Geriatric Medicine Book

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  • Infections in Older Adults

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Infections in Older Adults

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  1. Signs
    1. Atypical febrile response
      1. Temperature rise of 1.1 C (2 F) over baseline
      2. Fever suggesting severe infection: 38.3 C (101 F)
    2. Respiratory Rate may be slightly increased
    3. Neurologic changes
      1. Cognitive Impairment
      2. Altered Level of Consciousness
      3. Delirium (50%)
    4. Constitutional and ADL changes
      1. Anorexia or weight loss
      2. Functional decline
      3. Falls
  2. Common Serious Infections in Older Patients
    1. Systemic Infections
      1. Bacterial Pneumonia
      2. Influenza
      3. Urinary Tract Infections
    2. Skin Infections
      1. Herpes Zoster (Shingles)
      2. Methicillin-Resistant Staphylococcus aureus (MRSA)
      3. Vancomycin-Resistant Enterococcus (VRE)
  3. History and Examination Points
    1. Chronic medical conditions predisposing to infection
      1. Diabetes Mellitus
      2. Peripheral Vascular Disease
      3. Chronic Renal Failure
      4. Dysphagia with risk of Aspiration Pneumonia
    2. Immunosuppressant medications
      1. Corticosteroids
      2. Chemotherapy
      3. Antibiotics
    3. Immobility (risk for Decubitus Ulcers)
    4. Nutritional deficiency
    5. Neurologic Exam with Mental Status Examination
    6. Dermatologic infections
    7. Pulmonary symptoms
  4. Labs
    1. Complete Blood Count
      1. Leukocytosis present in 60% with serious infection
    2. Urinalysis and Urine Culture
  5. Radiology
    1. Chest XRay
  6. Prevention
    1. Respiratory infection prevention
      1. Pneumococcal Vaccine
      2. Influenza Vaccine
    2. Urinary Tract Infection prevention
      1. Limit Urinary Catheters
      2. Apply Topical Estrogen to vulva and vagina in women
      3. Treat Benign Prostatic Hypertrophy in men
  7. References
    1. Fraser (1997) J Gerontol Nurs 23:5
    2. Mouton (2001) Am Fam Physician 63:257

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