As our population ages more and more of our frail elders are cared for at home. As far as possible the aim is to keep them well in the community and out of hospitals. Infection is one of the more potentially preventable reasons for admissions to a health care facility.
Elders are at increased risk of infections compared to younger adults due to various physiological changes that occur with age leading to the blunting of the body’s ability to counter an acute infection. Also older adults tend to have multiple chronic medical illnesses, problems with memory, reduced absorption of nutrients from the gut and loss of fat and muscle stores over time. This leaves them vulnerable to infections compared to other members of the general population.
Infections in the older adult can be from many sources including respiratory tract infections, urinary tract infections, gut related infections and skin breakdown including pressure ulcers allowing a portal of entry for bacteria into a person’s bloodstream. Also patients who are on long term catheters for example urinary catheters for certain urological problems are also at risk of catheter related infections.
Influenza and pneumonia  are the major causes of admissions for the elderly in the United States. Viral flus are easily transmitted by loved ones to the elder patient by coughing or sneezing especially in closed environments at home. Precautions such as isolating oneself if one is unwell, observing strict hand washing techniques and wearing protective masks to prevent transmission of droplets to the elder is important. Annual flu vaccinations are also recommended for seniors to prevent infection. Also caregivers can also be vaccinated to reduce their risks of picking up flus and then passing it on the older adult under their care. Elders and carers can also be given pneumococcal vaccines to reduce their risk of bacterial pneumonias too.
Urinary Tract Infection
Urinary tract infection (UTI) is another common infection that occurs in the older adult. Women are at especially higher risk of UTI’s as they have shorter urethras compared to men allowing bacteria near the rectal area to migrate and enter the body more easily. Also after menopause women have a rapid fall in their oestrogen levels causing vaginal pH to rise due to a reduction in lactobacilli and making the lower genitourinary tract to become more susceptible to infection by pathogenic organisms. Cleaning techniques especially in females due to their anatomically shorter urinary tracts are important-front to back (anus) wiping techniques are useful to reduce migration of bacteria from the anal area to the urinary tract. Regular bowel opening is also important as an overloaded rectum can lead to incomplete emptying of the bladder. Fruits and a good amount of fibre can help with bowel opening. Good fluid intake also helps to reduce the occurrence of constipation and prevent urinary tract infections from occurring.
With age the skin of older adults becomes prone to breakdown as the outer layer of the skin becomes thinner and the skin becomes more fragile. Its ability to heal is also reduced. Blood vessels supplying the skin also become thinner making it vulnerable to bruising. Common infections in the elderly include pressure ulcers over the back, fungal infections between the toes of the feet or in the groin, skin tears along limbs due to friction, cellulitis and even shingles (herpes zoster infection). Good hydration maintains adequate moisturisation of skin reducing risk of skin breakdown. Moisture of skin can also be maintained by applying skin moisturisers and emollients. Indirectly circulation of skin is promoted when creams are applied to the patient by the carer. Strict hand washing techniques, dressing of open wounds, pressure sore prevention techniques and treatment of fungal infections are other important measures that can be taken. Care must be taken when moving patients as shearing forces when moving a patient across the surface of a bed for example can make fragile skin tear. Soiled adult diapers also must be changed as prolonged exposure might cause irritation of skin leading to its breakdown. Vaccine against herpes zoster virus can also be considered in older adults to prevent shingles however it is not recommended in the over 80’s due to its reduced effectiveness .
Seniors are also at increased risk of gastrointestinal related illnesses. Diarrheal illness can occur especially due to poor hygiene techniques employed by the carer of the elderly. Strict hand washing techniques should be employed especially during preparation and delivery of feeds and meals. Food should also be well cooked, prepared and stored to reduce the risk bacterial or viral contamination. Bacterial overgrowth also tends to occur with age due to reduced gut motility, suppression of healthy gut flora by antibiotics, constipation as a result of dehydration and reduced fibre intake in their diets. Elders especially in long term care institutions are those who have received prolonged antibiotic treatment are at risk of Clostridium Difficile
infection. This can also lead to diarrheal illness in the elderly.
Overall the risks of infections can be reduced by a trained and knowledgeable carer at home. By ensuring good hydration, nutrition, attention to skin care and maximizing safe mobility and independence as much as possible at home can go a long way in preventing them from falling ill and having to be admitted to the hospital.
1. AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003.
DR. MOHAMED SEENIKATTY is a specialist in Internal Medicine, a clinical fellow in Geriatric Medicine and a lecturer based in UiTM.