Here There and Everywhere

The next time your parent complains of feeling “out of sorts” or gives you a vague list of minor problems, don’t dismiss it as normal grumpiness. There’s a good chance your parent could have an infection.

Diagnosing the elderly with an infection can be difficult. Seniors are less likely to have classic symptoms such as fever, chills, and vomiting. Instead they might have atypical symptoms such as subnormal temperature, confusion, fatigue, and decreased appetite. In many cases, these subtle signs can be attributed to the normal aging process — or ignored until the late stages of the infection.

Let’s take a brief look at how the infection process works. When the human body is under stress or exposed to bacteria and viruses, it triggers a healing chain of events that, in most cases, results in the prevention of infection or illness. However, when the amount of bacteria is too great an infection occurs. At that point, the immune system kicks in doubly hard, releasing a flood of chemicals to attack the infection and promote recovery.

Seniors are more susceptible to infection because multiple chronic illnesses that occur with age put extra stress on the body, and the medications for these conditions can block the immune system. In addition, the immune system naturally weakens as we grow older.

The most common sites for infections in older adults are the urinary tract, the respiratory tract, and the skin. It also is common for seniors to develop an infection prior to an acute deterioration of their chronic medical condition or in combination with other acute medical problems. A typical example is the person with congestive heart failure who develops pneumonia. The symptoms of cough, congestion, and shortness of breath are similar and might occur simultaneously, or the onset of pneumonia might precipitate an acute attack of congestive heart failure.
So how do you know if your parent is developing an infection? Look for:

an acute change in his or her ability to perform day to day activities;
subnormal temperature;
increased pulse rate;
unexplained dehydration;
confusion;
poor appetite; and
fatigue with increased aches and pains.
For specific infections you might want to look for the following signs:

Respiratory infections

Cough
Increased mucus
Abdominal pain
Headache
Chest pain
Generalized weakness
Loss of appetite
Urinary infection

New onset of incontinence
Pain with urination
More frequent urination
Flank pain
Weakness
Blood in the urine
Skin infection
Redness
Warmth
Pain or tenderness
If you note any of these symptoms, due diligence requires a complete medical evaluation to determine the source of the infection and any other acute medical problems.

Why is this so important? The risk of sepsis, an overwhelming infection that enters the bloodstream, is higher in the elderly. The longer these types of symptoms go untreated, the more likely the bacteria will find its way into the bloodstream.

Another concern is the prevalence of antibiotic-resistant infections. The overuse of antibiotics for viral illnesses and the common cold have caused bacteria to mutate and become resistant to antibiotics that once treated most infections. The three super infections that pose a threat are Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C diff), and Vancomycin-resistant enterocolitis (VRE).

MRSA is diagnosed by obtaining a culture of the body fluid (sputum, urine, blood) where the infection is present. MRSA infections can occur anywhere in the body, and even though treatment with Vancomycin appears successful, a small amount of the bacteria can remain — a phenomenon medical professionals refer to as colonization. The remaining bacteria can cause infections to reoccur at any time.

C diff and VRE both cause diarrhea and are the result of antibiotics killing the normal, beneficial bacteria that reside in the intestinal tract and allowing infection-producing bacteria to proliferate. C diff can occur after the prolonged use of any antibiotic; VRE is specific to the use of Vancomycin. Treatment includes preventing dehydration associated with diarrhea, a bland diet, and bulking agents to decrease the amount of diarrhea, and administration of Flagyl to treat the condition and allow the normal bacteria to return to appropriate levels.

The good news is that most infections are isolated and can be treated with short-term antibiotics. Basic preventative measures — such as assuring that your parents have a pneumonia vaccination, receive the flu vaccine yearly, avoid others with acute infections, and stay well-hydrated — can decrease the likelihood of serious infections.

In addition, keeping the skin well moisturized can prevent skin infections. Dry skin is more likely to crack and tear, providing an opening for bacteria to enter. Urinary tract infections are prevented by good hygiene and adequate fluid intake.
Infection in the elderly is a serious concern, but a few simple measures and a diligent eye are all it takes to keep your parents healthy.

(For more information about infections in the elderly, super infections, and vaccinations go to http://www.health.nih.gov/topics. )