Infections in elderly

Infections carry high morbidity and mortality in elderly people. They have higher risk of hospitalization. Identifying and diagnosing infections at the earliest is essential. Although prevention is the best possible treatment. Aging changes in the body make the older adults vulnerable to various infections. Bedridden and hospitalized patients are at further risk of acquired infections. We need to be aware and alert about onset and progress of infections to prevent mortality.

Common infections seen in elderly are bacterial pneumonia, influenza, skin infections, urinary tract infections, gastrointestinal infections. Signs and symptoms may be masked due to underlying chronic illnesses, existing ongoing chronic inflammatory diseases. Nonspecific symptoms may start, they can be subtle or sometimes atypical to presentation of infections. Thus, diagnosis get delayed if we are not vigilant about the general condition and newer changes in health condition of the patient. Loss of appetite, incontinence, mental status changes like confusion, delirium, drowsiness are more common than typical fever and related signs. Decline in function, disinterest, sleep pattern changes can also be presenting symptoms.

Elderly are susceptible to pneumonia like infections due to decrease in their lung capacity, COPD, old fibrosis, etc lung parenchymal changes. Weakened immunity adds to the susceptibility. Inability to resist diseases increase the proneness to easily acquiring infections. Cellulitis, herpes, pressure ulcers are some other skin infections more commonly seen in older patients than younger ones. Diabetes can lead to skin, urine infections if uncontrolled sugars. Urinary catheters cause recurrent infections if long standing and untreated. Gastrointestinal infections are common due to change in intestinal flora. H.pylori and clostridial infections can be subsequent to chronic antibiotic or steroids use.

Preventing infections is the best policy to reduce further deterioration in general condition of the patient.

Annual flu vaccine is recommended. Pneumococcal vaccine is indicated in high risk, interstitial lung disease, chronic debilitated patients.