Infectious diseases in the elderly

Robert S. Anderson, Stephen Y. Liang

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

1 Scopus citations


Introduction. It is hard to conceive of a scenario more conducive to infection than that which exists for our older patients. Natural host defenses are compromised, risk factors are plentiful, and clinical markers of disease are altered. To make matters more challenging, those over 85 years of age represent the fastest growing demographic and are at the greatest risk for health-related complications and death [1]. Relative mortality rates for sepsis and pneumonia are three times that of young people, while mortality rates for appendicitis may be as high as 20 times that of younger adults [2]. Age-related impairment of defenses. It has been argued that geriatric patients represent the largest group of immunocompromised patients treated by emergency physicians (EPs) [3]. Immunosenescence reflects the reality of worn-out adaptive immunity, where T cells are exhausted from a lifetime of antigenic exposure [4]. B cells also suffer from a lack of T-cell regulation leading to attenuated antibody responses [5]. Functional and anatomic changes likewise render older patients more vulnerable to infection. Urinary stasis from either neuromuscular dysfunction or obstruction promotes bacterial growth. The epithelial shield is less apt to present a robust mechanical barrier to skin and other outside flora. A previously stalwart pulmonary system can fall apart on many levels. Delayed cough reflex, poor mucociliary clearance, floppy airways, a stiff thoracic cage, and impaired thoracic muscle endurance can predispose a senior to infection. Chronic malnourishment further depletes existing reserves. Finally, thermoregulatory failure blunts the traditional febrile response, impeding host response to and clinician recognition of ongoing infection.

Original languageEnglish
Title of host publicationGeriatric Emergency Medicine
Subtitle of host publicationPrinciples and Practice
PublisherCambridge University Press
Number of pages9
ISBN (Electronic)9781139250986
ISBN (Print)9781107677647
StatePublished - Jan 1 2014


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