From the Guidelines
Elderly individuals can be septic without having a fever due to age-related changes in their immune system and thermoregulatory responses. As people age, their immune system becomes less efficient (immunosenescence), resulting in a diminished inflammatory response to infections 1. The body's ability to mount a fever, which is a protective mechanism against infection, becomes impaired. Additionally, older adults often have a lower baseline body temperature, so even when they do develop a fever, it might not reach the traditional threshold of 38°C (100.4°F).
Some key points to consider in the diagnosis of sepsis in elderly patients include:
- Chronic conditions common in the elderly, such as diabetes or kidney disease, can further suppress fever responses
- Medications frequently prescribed to older adults, including non-steroidal anti-inflammatory drugs, steroids, and certain psychiatric medications, can mask fever symptoms
- The clinical manifestations of diseases and infections are often subtle, atypical, or nonexistent in the very old, making diagnosis more challenging 1
- Healthcare providers should maintain a high index of suspicion for sepsis in elderly patients who present with subtle changes in mental status, increased respiratory rate, decreased blood pressure, or other non-specific symptoms, even without fever
It is essential to note that the diagnosis of infections in residents of long-term care facilities is often difficult due to the unique characteristics of this population, including age-related immunologic changes, chronic cognitive and/or physical impairments, and diseases that alter host resistance 1. The guidelines and standards of practice used for diagnosis of infections in patients in acute-care facilities may not be applicable nor appropriate for residents in long-term care facilities. Healthcare providers should prioritize a thorough assessment and careful observation of elderly patients with suspected sepsis, rather than relying solely on the presence of fever.
From the Research
Sepsis in the Elderly
- Sepsis is a potentially fatal response to infection that can affect patients of all ages, including the elderly 2.
- The elderly are more susceptible to sepsis due to various risk factors, including age, chronic medical conditions, and the presence of invasive devices 2, 3.
- Sepsis in older adults can present atypically, making diagnosis and management more challenging 2.
Atypical Presentation of Sepsis
- Older adults with sepsis may not always exhibit typical symptoms, such as fever 3.
- Instead, they may present with non-specific symptoms, such as altered mental status or functional decline 3.
- This atypical presentation can lead to delayed diagnosis and treatment, which can worsen outcomes 3.
Diagnosis and Management
- Early recognition and treatment of sepsis are crucial to reducing morbidity and mortality 4, 5.
- Diagnosis of sepsis involves identifying the source of infection, as well as the presence of organ dysfunction 4, 5.
- Management of sepsis includes antimicrobial therapy, fluid resuscitation, and supportive care 4, 5.
- In older adults, management of sepsis must take into account unique considerations, such as antimicrobial selection and dosing, delirium management, and goals of care discussions 3.