Sepsis in the older person

Abstract

Background: Sepsis is a common condition, with an estimated 30 million cases worldwide each year, resulting in 6 million sepsis-related deaths. Some 60% of all sepsis events and 80% of sepsis-associated deaths occur in the older population. This is because the ageing process, and the presence of multiple comorbidities, make many older people vulnerable to developing, and dying from, sepsis. However, serious illness and death from sepsis can be avoided if the signs and symptoms are identified quickly, and interventions started early. Methods: This article explains current research and guidelines with regard to the causes, recognition, treatment and prevention of sepsis in the older population, and considers the role of care home staff in supporting effective care of residents as risk of developing sepsis. Conclusions: Care home staff are well-positioned to recognise sepsis and contribute to treatment, as their in-depth knowledge of residents makes it easier for them to identify changes in residents' behaviours and health status, which may indicate sepsis. By taking steps to ensure the risk of developing infections is reduced, care home staff can make a valuable contribution to the prevention of sepsis.

Perceptions of Relatives about Symptoms and Signs in Older Adults with Sepsis: A Cross-Sectional Study

“…These additional symptoms and signs are both typical and atypical presentations of sepsis, as verified in the criteria of Centers for Disease Control and Prevention (CDC) 1 and previous studies. 2,5,6,7,16,26 These findings supported the existing knowledge that sepsis frequently manifests as a variety of presenting symptoms and signs. 2,26 In terms of the top five typical presentations in our study, these were drowsiness/deep sleep, rapid breathing/gasping, fever, chilling, and difficulty breathing/ shortness of breath/dyspnea, which were consistent with the typical presentations from the previous studies 2,6,27,28 and CDC information, which indicate that a patient with sepsis may present one or more of the following symptoms or signs, rapid heart rate or low blood pressure, fever, shivering or feeling very cold, confusion or disorientation, shortness of breath, extreme pain or discomfort, and clammy or sweaty skin.…”

“…2,5,6,7,16,26 These findings supported the existing knowledge that sepsis frequently manifests as a variety of presenting symptoms and signs. 2,26 In terms of the top five typical presentations in our study, these were drowsiness/deep sleep, rapid breathing/gasping, fever, chilling, and difficulty breathing/ shortness of breath/dyspnea, which were consistent with the typical presentations from the previous studies 2,6,27,28 and CDC information, which indicate that a patient with sepsis may present one or more of the following symptoms or signs, rapid heart rate or low blood pressure, fever, shivering or feeling very cold, confusion or disorientation, shortness of breath, extreme pain or discomfort, and clammy or sweaty skin. 1 Regarding the atypical presentations found in our study, malaise/fatigue, loss of appetite/reduced food intake, signs of dehydration, comorbidity exacerbations, and decreased activities of daily living were the top five most common atypical presentations.…”

“…1 Previous studies have also identified atypical presentations of symptoms and signs in older adults with sepsis. 2,4,6,7 Atypical presentations are defined as no signs and symptoms or unusual signs and symptoms that are unrelated to sepsis or even the reverse of what is expected. 7 There are 11 atypical presentations found in older adults, including malaise/fatigue, restless/ agitation, skin rash, dizziness/fainting/unconsciousness, signs of dehydration, comorbidity exacerbations, loss of appetite/reduced food intake, urine or feces incontinence, decreased walking, decreased activities of daily living, and falls.…”

“…1 Many factors contribute to the higher prevalence of sepsis in older adults, such as aging itself due to changes in the immune system, preexisting co-morbidities with multiple drugs, use of invasive medical devices, poor functional status, malnutrition, and recurrent hospitalization. 2 As the…”