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Spotting Infections in Your Elderly Parents

I am printing this entire article because few of you will be reading the Military Officers Association of America newsletter, and this is one of the best articles I have seen on the subject. It is SO easy to dismiss a parent’s complaints as just being a normal part of aging – and it is important to catch these things early.

Role Reversal — How to Spot Infections
2008/08/22 00:00:00
By Nanette Lavoie-Vaughan

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. )

Nanette Lavoie-Vaughan is an adult nurse practitioner and professional consultant. She is a featured speaker at national professional conferences and writes about geriatrics for multiple publications. If you’d like to send Nanette a comment, question, or suggestion for a future column, please e-mail rolereversal@moaa.org.

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August 28, 2008 - Posted by | Communication, Community, Family Issues, Health Issues, Relationships |

9 Comments »

  1. Nice blog! Keep up the good work.

    Comment by health day | August 28, 2008 | Reply

  2. I was shocked how my mother ( age 89 ) became confused and combative. I thought her dementia was in fast forward. Turn out she had a urinary tract infection and abscessed teeth. She never complained of any type of pain and no fever. A course of antibiotics and she was back. Thanks for the info.

    Comment by M.E. | August 1, 2011 | Reply

    • Thank you for your input, M.E. We have a rule – any one who goes to hospital or rehab has someone with them, a family member, who is watching and monitoring. Woe to those who don’t! We know what is normal and what is not, and when things start going la-la-land, we have to advocate. Busy staffs just think they are dealing with dementia or contrariness; we know it is anomalous behavior. I’m glad this post helped you, and I thank you for your comment which may help others.

      Comment by intlxpatr | August 1, 2011 | Reply

  3. Thank you. This exactly mirrors the experience my mother is going through. She has had two hospitalizations and IV antibiotics for sepsis and still no diagnosis of the bug. One tip is that hallucinations (dementia) were viewed by the emergency staff as a reaction to pain killers (panadeine forte). However any hallucinations from codeine-type analgesics wears off by @ 2 hours.

    Comment by Andrea madon | August 25, 2011 | Reply

  4. Andrea, our Dad had a reaction to one particular diuretic he was given in the hospital and rehab, Lasik, or something like that. And that is the problem; hospitals and rehabs give what they think the patient needs, and usually the cheapest alternative. We had to insist he be given an alternative; we always knew when they put him on the bad drug because Dad became not-Dad.

    Comment by intlxpatr | August 25, 2011 | Reply

  5. Just had a similar experience with my 70 y.o. mom, who is a breast cancer patient and had her normal gut flora wiped out by chemo. In ten minutes she went from smart lawyer mom to terrified rabbit who didn’t know her own name. Thank goodness I was there to be her voice and answer the questions she couldn’t. I thought at first she’d had a stroke; turned out it was a c. difficile infection. The rapid onset of delirium was terrifying. She is back home now, but still experiencing some confusion – I’m hoping it will be gone within the week. Something your readers should know is that these things can come on fast but take much longer to fully resolve. My heart goes out to anyone else who has experienced this.

    Comment by Jennifer | December 3, 2012 | Reply

  6. Oh Jennifer, I am so sorry that has happened to your mother. It is terrifying not to know how long it is going to take for them to return to “normal.” Even normal can be different from earlier normal; we watched our father become irrational – and frustrated. It was hard on everyone, especially him.

    Comment by intlxpatr | December 3, 2012 | Reply

  7. I wish I knew UTI’s were so serious and caused all these problems, my mother (aged 76) died of this. She went to hospital reportedly ok and died 15 hours later. Even the hospital didn’t know how serious it was until it was too late. If your parent starts getting confused/hallucinations/memory loss, loss of appetite, vomiting, dehydration, temperature increase then it could be a serious UTI.

    Comment by John | May 20, 2014 | Reply

  8. John, I am so sorry. Our medical professionals have their hands full, and the population of elderly continues to explode. I know they do their best, and the elderly need an advocate with them to speak for them when they are incapacitated. Also, medications react differently with the elderly; you can give a normal dose to a frail person and it is way too much. The problem with UTIs is also that sometimes they are UNsymptomatic, or the symptoms are not usually associated with UTIs. I’m so sorry your mother died of something that could have been cured.

    Comment by intlxpatr | May 20, 2014 | Reply


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