Infections In The Elderly

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Epidemiology 4 Clinical-manifestations 5 Management 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• infectious arthritis in the elderly
• infectious outbreaks in nursing homes

Etiology

• incidence & type of infection varies with functional status

• healthy, independent elderly

• pneumonia*
• bronchitis
• urinary tract infection*
• endocarditis, especially due to Enterococci
• intra-abdominal infections - diverticulitis - cholangitis
• recurrent Herpes zoster ( shingles)

• frail, debilitated residents of long-term care facilities

• pneumonia secondary to aspiration

• dysphagia
• feeding gastrostomy

• epidemic viral respiratory infections ( influenza, RSV)
• urinary tract infections

• catheter-associated urinary tract infection
• urinary retention

• skin & other soft tissue infections*
• epidemic gastroenteritis
• tuberculosis ( reactivation)

• hospitalized, acutely ill elderly

• urinary tract infection

• urinary catheter infections

• pneumonia -> aspiration
• catheter-related infections
• wound infections

• surgery
• diabetes mellitus
• vascular disease

• microbial etiology in elderly differs from younger patients
• * three most common infections in the geriatric population

Epidemiology

• incidence & prevalence
• many types of infections are more common in the elderly
• morbidity & mortality is generally higher in the elderly

Clinical-manifestations

• fever may be absent or blunted 20-50% of infections
• leukocytosis may be absent
• atypical presentation of infection is common

• altered mental status
• falls
• failure to thrive

Management

• reducing morbidity & mortality for infections in the elderly

• prevention ( prophylaxis)
• early recognition/ empiric antimicrobial therapy
• asymptomatic bacteriuria requires no treatment

• antibiotic resistance in long-term care facilities

• ongoing surveillance for antibiotic resistance

• molecular typing of isolates when rate of antibiotic resistance increases

• hygiene control to limit spread of single clonal strains
• antibiotic controls to limit spread of multiple strains of antibiotic resistant bacteria
• administrative support, resources, monitoring adherence to control measures with appropriate feedback
• appropriate screening & cohorting of colonized & infected individuals

• prevention/ prophylaxis:

• influenza vaccination (patients & health care workers)
• Pneumovax
• tetanus immunization
• hepatitis B vaccination

More General Terms

• geriatrics
• infection (infectious disease)

Additional Terms

• age-associated changes in immunity
• antibiotic resistance in nursing homes
• antibiotic side effects in the elderly

References

1. Norman D, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
2. Internal Medicine World Report 2006; 21(2)
3. High KP et al, Clinical practice guidelines for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Disease Society of America. Clin Infect Dis 2009, 48:149 PMID: [1]
4. National Guideline Clearinghouse Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. ngc-guideline: [2]

infections in the elderly