Abstract
Sepsis in older adults may be undetected due to normal age-related changes. In this chapter, special considerations for detection of sepsis are included. Evolving definitions of sepsis are described over the past three consensus conferences, now referred to as Sepsis-1, Sepsis-2, and Sepsis-3. A review of normal organ changes associated with aging includes the following systems, neurologic, cardiovascular, pulmonary, renal, hepatic, and coagulation, which are used to assess organ dysfunction. Presentation of acute mental status, pneumonia, and urinary tract infections to the ICU is described. Nonspecific symptoms in older adults (e.g., changes in activity level, balance issues/falls, decreased appetite, confusion, and any decrease in mental status) may be early warning signs of sepsis. A brief discussion of outcomes includes survivorship, functional status, long-term mortality, and end of life.
This is a preview of subscription content, log in via an institution to check access.
References
American Thoracic Society (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171(4): 388–416. https://doi.org/10.1164/rccm.200405-644ST
Angus DC, Burgner D, Wunderink R, Mira JP, Gerlach H, Wiedermann CJ, Vincent JL (2003) The PIRO concept: P is for predisposition. Crit Care 7(3):248–251
Armanios M, de Cabo R, Mannick J, Partridge L, van Deursen J, Villeda S (2015) Translational strategies in aging and age-related disease. [Interview]. Nat Med 21(12):1395–1399. https://doi.org/10.1038/nm.4004
Baldwin MR, Narain WR, Wunsch H, Schluger NW, Cooke JT, Maurer MS, …, Bach PB (2013) A prognostic model for 6-month mortality in elderly survivors of critical illness. Chest 143(4): 910–919. https://doi.org/10.1378/chest.12-1668
Bantel H, Schulze-Osthoff K (2009) Cell death in sepsis: a matter of how, when, and where. [Comment]. Crit Care 13(4):173. https://doi.org/10.1186/cc7966
Bernard GR, Doig G, Hudson LD, Lemeshow S, Marshall JC, Russell J, …, Wheeler AP (1993) Quantification of organ failure for clinical trials and clinical practice. AJRCC 151(4):A323
Besdine RW (2013) Selected physiologic age-related changes. Merck Manuel. Retrieved from http://www.merckmanuals.com/professional/geriatrics/approach_to_the_geriatric_patient/physical_changes_with_aging.html
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, …, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655
Boucher BJ (2012) The problems of vitamin d insufficiency in older people. Aging Dis 3(4): 313–329
Center for Medicare and Medicaid Services (2015) New medicare data available to increase transparency on hospital utilization. Fact Sheet, from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-01.html
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41
De Gaudio AR, Rinaldi S, Chelazzi C, Borracci T (2009) Pathophysiology of sepsis in the elderly: clinical impact and therapeutic considerations. [Review]. Curr Drug Targets 10(1):60–70
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, …, Moreno R (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41(2):580–637. https://doi.org/10.1097/CCM.0b013e31827e83af
Driscoll I, Davatzikos C, An Y, Wu X, Shen D, Kraut M, Resnick SM (2009) Longitudinal pattern of regional brain volume change differentiates normal aging from MCI. Neurology 72(22): 1906–1913. https://doi.org/10.1212/WNL.0b013e3181a82634
Dupre ME, Liu G, Gu D (2008) Predictors of longevity: evidence from the oldest old in China. Am J Public Health 98(7):1203–1208. https://doi.org/10.2105/AJPH.2007.113886
Falcone M, Corrao S, Venditti M, Serra P, Licata G (2011) Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia. [Comparative Study Multicenter Study]. Intern Emerg Med 6(5): 431–436. https://doi.org/10.1007/s11739-011-0521-y
Franzke B, Neubauer O, Wagner KH (2015) Super DNAging-New insights into DNA integrity, genome stability and telomeres in the oldest old. Mutat Res Rev Mutat Res 766: 48–57. https://doi.org/10.1016/j.mrrev.2015.08.001
Gaieski DF, Edwards JM, Kallan MJ, Carr BG (2013) Benchmarking the incidence and mortality of severe sepsis in the United States. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Crit Care Med 41(5):1167–1174. https://doi.org/10.1097/CCM.0b013e31827c09f8
Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, …, Moore FA (2012) Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. [Research Support, N.I.H., Extramural Review]. J Trauma Acute Care Surg 72(6):1491–1501. https://doi.org/10.1097/TA.0b013e318256e000
Gerlach H, Dhainaut JF, Harbarth S, Reinhart K, Marshall JC, Levy M (2003) The PIRO concept: R is for response. Crit Care 7(3):256–259
Girard TD, Ely EW (2007) Bacteremia and sepsis in older adults. Clin Geriatr Med 23(3):633–647, viii. https://doi.org/10.1016/j.cger.2007.05.003
Girard TD, Opal SM, Ely EW (2005) Insights into severe sepsis in older patients: from epidemiology to evidence-based management. Clin Infect Dis 40(5):719–727. https://doi.org/10.1086/427876
Gordis L (2014) Epidemiology, 5th edn. W. B. Saunders, Philadelphia
Green JE, Ariathianto Y, Wong SM, Aboltins C, Lim K (2014) Clinical and inflammatory response to bloodstream infections in octogenarians. [Research Support, Non-U.S. Gov’t]. BMC Geriatr 14(1):55. https://doi.org/10.1186/1471-2318-14-55
Grizzi F, Di Caro G, Laghi L, Hermonat P, Mazzola P, Nguyen DD, …, Chiriva-Internati M (2013). Mast cells and the liver aging process. Immun Ageing 10(1):9. https://doi.org/10.1186/1742-4933-10-9
Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ (2008a) Going from evidence to recommendations. BMJ 336(7652):1049–1051. https://doi.org/10.1136/bmj.39493.646875.AE
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008b) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Hallingbye T, Martin J, Viscomi C (2011) Acute postoperative pain management in the older patient. Aging Health 1–22. Retrieved from http://www.medscape.com/viewarticle/756607
Han JH, Vasilevskis EE, Schnelle JF, Shintani A, Dittus RS, Wilson A, Ely EW (2015) The diagnostic performance of the Richmond agitation sedation scale for detecting delirium in older emergency department patients. [Observational Study Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, Non-P.H.S.] Acad Emerg Med 22(7):878–882. https://doi.org/10.1111/acem.12706
Hanratty B, Lowson E Holmes L, Grande G, Jacoby A, Payne S, …, Whitehead M (2012) Breaking bad news sensitively: what is important to patients in their last year of life? [Research Support, Non-U.S. Gov’t]. BMJ Support Palliat Care 2(1):24–28. https://doi.org/10.1136/bmjspcare-2011-000084
Heineman JM, Hamrick-King J, Sewell BS (2010) Review of the aging of physiological systems. In: Mauk KL (ed) Gerontological nursing competencies for care, 2nd edn. Jones and Bartlett Publishers, Boston, pp 129–216
Heppner HJ, Singler K, Kwetkat A, Popp S, Esslinger AS, Bahrmann P, …, Christ M (2012) Do clinical guidelines improve management of sepsis in critically ill elderly patients? A before-and-after study of the implementation of a sepsis protocol. Wien Klin Wochenschr 124(19–20): 692–698. https://doi.org/10.1007/s00508-012-0229-7
Heppner HJ, Cornel S, Peter W, Philipp B, Katrin S (2013) Infections in the elderly. Crit Care Clin 29(3):757–774. https://doi.org/10.1016/j.ccc.2013.03.016
High K, Bradley S, Loeb M, Palmer R, Quagliarello V, Yoshikawa T (2005) A new paradigm for clinical investigation of infectious syndromes in older adults: assessing functional status as a risk factor and outcome measure. [Review]. J Am Geriatr Soc 53(3):528–535. https://doi.org/10.1111/j.1532-5415.2005.53240.x
Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM (2012) Population burden of long-term survivorship after severe sepsis in older Americans. [Research Support, N.I.H., Extramural]. J Am Geriatr Soc 60(6):1070–1077. https://doi.org/10.1111/j.1532-5415.2012.03989.x
Jones C (2014) Recovery post ICU. Intensive Crit Care Nurs 30(5):239–245. https://doi.org/10.1016/j.iccn.2014.06.001
Juthani-Mehta M, De Rekeneire N, Allore H, Chen S, O’Leary JR, Bauer DC, …, Quagliarello V (2013) Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the health, aging, and body composition study. [Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural]. J Am Geriatr Soc 61(7):1111–1118. https://doi.org/10.1111/jgs.12325
Kale SS, Ahuju N, Yende S (2012) Aging, infection, and immunity. In: Newman AB, Cauley JA (eds) The epidemiololgy of aging. Springer, New York, pp 237–253
Kane RJ, Ouslander JG, Abrass IB, Resick B (2013) Clinical implications of the aging process, Essentials of clinical geriatrics, 5th edn. McGraw-Hill Education LLC, New York, pp 3–21
Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R (2015) Systemic inflammatory response syndrome criteria in defining severe sepsis. [Research Support, Non-U.S. Gov’t]. N Engl J Med 372(17):1629–1638. https://doi.org/10.1056/NEJMoa1415236
Kinasewitz GT, Yan SB, Basson B, Comp P, Russell JA, Cariou A, …, Dhainaut JF (2004) Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism [ISRCTN74215569]. Crit Care 8(2): R82–R90
Kleinpell R, Aitken L, Schorr CA (2013) Implications of the new international sepsis guidelines for nursing care. Am J Crit Care: Off Publ Am Assoc Crit-Care Nurses 22(3):212–222. https://doi.org/10.4037/ajcc2013158
Lalley PM (2013) The aging respiratory system – pulmonary structure, function and neural control. Respir Physiol Neurobiol 187(3):199–210. https://doi.org/10.1016/j.resp.2013.03.012
Lemay AC, Anzueto A, Restrepo MI, Mortensen EM (2014) Predictors of long-term mortality after severe sepsis in the elderly. [Research Support, N.I.H., Extramural]. Am J Med Sci 347(4): 282–288. https://doi.org/10.1097/MAJ.0b013e318295a147
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31(4): 1250–1256
Lineberry C, Stein DE (2014) Infection, sepsis, and immune function in the older adult receiving critical care. Crit Care Nurs Clin North Am 26(1):47–60. https://doi.org/10.1016/j.ccell.2013.09.009
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, …, Whitney CG (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72. CID41620 [pii]. https://doi.org/10.1086/511159
Marshall JC (2014) The PIRO (predisposition, insult, response, organ dysfunction) model: toward a staging system for acute illness. [Review]. Virulence 5(1):27–35. https://doi.org/10.4161/viru.26908
Martin GS, Mannino DM, Moss M (2006) The effect of age on the development and outcome of adult sepsis. [Comparative Study Research Support, N.I.H., Extramural]. Crit Care Med 34(1): 15–21
Martin-Plank L (2014) Chest disorders. In: Kennedy-Malone L, Fletcher KR, Martin-Plank L (eds) Advanced practice nursing in the care of older adults. F.A. Davis Company, Philidelphia, pp 240–244
Mayr FB, Yende S, Angus DC (2014) Epidemiology of severe sepsis. [Review]. Virulence 5(1): 4–11. https://doi.org/10.4161/viru.27372
Merkelz KP, Mouton CP, Espino DV (2002) Urinary tract infections. In: Ham RJ, Sloane PD, Warshaw GA (eds) Primary care geriatircs, 4th edn. Mosby, St. Louis, pp 631–636
Metcalf TU, Cubas RA, Ghneim K, Cartwright MJ, Grevenynghe JV, Richner JM, …, Haddad EK (2015) Global analyses revealed age-related alterations in innate immune responses after stimulation of pathogen recognition receptors. Aging Cell 14(3):421–432. https://doi.org/10.1111/acel.12320
Mora F (2013) Successful brain aging: plasticity, environmental enrichment, and lifestyle. Dialogues Clin Neurosci 15(1):45–52
Morris PE, Berry MJ, Files DC, Thompson JC, Hauser J, Flores L, …, Young MP (2016) Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. [Research Support, N.I.H., Extramural]. JAMA 315(24): 2694–2702. https://doi.org/10.1001/jama.2016.7201
Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN (2009) Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. [Randomized Controlled Trial Research Support, N.I.H., Extramural]. Am J Crit Care 18(5):428–437; quiz 438. https://doi.org/10.4037/ajcc2009792
Munro CL, Grap MJ, Sessler CN, Elswick RK Jr, Mangar D, Karlnoski-Everall R, Cairns P (2015) Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia. [Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural]. Chest 147(2):328–334. https://doi.org/10.1378/chest.14-0692
Netzel P (2012) Health problems associated with aging. In: Foster JG, Prevost SS (eds) Advanced practice nursing in adults in acute care. F.A. Davis Company, Philidelphia, pp 70–86
Opal SM, Girard TD, Ely EW (2005) The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis 41(Suppl 7):S504–S512. https://doi.org/10.1086/432007
Pathophysiologic concepts of aging (2016) In: Caproitti T, Frizzell JP (eds) Pathophysiology: introductory concepts and clinical perspectives. F.A. Davis, Philadelphia, pp 1091–1105
Pena OM, Hancock DG, Lyle NH, Linder A., Russell JA, Xiu J, …, Hancock RE (2014) An endotoxin tolerance signature predicts sepsis and organ dysfunction at initial clinical presentation. EBioMedicine xx–xxx. https://doi.org/10.1016/j.ebiom.2014.10.003
Pisani MA (2009) Considerations in caring for the critically ill older patient. [Research Support, N.I.H., Extramural Review]. J Intensive Care Med 24(2):83–95. https://doi.org/10.1177/0885066608329942
Porth CM (2011) Essentials of pathyphysiology, 3rd edn. Wolters Kluwer Health-Lippincot Willimas & Williams, Philadelphia
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, …, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. N Engl J Med, 345(19): 1368–1377. https://doi.org/10.1056/NEJMoa010307
Rowe T, Juthani-Mehta M (2014) Diagnosis and management of urinary tract infection in older adults. [Research Support, N.I.H., Extramural Review]. Infect Dis Clin N Am 28(1):75–89. https://doi.org/10.1016/j.idc.2013.10.004
Rowe T, Araujo KL, Van Ness PH, Pisani MA, Juthani-Mehta M (2016) Outcomes of older adults with sepsis at admission to an intensive care unit. Open Forum Infect Dis 3(1):ofw010. https://doi.org/10.1093/ofid/ofw010
Royle NA, Booth T, Valdes Hernandez MC, Penke L, Murray C, Gow AJ, …, Wardlaw JM (2013) Estimated maximal and current brain volume predict cognitive ability in old age. Neurobiol Aging 34(12):2726–2733. https://doi.org/10.1016/j.neurobiolaging.2013.05.015
Schmitt R, Cantley LG (2008) The impact of aging on kidney repair. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Review]. Am J Physiol Ren Physiol 294(6):F1265–F1272. https://doi.org/10.1152/ajprenal.00543.2007
Schwartz JB, Zipes DP (2011) Cardiovascular disease in the elderly, 9th edn. Saunders, Philadelphia
Seaman JB (2013) Improving care at end of life in the ICU: a proposal for early discussion of goals of care. J Gerontol Nurs 39(8):52–58. https://doi.org/10.3928/00989134-20130530-01
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, …, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). [Consensus Development Conference Research Support, Non-U.S. Gov’t]. JAMA 315(8): 801–810. https://doi.org/10.1001/jama.2016.0287
Sjoding MW, Prescott HC, Wunsch H, Iwashyna TJ, Cooke CR (2016) Longitudinal changes in ICU admissions among elderly patients in the United States. Crit Care Med 44(7):1353–1360. https://doi.org/10.1097/CCM.0000000000001664
Sonneville R, Verdonk F, Rauturier C, Klein IF, Wolff M., Annane D, …, Sharshar T (2013) Understanding brain dysfunction in sepsis. Ann Intensive Care 3(1):15. https://doi.org/10.1186/2110-5820-3-15
Stolbrink M, McGowan L, Saman H, Nguyen T, Knightly R, Sharpe J, …, Turner AM (2014) The early mobility bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. [Research Support, Non-U.S. Gov’t]. J Hosp Infect 88(1):34–39. https://doi.org/10.1016/j.jhin.2014.05.006
Tajiri K, Shimizu Y (2013) Liver physiology and liver diseases in the elderly. World J Gastroenterol 19(46):8459–8467. https://doi.org/10.3748/wjg.v19.i46.8459
Tang VL, Halm EA, Fine MJ, Johnson CS, Anzueto A, Mortensen EM (2014) Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system. [Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural]. J Hosp Med 9(6):379–383. https://doi.org/10.1002/jhm.2184
U.S. Census Bureau (2010) Profile of general population and housing characteristics: 2010. American Fact Finder. Retrieved 7 July 2016, 2016, from http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF
U.S. Department of Commerce (2015) Older Americans month: May 2015. Profile America: facts for features. Retrieved 6 July 2016, 2016, from http://www.census.gov/newsroom/facts-for-features/2015/cb15-ff09.html
Umberger R, Callen B, Brown ML (2015) Severe sepsis in older adults. [Review]. Crit Care Nurs Q 38(3):259–270. https://doi.org/10.1097/CNQ.0000000000000078
Vanderspank-Wright B, Fothergill-Bourbonnais F, Malone-Tucker S, Slivar S (2011) Learning end-of-life care in ICU: strategies for nurses new to ICU. Dynamics 22(4):22–25
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, …, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-related problems of the European Society of Intensive care medicine. Intensive Care Med 22(7):707–710
Vincent JL, Opal S, Torres A, Bonten M, Cohen J, Wunderink R (2003a) The PIRO concept: I is for infection. Crit Care 7(3):252–255
Vincent JL, Wendon J, Groeneveld J, Marshall JC, Streat S, Carlet J (2003b) The PIRO concept: O is for organ dysfunction. Crit Care 7(3):260–264
Waterworth S, Gott M (2010) Decision making among older people with advanced heart failure as they transition to dependency and death. [Review]. Curr Opin Support Palliat Care 4(4): 238–242. https://doi.org/10.1097/SPC.0b013e328340684f
Weinstein JR, Anderson S (2010) The aging kidney: physiological changes. [Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, P.H.S. Review]. Adv Chronic Kidney Dis 17(4): 302–307. https://doi.org/10.1053/j.ackd.2010.05.002
Willcox DC, Willcox BJ, Wang NC, He Q, Rosenbaum M, Suzuki M (2008) Life at the extreme limit: phenotypic characteristics of supercentenarians in Okinawa. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. J Gerontol A Biol Sci Med Sci 63(11): 1201–1208
Wong LS, van der Harst P, de Boer RA, Huzen J, van Gilst WH, van Veldhuisen DJ (2010) Aging, telomeres and heart failure. Heart Fail Rev 15(5):479–486. https://doi.org/10.1007/s10741-010-9173-7
Zhang J, Rane G, Dai X, Shanmugam MK, Arfuso F, Samy RP, …, Sethi G (2016) Ageing and the telomere connection: an intimate relationship with inflammation. Ageing Res Rev 25:55–69. https://doi.org/10.1016/j.arr.2015.11.006
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this entry
Cite this entry
Umberger, R., Callen, B., Brown, M.L. (2018). Manifestations of Sepsis in Older Adults. In: Fulop, T., Franceschi, C., Hirokawa, K., Pawelec, G. (eds) Handbook of Immunosenescence. Springer, Cham. https://doi.org/10.1007/978-3-319-64597-1_135-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-64597-1_135-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-64597-1
Online ISBN: 978-3-319-64597-1
eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences