Source: Predisposition to Infection in the Elderly

remain a significant contributor to mortality among older adults, even with advancements in antibiotic treatments. Managing in this population poses unique challenges, necessitating early detection and treatment due to the increased risk of morbidity and mortality. In this article, we 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 happen in diverse groups of people. In this section, we will talk about the epidemiology and risk factors of infections in older people.

Common Types and Sources of Infections in Older Adults

Older people can get many kinds of infections, but some are more common than others. Here are some of the most common types and sources of infections in older adults:

  • Pneumonia: This is an infection that affects the lungs. It can make it hard to breathe and cause coughing, chest pain, and fever. Pneumonia can be caused by bacteria, viruses, fungi, or other germs. Some of the common 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): This is an infection that affects the bladder, kidneys, or other parts of the urinary system. It can cause pain or burning when urinating, frequent or urgent need to urinate, blood in the urine, and fever. UTIs can be caused by bacteria, fungi, or other germs. 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): This is an infection that affects the skin or the tissues under the skin. It can cause redness, swelling, pain, warmth, and pus. SSTIs can be caused by bacteria, fungi, or other germs. Some of the 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? There are many factors that make older people more vulnerable and less able to fight off infections. Here are some of them:

  • Immune senescence: This means that the immune system, which is 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, which are 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: This means that 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 the blood flow and the healing of wounds, which can lead to more infections. Heart disease can reduce the oxygen supply to the tissues, which can make infections more severe. Kidney disease can affect the elimination of drugs, which can affect the dosage and effectiveness of antibiotics.
  • Invasive procedures: This means that 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 can involve germs that are resistant to antibiotics.

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 the use of 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, which is a common drug used to treat staph infections. MRSA can be spread by contact with infected people or surfaces. It can cause serious and sometimes fatal infections in older people, especially those who have weak immune systems, wounds, or medical devices.
  • Vancomycin-resistant enterococcus (VRE): This is a type of bacteria that can cause UTIs, blood infections, and wound infections. It is resistant to many antibiotics, especially vancomycin, which is 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. Signs are things that you can see or measure, such as fever, rash, or blood pressure. Symptoms are things that you can feel or describe, such as pain, nausea, or fatigue. Signs and symptoms can help doctors diagnose infections and decide on 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. In this section, we will talk about 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, which is below 38°C (100.4°F), or no fever at all. 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 . 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:

  • : This is when the ability to perform daily activities, such as walking, dressing, or eating, is reduced or impaired. 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, changes, or social isolation. Therefore, it is important to rule out other causes before attributing anorexia to an infection.
  • Pain: This is when there is a sensation of discomfort or distress in a part of the body. Pain 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 are methods that can help identify the type and source of the infection and guide the treatment. However, these methods also have some limitations and challenges in 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 common 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 are tests that use machines to create pictures of the inside of the body. Some of the common imaging studies for infections are chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), and ultrasound. These tests can help locate and visualize the infection, but they 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 of the 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, which can delay the treatment.

Need for Early Detection and Prompt Initiation of Treatment in Older Patients with Infections

Why is it important to diagnose and treat infections in older people as soon as possible? Because infections can have serious and sometimes fatal consequences in older people. Infections can worsen the existing health problems, cause new complications, or lead to sepsis, which is a life-threatening condition that occurs when the body's response to an infection damages its own organs. Therefore, it is crucial to detect and treat infections in older people early and promptly.

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. By 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 the infections in the first place, by following the hygiene and vaccination 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, , 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 , might be the sole indicator of a UTI.

Pneumonia

Pneumonia is a common respiratory infection in the elderly. Symptoms may involve cough, fever, chills, , chest pain, and confusion. Nonetheless, older adults might lack fever or cough, with confusion or a decline in functional status serving 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 stemming from the body's response to infection, inflicting harm on 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, which are illnesses caused by tiny germs that can make you sick. Infections can be quite common and serious in older people, who have a harder time fighting off germs than younger people. That is why it is especially important to prevent infections in older people.

How can you do that? By following some simple and straightforward tips that can help you keep germs away from your body. Here are some of the best practices to prevent infections in older adults:

  • Hand hygiene: This means that 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 parts of your body, and get sick. You should wash your hands before and after eating, after using the bathroom, after coughing or sneezing, after touching animals, and after visiting someone who is sick. You should also wash your hands whenever they look dirty or feel sticky.
  • 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. You should also avoid crowded places, where germs can spread easily. If you must be near someone who is sick, you should 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: This means that you should cover your mouth and nose when you cough or sneeze, using a tissue or your sleeve. This can help prevent the germs from flying out of your mouth or nose and landing on other people or surfaces. You should also throw away the tissue after using it and wash your hands or use hand sanitizer. You should also avoid coughing or sneezing into your hands, because you can spread the germs to other things that you touch.
  • Face touching: This means that 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: This means that 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 can also affect your overall health. You should brush your teeth at least twice a day, using a soft-bristled toothbrush and fluoride toothpaste. You should also floss your teeth at least once a day, to remove the food and plaque that can cause cavities and gum problems. You should also visit your dentist regularly, for check-ups and cleanings, and to treat any oral problems that you may have.

These are some of the best practices to prevent infections in older adults. By following these tips, you can reduce the 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? You need to get the right treatment for your infection. Treatment is the way to help your body fight off the germs that make you sick. Treatment can also help you feel better and prevent complications.

But not all infections are the same. They can be caused by different kinds of germs, such as bacteria, viruses, fungi, or parasites. 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 common 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.

The most common treatment for bacterial infections is antibiotics. Antibiotics are drugs that can kill or stop the growth of bacteria. There are many kinds of antibiotics, and each one works against a specific type of bacteria. For example, penicillin is an antibiotic that can treat strep throat, which is caused by a type of bacteria called streptococcus.

However, antibiotics are not always effective 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, which can harm your health. Therefore, you should only take antibiotics when they are prescribed by your doctor and follow the instructions carefully. You should not 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 infections caused by viruses, which are 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 are drugs that can interfere with the life cycle of viruses and prevent them from multiplying and spreading. There are many kinds of antiviral medications, and each one works against a specific type of virus. For example, oseltamivir is an antiviral medication that can treat influenza, which is caused by a type of virus called influenza virus.

However, antiviral medications are not always effective or safe. Some viruses can become resistant to antiviral medications, which means that the medications 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 they are prescribed by your doctor and follow the instructions carefully. You should also get vaccinated against viral infections, such as the flu or shingles, to prevent them from happening in the first place.

Hospitalization for Severe Infections

Severe infections are infections that are profoundly serious and can threaten your life. Some examples of severe infections 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. In the hospital, you can get the best treatment for your infection, 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 are infections that you get while staying in the hospital. Therefore, you should only go to the hospital when it is necessary and follow the advice of your doctor and the hospital staff. You should also try to stay positive, calm, and hopeful, and stay connected with your family and friends. You should also try to recover as soon as possible and go back to your home and your normal activities.

Treatment for Terminal Illnesses

What if you have an infection and you 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: This is when you feel hurt or sore in your body. Pain can make you feel miserable and 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 to your stomach and want to throw up. Nausea can make you lose your appetite and your weight. Palliative care can help you with nausea by giving you medicines or other treatments that can make you feel better.
  • Breathlessness: This is when you have trouble breathing or feel like you can't get enough air. Breathlessness 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 in your life, and connect with your loved ones.

One form of palliative care is . is a type of care that you can get when you are in the final stages of your life. Hospice care can offer you comfort and support in your home, in a hospital, or in a special facility. Hospice care can provide you with 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.

You and your family can decide what kind of treatment you want for your infection when you have a terminal illness. You can ask your doctor, your power of attorney (if you cannot make your own decisions), and your family to help you with your choice. You can choose to get treatment for your infection, such as antibiotics or antiviral medications, or you can choose to get only , 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. This is because your body is too weak to fight the infection or handle the treatment. 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. You should also talk to your doctor, your power of attorney, and your family about your wishes and preferences. You should also write down your wishes and preferences in a document called an advance directive. 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.

To prevent infections in older adults, emphasizing hand hygiene, oral hygiene, and vaccination is essential. Additionally, understanding 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, is crucial.

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.

Resources

The Importance of Caregiver Journaling

Reporting Changes of Condition to Hospice

Common Infections in Older Adults

Common Infections in the Elderly: Causes, Facts, and Treatments

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

Infections in the Elderly Critically-Ill Patients

Predisposition to Infection in the Elderly

Challenges with Diagnosing and Managing Sepsis in Older Adults

Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities

Standard Precautions

Skin and Wound Infections: An Overview

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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