Older adults are at a greater risk for Sepsis, which is an illness that can kill you before you realize you have it. Even survival from sepsis can have lasting health consequences. So it is important to understand what sepsis is, how you get it, and how to recognize the symptoms.
What is Sepsis and How do I Get It?
Sepsis is your body’s extreme response to an infection you already have. Although older adults are at a greater risk for sepsis, it doesn’t spare younger persons or even children. Many people who develop sepsis are surprised by the diagnosis. They didn’t think the infection they had was much to worry about. Or they thought they were treating the infection properly. This is what happened to Sarah Moss.
Sarah had a urinary tract infection but had gone to work anyway. She didn’t stay long because she was having “sweat attacks and pain in my kidneys”. She saw a doctor, who prescribed antibiotics, and then she went home to bed. During the night she had severe pain in her head and down her neck. She was hallucinating and sweating profusely. The next morning she called the doctor and was told it would take longer for the antibiotics to work. By that afternoon she could barely lift her head. She felt “like I was going to die” so her sister took her into the doctor. Upon checking her vitals, the doctor immediately called an ambulance. Sarah’s next memory is waking in a dark room with her family around her. She was connected to lots of IV drips and was told they had given her pain medications. Tests revealed she had developed sepsis and that she had gone into septic shock. She was lucky to be alive. Sarah was treated for it and survived, but she still has medical issues from sepsis.
Gene Mayfield has a similar story. At the beginning of October he had not been feeling well and thought he had the flu. Because Halloween and his wedding anniversary were coming up, he thought he would just power through it. By Halloween night he was so sick he needed an ambulance. Lab results showed he had pneumonia and was in septic shock. They told his wife he had a 30% chance of living. Gene doesn’t remember much of his week in intensive care, but to this day he is suffering from post-sepsis syndrome.
Post-sepsis sydrom affects up to 50% of sepsis survivors. They are left with physical and/or psychological long-term effects, such as:
Insomnia, difficulty getting to sleep or staying asleep
Nightmares, vivid hallucinations and panic attacks
Disabling muscle and joint pains
Decreased mental (cognitive) functioning
Loss of self-esteem and self-belief
Sepsis can result from any infection you already have. It can be in your skin, lungs, urinary tract, your gut, or somewhere else. The initial infection can seem minor, but if you develop sepsis it must be diagnosedquickly. Sepsis is life-threatening and can rapidly cause tissue damage, organ failure, and death.
Why Older Adults are at a Greater Risk for Sepsis?
No one is immune to infection. Almost any infection can lead to sepsis, but older adults are at a greater risk for sepsis. This can be because of a weakened immune systems. Older adults often have chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease. Diabetics, for example, can develop sores and wounds that heal slowly and are prone to infection. Insertions of medical devices like catheters, feeding tubes and IVs also create situations where older adults are at a greater risk for sepsis. Additionally, older adults tend to see health professionals and clinics more often. Frequent visits to health care settings present a greater chance of coming in contact with infectious viruses and bacteria, as does any surgery, no matter how minor.
Several studies have demonstrated that older adults are at a greater risk for sepsis over younger persons. One study found that, although the elderly constitute only one-fifth of the US population, they constitute two-thirds of the patients admitted to the hospital with sepsis.
Older Adults are at a Greater Risk for Sepsis Shock and Complications
Older Adults are Often Misdiagnosed
Older adults are at a greater risk for sepsis symptoms being misdiagnosed, too. In older adults non-specific signs of sepsis can be masked by common ailments affecting older adults. Symptoms, such as altered mental states, delirium, weakness, anorexia, falls, and urinary incontinence. Other studies have shown the existence of a fever can be blunted up to 47% or non-existent in older adults during the early onset of sepsis. Early diagnosis of sepsis greatly enhances the opportunity for positive outcomes.
Deaths and Serious Complications are Greater
Deaths among the elderly diagnosed with sepsis are also much higher. Several studies have found death rates of 50-60% in elderly patients with severe sepsis and septic shock. This makes the mortality due to severe sepsis in the elderly to be 1.3-1.5 times higher than in younger people. Older adults are at greater risk for organ failure and amputations, too. Anyone who is 65 or older should immediately get medical assistance if even the slightest hint of sepsis is exhibited.
What are the Signs of Sepsis?
There is no single symptom of sepsis. One should look for a combination of confusion or disorientation, shortness of breath, high heart rate (greater than 90 beats per minute), fever/shivering or feeling very cold, hypothermia (lower than normal body temperature) extreme pain or discomfort, swelling, and clammy or sweaty skin.
That’s a lot to remember so The Sepsis Alliance created a graphic and acronym to help people easily remember the main symptoms of sepsis.
If you notice anyone with a combination of these symptoms, call 911 or seek the nearest emergency room. Be sure to tell the medical professionals that you suspect sepsis. Do not allow the doctors, nurses, or your loved one to ignore your concerns. Insist that your loved one submit to treatment and that the medical staff test for sepsis immediately. Every hour that a person with sepsis goes without treatment, their risk of death increases by eight percent. If your loved one is an older adult, then doctors must begin medical test for sepsis right away. Older adults are at a greater risk for sepsis, and diagnosis of sepsis in older adults is more difficult.
Remember sepsis can occur from any infection and you may not even realize you have an infection. Older adults may not exhibit a high fever or any fever at all. For older adult’s symptoms of being cold, tired, confused or shortness of breath may be mistaken for symptoms of other illnesses or even simply old age.
If the medical professional tells you not to worry, don’t be afraid to ask for a second opinion. Remember older adults are at a greater risk for sepsis and are more difficult to diagnose. If you and your loved one are sent home, then watch closely for any signs of deterioration. Do not hesitate to go back to the emergency department or urgent care center if you are concerned.
Can you Prevent Sepsis?
You can decrease your chances of developing sepsis by avoiding infections. The Sepsis Alliance recommend the following:
Taking antibiotics if prescribed
Finishing the entire course of antibiotics
Don’t take antibiotics or take someone else’s antibiotics needlessly to reduce the chances of developing antibiotic-resistant infections
Frequent and thorough hand washing
Asking your doctor, nurse, or other healthcare professional to wash their hands if you have not seen them do so
Ensure that sterile technique is used for any invasive procedure, like insertion of a urinary catheter or intravenous catheter
Consult with your doctor about recommended vaccines
Get vaccinated for the seasonal flu
Cough into your elbow, not your hand (to help prevent spreading infection if you are sick)
Maintain a healthy lifestyle with nutritious food, exercise, and rest
Seek medical help if an illness does not seem to be improving or it is getting worse
The Sepsis Alliance is a rich resource of information about sepsis. It also houses many stories of people who have survived sepsis and tributes to those who have not. They also have a special section on sepsis and children. Other resources used in the writing of this article are:
Girard TD, Opal SM, Ely EW. Insights into severe sepsis in older patients: from epidemiology to evidence-based management. Clin Infect Dis. 2005;40:719–727. [PubMed]
Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005;41 Suppl 7:S504–S512. [PubMed]
De Gaudio AR, Rinaldi S, Chelazzi C, Borracci T. Pathophysiology of sepsis in the elderly: clinical impact and therapeutic considerations. Curr Drug Targets. 2009;10:60–70. [PubMed]
Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult
Nasa P, Juneja D, Singh O, Dang R, Arora V. Severe Sepsis and its Impact on Outcome in Elderly and Very Elderly Patients Admitted in Intensive Care Unit. J Intensive Care Med. 2011:Epub ahead of print. [PubMed]
Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing. 2005;34:157–162. [PubMed]
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. [PubMed]
Centers for Disease Control and Prevention: Sepsis