Fever Response in Elderly Nursing Home Residents: Are the Older Truly Colder?

Castle, Steven; Norman, Dean C.; Yeh, Michael W.; Miller, D. K.; Yoshikawa, Thomas T.

doi:10.1111/j.1532-5415.1991.tb04450.x

Cited by 152 publications

(104 citation statements)

References 29 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As specific symptoms are often lacking [9][10][11] the presence of fever, in terms of > 38°C, is often evaluated as a significant symptom of illness and an important reason for taking further action. However, fever in frail NHR has been reported to be lower than traditionally stated [17][18][19]. In addition, the effects on body temperature from medication with paracetamol daily have to be considered.…”

Section: Discussionmentioning

confidence: 99%

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

Sund‐Levander

Grodzinsky

2015

Clin Med Rev Case Rep

View full text Add to dashboard Cite

rectally. One morning nursing assistants (NA) observed that Mr. Nilsson was behaving differently, e.g. he did not feel well, expressed as "expression in the eyes", less appetite, lethargy and general signs of illness. They also observed respiratory symptoms. The NA continued to report about his changed condition for the next few days to the registered nurse (RN), who noted that he might have a cold but took no further action as he did not have a fever. His ear temperature was 37.6°C in the morning and 36.8°C in the afternoon the first day, and 37.2°C in the morning and 37.3°C in the evening the second day. Day six Mr. Nilsson's temperature is 38.1°C and hence the RN informs the general practitioner (GP), who takes no further action. There is no more RN documentation about his condition until day 16, when the RN order paracetamol due to increased body temperature (38.9°C). The next morning the nurse contacts the GP who prescribes antibiotics due to suspected pneumonia. The condition worsens and Mr. Nilsson dies on day 24. See flowchart over the 24 days in figure 1. DiscussionThis case illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. It is well known that nonspecific symptoms and lack of specific ones are common in NHR [9-11], contributing to a delayed diagnosis and treatment [10]. These atypical signs are observed as absence of fever, weakness, falling, weight loss, physical dysfunction and cognitive decline [3,7,[12][13][14]. In addition, early signs of infection are very similar to, and also as diffuse as, signs of acute illness [12,15,16]. Changes, such as lethargy, weakness, decreased appetite, agitation, disorientation, dizziness, falls and delusions are reported to have high predictive values for acute illness in frail elderly [16]. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. An individual that normally is confused, anxious and restless may become apathetic and infirm, or vice versa, when infection is suspected. On the other hand, an individual who normally is unrestrained could become more confused, aggressive, anxious and restless. As specific symptoms are often lacking [9][10][11] the presence of fever, in terms of > 38°C, is often evaluated as a significant symptom of illness and an important reason for taking further action. However, fever in frail NHR has been reported to be lower than traditionally stated [17][18][19]. In addition, the effects on body temperature from medication with paracetamol daily have to be considered. AbstractSigns and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms ...

show abstract

Section: Discussionmentioning

confidence: 99%

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

Sund‐Levander

Grodzinsky

2015

Clin Med Rev Case Rep

View full text Add to dashboard Cite

show abstract

“…Örneğin ruptüre olmuş bir aort anevrizması yaşlı hastada acil defekasyon hissine neden olabilir, ya da apandisiti olan yaşlı hastalar sadece artmış defekasyon sıklığı ile başvurabilir. Ciddi akut batın problemi olsa da yaşlı hastalar genellikle afebrildirler (22,23). Hipotansif olması gereken kronik hipertansiyonu bulunan bazı geriatrik hastalarda kan basıncı değerleri yanıltıcı biçimde normal ölçülebilir.…”

Section: Tanı Koymada Güçlüklerunclassified

Geriatrik hastada akut karın ağrısına yaklaşım

Ersel¹

2014

Ege Tıp Dergisi

View full text Add to dashboard Cite

Dünya nüfusunun hızla yaşlanması sonucu acil servislere karın ağrısı ile başvuran geriatrik yaş grubu hasta sayısı da hızla artmaktadır. Değişen fizyoloji, komorbid hastalıklar, iletişim güçlükleri, çoklu ilaç kullanımı, yaşlı hastalarda akut karın tablosunda tanı koymayı güçleştirmektedir. Bu güçlüklere karşın bir çok hastanın organ spesifik tanısı acil serviste konmaktadır. Geriatrik yaş grubundaki hastalarda karın ağrısı tablosunda altta yatan bir cerrahi patoloji olma olasılığı yüksektir. Bu nedenle geriatrik hastaların karın ağrılarında tetkik ve konsültasyon istemleri diğer hasta gruplarına oranla daha hızlandırılmış ve öncelikli olarak yapılmalı, tanı güçlüğü çekilen hastalarda yatış ile gözlem ön plana alınmalıdır.Anahtar Sözcükler: Acil servis, acil yaklaşım, akut batın, geriatrik hasta. Summary As a result of rapidly aging of the world's population, the number of patients admits with complaint of acute abdominal pain to the emergency deparments in the geriatric age group is increasing. Changing physiology, comorbid disorders, barriers to communication and polypharmacy makes it difficult to make diagnosis in elderly patients

show abstract

“…Castle SC & Al (1991) found that, in a nursing home population, baseline body temperatures are approximately 0.5°C below those of a normal young person and that with infection, despite a rise in temperature comparable to that seen in the young, the maximum temperature may be below the traditional definition of fever. However, a temperature of 37.8°C coupled with a decline in functional status is highly indicative of infection in this population.…”

Section: Clinical Presentation Of Infectionsmentioning

confidence: 99%

“…However, a temperature of 37.8°C coupled with a decline in functional status is highly indicative of infection in this population. (Castle SC & Al, 1991) The presence or absence of fever-aside from facilitating or inhibiting the diagnosis of infection-has other implications. The presence of fever (as defined by an oral temperature of 38.3°C) is highly specific for the presence of a serious, usually bacterial, infection (Keating MJ III, & Al, 1984;Wasserman M & Al, 1989).…”

Section: Clinical Presentation Of Infectionsmentioning

confidence: 99%