriate use of antibiotics for bacterial infections and the challenges associated with antiviral medications for viral infections.
In summary, a comprehensive approach to managing infections in the geriatric population involves early recognition of atypical symptoms, judicious use of diagnostic methods, proactive infection prevention strategies, and tailored treatment approaches to ensure the well-being of older adults. By prioritizing these measures, healthcare providers, caregivers, and family members can contribute to the overall comfort and quality of life for older adults facing infections.
