Infection, Sepsis, and Immune Function in the Older Adult Receiving Critical Care

https://doi.org/10.1016/j.ccell.2013.09.009Get rights and content

Section snippets

Key points

  • The elderly population (those >65 years old) is projected to increase significantly over the next few decades, leading to increased hospitalizations and utilization of intensive care unit resources for sepsis.

  • The elderly have increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence, frequent instrumentation, institutionalization, and clinician underrecognition of infection.

  • Infection can vary in severity along a continuum,

Epidemiology

Critical care services for sepsis represent an enormous portion of hospital costs in the United States, much of it consumed by the elderly.7, 10 The elderly are at particular risk for sepsis and severe sepsis, accounting for nearly two-thirds of all patients hospitalized with sepsis in 2008,13 and, as the population ages, its incidence has been predicted to increase.9 The National Center for Health Statistics (NCHS) data, published in 2011, confirm the increasing incidence and cost of treating

Outcomes and patient perspective

Although advanced age has been noted in most epidemiologic studies as being an independent predictor of death, with age 65 years or older being independently associated with a 2.3 times higher risk of death, severity of illness holds greater prognostic significance.7, 15 Although the elderly have been found to have a greater severity of illness with the presence of shock and renal dysfunction on admission,29 it has been demonstrated that the elderly do benefit from aggressive interventions.28

Summary

The elderly are a group at significant risk for increased morbidity and mortality from sepsis. A constellation of factors, including diminished physiologic reserve, immunosenescence, comorbid illness, institutionalization, frequent instrumentation, and decreased access to care makes them particularly vulnerable to developing life-threatening infections. Their clinical presentation is often atypical, leading to missed diagnoses and delays in appropriate treatment, contributing to increased

First page preview

First page preview
Click to open first page preview

References (31)

  • P. Nasa et al.

    Severe sepsis and septic shock in the elderly: an overview

    World J Crit Care Med

    (2012)
  • R.P. Dellinger et al.

    Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012

    Crit Care Med

    (2013)
  • R.M. Kleinpell et al.

    Incidence, pathogenesis, and management of sepsis: an overview

    AACN Adv Crit Care

    (2006)
  • M.M. Levy et al.

    The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

    Crit Care Med

    (2010)
  • M.M. Levy et al.

    2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference

    Crit Care Med

    (2003)
  • Cited by (0)

    No disclosures to make.

    View full text