The critically ill older patient with sepsis: a narrative review

Abstract

Sepsis is a significant public health concern, particularly affecting individuals above 70 years in developed countries. This is a crucial fact due to the increasing aging population, their heightened vulnerability to sepsis, and the associated high mortality rates. However, the morbidity and long-term outcomes are even more notable. While many patients respond well to timely and appropriate interventions, it is imperative to enhance efforts in identifying, documenting, preventing, and treating sepsis. Managing sepsis in older patients poses greater challenges and necessitates a comprehensive understanding of predisposing factors and a heightened suspicion for diagnosing infections and assessing the risk of sudden deterioration into sepsis. Despite age often being considered an independent risk factor for mortality and morbidity, recent research emphasizes the pivotal roles of frailty, disease severity, and comorbid conditions in influencing health outcomes. In addition, it is important to inquire about the patient's preferences and establish a personalized treatment plan that considers their potential for recovery with quality of life and functional outcomes. This review provides a summary of the most crucial aspects to consider when dealing with an old critically ill patient with sepsis.

Inflammaging in Multidrug-Resistant Sepsis of Geriatric ICU Patients and Healthcare Challenges

“…Particularly, aging exacerbates the rate of sarcopenia and frailty post-sepsis, leading to accelerated muscle loss and increased frailty in older adults. This results from sepsis-induced muscle wasting, prolonged immobility, and pre-existing age-related muscle decline [107]. Aging widens the spectrum of severity in sarcopenia and frailty, influencing outcomes in older populations.…”

“…Exploring alternative treatment strategies, such as immunomodulatory therapies, is also pivotal in enhancing the immune response of older adults, who may have diminished immune function due to age-related changes. Personalized care is another significant area, with an emphasis on developing individualized treatment plans that consider factors such as frailty, comorbidities, and patient values, acknowledging the complexity and heterogeneity of the geriatric population [107]. Improving data collection and standardization is crucial for better understanding the epidemiology of sepsis in older adults, which can guide research, policy, and clinical practice.…”

“…Improving data collection and standardization is crucial for better understanding the epidemiology of sepsis in older adults, which can guide research, policy, and clinical practice. Lastly, there is a need for strategies that improve early diagnosis and intervention in older adults, who are at higher risk for delayed diagnosis and poor outcomes, to mitigate the significant morbidity and mortality associated with sepsis in this age group [107,108].…”

Revolution in sepsis: a symptoms-based to a systems-based approach?

“…5 ) [ 16 ]. Dehydration is common in older adults, often necessitating an initial 500 mL crystalloid bolus [ 80 ]. Prior to 2001, use of fluid resuscitation was largely based on historical experience without empirical support from either animal studies or clinical trials [ 16 ].…”

“…Males appear to have a higher risk of mortality than females [122], which may be due to females having a more robust cell-mediated immune response [144]. Sepsis continues to pose a significant threat to the senior population with their lower physiological reserves and multiple comorbidities [80]. Sepsis is a clinical syndrome that develops from a dysregulated host response to infection [68,91].…”