Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review

Abstract

Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mortality, and higher healthcare costs. This is because the microorganisms involved are multidrug-resistant and, therefore, more difficult to eliminate. Moreover, geriatric patients are frequently transferred from one facility (nursing homes, skilled nursing facilities, home care, and other specialty clinics) to another or from one hospital ward to another; these transitions cause care fragmentation, which can undermine the effectiveness of treatment and allow pathogens to be transferred from one setting to another and from one person to another. Multifactorial efforts such as early recognition of infections, restricted use of invasive devices, and effective infection control measures (surveillance, isolation practices, hand hygiene, etc.) can contribute to significant reduction of HAIs in geriatric patients.

Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta‐analysis of matched studies

“…The current meta‐analysis noted a shorter hospital stay in those undergoing laparoscopic surgery. This is an important finding as a prolonged hospital stay within elderly patients, could predispose them to an increased risk of hospital‐acquired infections, leading to a substantial reduction in their functional capacity and increasing their out‐of‐pocket expenditure 56,57 . A decrease in functional status in these vulnerable patients could increase their risk of dependency and decrease their quality of life.…”

“…This is an important finding as a prolonged hospital stay within elderly patients, could predispose them to an increased risk of hospital-acquired infections, leading to a substantial reduction in their functional capacity and increasing their out-of-pocket expenditure. 56,57 A decrease in functional status in these vulnerable patients could increase their risk of dependency and decrease their quality of life. The review also noted an increased operative time following laparoscopic surgery compared to open surgery.…”

Healthcare-related infections within nursing homes (NHS): A qualitative study of care practices based on a systemic approach

“…4,5 There are many microorganism responsible of these infections and many of these are multidrug-resistant, which is why the prevention of their transmission is essential. 6 The infection can be contracted at different times and settings 7 making infection control approaches a criticism in these structures. 8 However, even if the prevention intervention are easy-to-do 8 and cost-effective, 9 this phenomenon still remains in focus.…”

Infections and hospital bed-days among aging adults: A five-year retrospective study in a Belgian general hospital

“…Elderly patients are at high risk for healthcare-associated (HA) or nosocomial infections due to the age-related decline in the immune system, along with co-morbid conditions that often complicate infections and diminish the ability to treat them effectively. HA infections in elderly patients are therefore responsible for longer hospital stays, extended antibiotic therapy, significant mortality, and higher healthcare costs ( 19 , 20 ). Importantly, those infections are difficult to treat, and might often be caused by antibiotic resistance ( 21 , 22 ).…”