Effect of Aging on the Clinical Significance of Fever in Ambulatory Adult Patients

Abstract

To study the effect of age on ultimate outcome of febrile illness, the authors prospectively studied 1,202 adult patients who came to an emergency room/walk-in clinic setting with temperatures of 101.0 degrees F (38.3 degrees C) or more. The patients were divided into four age categories: 17 to 40 years, 40 to 59 years, 60 to 79 years, and 80 years old or older. Advancing age was significantly (P less than 0.0005) associated with more serious disease, a higher rate of bacterial pathogen isolation, and a higher rate of life-threatening or deadly consequences. Of patients 17-39 years old, 58.2 per cent had viral syndromes, otitis media, or pharyngitis as the causes of fever. Of patients aged 40-59 years, only 20.7 per cent had one of these diseases. However, of patients 60 years old or older, only 4.1 per cent (15 of 370) had viral syndromes, otitis media, or pharyngitis, and the overall rate of hospitalization for this group was 92.5 per cent. The authors conclude that febrile patients 60 years old or older seen in emergency room/ambulatory care settings are extremely likely to have serious diseases. Caution should be exercised before concluding that their fevers are of benign origin.

Predictors of outcome in geriatric patients with urinary tract infections

“…Although the presence of fever may often indicate significant infection, its absence may not reliably exclude serious illness (28,29). In this study, abnormal temperature was significantly correlated only with prolonged duration of i.v.…”

Influence of Aging and Environment on Presentation of Infection in Older Adults

“…34 It is important to recognize that a robust fever of 38.3°C or higher in a geriatric patient is indicative of a serious infection and needs to be promptly addressed. 40 …”

Fever in the Elderly

“…In older persons, a robust febrile response to infection has special significance. One large study of 11200 ambulatory patients demonstrated that an oral temperature of 38.3ЊC in elderly patients was usually due to a serious bacterial or viral infection [36]. Fever or at least an elevation of temperature over baseline will still occur in most cases of infection in the geriatric patient.…”

“…Fever or at least an elevation of temperature over baseline will still occur in most cases of infection in the geriatric patient. However, unlike in the young, whose fevers are associated mostly with benign viral infections, in the elderly (especially those aged 180 years), oral temperatures reaching or exceeding 38.3ЊC will more likely be associated with serious bacterial or viral infections [36][37][38]. This can be expected to be particularly true for frail, debilitated patients.…”