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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.
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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.
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Infection can vary in severity along a continuum,
Infection, Sepsis, and Immune Function in the Older Adult Receiving Critical Care
Section snippets
Key points
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
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