Dr Asmaa fathy abdellah hassan Infection in Elderly Dr Asmaa fathy abdellah hassan Lecturer of Geriatric Medicine Department of Geriatric and Gerontology Ain Shams University

keynote INTRODUCTION RISK FACTORS FOR INFECTIONS IN ELDERLY Aging immunity ELDERLY ‘S EXPOSURE TO RESISTANT ORGANISMS Indicators of infection Different types of infection vaccination

INTRODUCTION • Infectious diseases have a significant morbidity and mortality in the elderly population even in the modern era of antibiotics. • Older adults are more likely to be hospitalized as a result of infectious processes and the longer the hospital stay, the greater the likelihood that they will develop infectious complications. • The clinical presentation of infection in the elderly is often atypical, subtle, and elusive. • This makes early diagnosis and initiating treatment a challenge.

• Elderly may not only have fewer symptoms, but might present with nonspecific consequences of infection that on the surface appear unrelated. • Aside from prevention, early diagnosis with rapid institution of antimicrobial therapy is the mainstay of treatment for reducing the high morbidity and mortality of infection in the aged. EXAMPLES ON NONSPECIFIC SYMPTOMS: • Generalized malaise • Falls • Changes in mental status or cognitive impairment • Anorexia

RISK FACTORS FOR INFECTIONS IN ELDERLY • Immune aging. • comorbid illnesses. • increased exposure to pathogens in institutions. • complications of medical treatment.

ELDERLY ‘S EXPOSURE TO RESISTANT ORGANISMS: •Elderly are more likely to harbour resistant organisms as more likely to be – Hospitalised – Admitted to nursing home – Exposed to multiple antibiotics •Methicillin-resistant Staphylococcus aureus (MRSA). vancomycin-resistant enterococci (VRE). • fluoroquinolone-resistant Streptococcus pneumoniae

COMPLICATION OF TREATMENT • Invasive devices, which include indwelling urinary catheters, intravenous catheters, feeding tubes, and tracheostomies, are more common in the elderly. • These devices compromise host defenses enabling bacteria to enter the body and cause infection. • Chemotherapeutic, immunosuppressive therapy.

OUTCOMES FROM INFECTION IN ELDERLY • the mortality from common infections is 2- to 20-fold higher than in younger adults. • Declines in the host inflammatory response, impaired functional status, presence of comorbid illness, and virulence of the infecting pathogen all contribute to the severity of the infection and increased likelihood of death. • In addition, delay in diagnosis and lack of treatment contribute substantially to mortality from infection in older adults.

THE DELAY IN DIAGNOSING INFECTION IN ELDERLY The clinical findings of infection such as fever, changes in laboratory tests, and physical findings may be atypical in older adults. • the normal baseline temperatures are lower in elderly. The febrile response may be absent or blunted in infected older adults. • Other aspects of the inflammatory response, such as leukocytosis, may be lacking in the older adult patient. • Because of the lack of an inflammatory response, many older adults will not have localizing symptoms or focal findings on physical examination..

• For example, typical signs of peritonitis may be unimpressive or absent in the older adult with appendicitis, diverticulitis, or cholecystitis. • the older adult with altered cognitive function may not be able to perceive symptoms of infection or communicate them to their health care provider

Fever the cardinal feature of infection, is absent in 30 to 50 percent of frail, older adults, even in the setting of serious infections like pneumonia or endocarditis. • The blunted febrile response in older adults is due to changes in multiple systems responsible for thermoregulation: shivering, hypothalamic regulation and thermogenesis by brown adipose tissue are all impaired with advanced age. Fever definition — Relatively healthy, community-dwelling older adults may be appropriately managed using conventional definitions of fever.

Fevers >38°C .indicate a potential for serious infection, while hypothermia relative to baseline body temperatures may signify severe infection or even sepsis . Fever in frail elderly patients may be considered as one or more of the following: Single oral temperature >37.8°C (>100ºF) Persistent tympanic membrane temperature ≥37.2°C (99.0ºF) Rectal temperature ≥37.5°C (99.5ºF) Rise in temperature of ≥1.1°C (≥2°F) above baseline temperature

Different types of infection

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