Sepsis Symptoms In The Elderly

Sepsis Symptoms In The Elderly

Sepsis is a serious infection that can be extremely dangerous for older adults, so recognising the symptoms early and taking fast action could potentially save a life. Here, we are taking a look at why older adults tend to be more susceptible to developing sepsis, the most recognisable symptoms, red flags to watch out for, what to do if you suspect sepsis, and how home care could help to prevent this from happening.

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about sepsis in older adults, we can help.

Why do older people have a higher risk for getting sepsis?

Older adults aged 65 and over are thought to be more likely to end up in hospital with sepsis than other age groups, with around 256,000 patients developing sepsis annually across the UK. In fact, an estimated 63% of people aged 60 and over who go into intensive care are thought to have sepsis when they go into hospital. When this happens, over 40% of older patients may go back into hospital within just 3 months of having this infection, either with sepsis or another illness.

There are several reasons older adults are more at risk, including:

Sarcopenia (muscle loss) – Around 10-16% of older people are thought to have sarcopenia, and this can lead to a higher risk of sepsis
Weakened immune system – Sepsis is an infection, and as older adults usually have a weaker immune system their bodies could find it more challenging to fight infection, making them more susceptible to sepsis
Increased infection risk – Older people are more likely to get infections, for example, if they are unable to keep a small cut clean, or if they live with a catheter or stoma
Frequent hospital stays – Older adults tend to end up in hospital more than other age groups, and this can put them at risk of developing sepsis – around 15 in every 1,000 patients in hospital are thought to develop sepsis
Dehydration and malnutrition – Older adults tend to experience dehydration and malnutrition more often, and this can cause a weakened immune system which can lead to sepsis

Comorbid conditions – People who live with conditions like cancer, diabetes or heart disease may have a higher risk of developing sepsis

What are the key symptoms of sepsis in older adults?

Recognising the main symptoms of sepsis is more difficult in older adults, but is incredibly important to get right as early as possible in order to avoid a medical emergency.

The main symptoms of sepsis include feeling ill, like you have the flu, weakness or fatigue, a fast heart rate, rapid breathing or shortness of breath, confusion or disorientation, general discomfort, sweating or feeling clammy, mottled skin, low blood pressure, and urinating less frequently.

While a temperature above 38°C or below 36°C can be a sign of sepsis, it is important to know that NICE guidance is clear that temperature alone should never be used to rule sepsis in or out. This is particularly relevant for older or frail adults, who may not develop a raised temperature even when seriously ill with sepsis. This is one of the reasons sepsis can be so difficult to spot in older people — waiting for a fever that may never appear could cost vital time. If other signs are present, seek emergency help immediately regardless of whether a temperature is raised.Other notable signs to be aware of include chills, a rapid heart rate, sudden changes in cognition, disorientation or drowsiness, rapid breathing, low blood pressure, decreased urine output, and skin that feels cold and clammy, or looks pale. The signs of sepsis can be subtle in older adults, and therefore mistaken for something potentially less serious like a urinary tract infection (UTI). Around 25% of all adult sepsis cases originate in the urinary tract — a type known as urosepsis. In more severe cases of sepsis or septic shock, UTIs are identified as the source in roughly 10 to 30% of cases. This is why prompt treatment of UTIs in older adults is so important.

When it comes to visible signs of sepsis, it can help to watch out for rashes and skin changes. Skin may look discoloured (blue, grey or pale) and blotchy. The lips or tongue may also look discoloured, and on brown or black skin this could be seen more easily on the palms or soles of the feet. If there is a rash, you can roll a glass over it to see if it fades or not – if the rash does not fade, this could be an indication of sepsis.

One other helpful tool for spotting these signs is the SEPSIS acronym:

S – Slurred speech and/or confusion

E – Extreme shivering and/or muscle pain

P – Passing no urine (in a day)

S – Severe breathlessness

I – It feels like “I might die”

S – Skin mottled or discoloured

Sepsis that is not treated immediately can develop into septic shock, which causes low blood pressure and potential organ failure. This is life-threatening, so it is important to be aware that sepsis can progress at a rapid pace from the initial infection to the septic shock stage, causing death in just 12 hours in some cases. In older people, this can develop more slowly, so understanding the unique signs of this is important so they are not missed.

What other red flags are important to watch out for?

Sepsis can be very difficult to notice in older people with dementia, learning disabilities or anyone who struggles with communication. Some of the less common signs to watch out for include a reduced appetite, being unsteady on their feet or falling, and drowsiness. Research shows that older adults are not only more likely to experience sepsis, but are also more likely to experience longer lasting consequences from the infection, including physical and cognitive limitations. For this reason, taking rapid action is crucial if you suspect sepsis.

What to do if you suspect sepsis?

Erring on the side of caution is always best when it comes to sepsis; if you suspect this could be the case, it is much better to “overreact” and be wrong, than to hesitate. If you have questions about sepsis symptoms in yourself or a loved one you can call NHS 111 to discuss this, but if there is any sign of sepsis, call an ambulance straight away, or go to A&E – this is a medical emergency. If you are experiencing symptoms yourself, get someone else to drive you to the hospital – do not drive there yourself.

Time is critical with sepsis. Current NICE guidance is clear that for anyone showing high-risk signs of sepsis, antibiotics should be given as quickly as possible — and within one hour. This is why acting immediately is so important; the sooner treatment begins, the better the chance of recovery.

If you suspect sepsis:

Call 999 or go to A&E without delay
Tell the 999 operator that you suspect sepsis so they can prioritise the response
Monitor symptoms until the ambulance arrives, so you can tell paramedics the progression of the infection

How can home care teams help to prevent sepsis?

Home care can play an important role in preventing and noticing signs of sepsis in older people, and there are a number of ways they can do this:

Checking vital signs every day to spot early signs of sepsis
Promoting good hygiene in older people, and helping with personal care
Monitoring the person’s overall health to avoid sepsis
Being aware of their general personality so signs of confusion are more evident
Checking regularly for rashes and other skin changes that could indicate sepsis
Regularly cleaning and checking wounds for signs of infection, like pressure sores
Managing urinary tract infections (UTIs), which commonly lead to sepsis
Regularly changing catheters and other equipment to check for signs of infection
Ensuring medications are taken correctly to manage chronic health conditions
Taking the person to get their pneumococcal vaccine, which can reduce the likelihood of sepsis
Encouraging a healthy diet to maintain overall health and reduce the likelihood of sepsis developing
Prompting fast medical attention if symptoms do arise

At Home Instead, our Care Professionals are trained to recognise when someone’s condition may be deteriorating and to seek medical help without delay. Having a familiar, trusted person present who knows to act quickly could be lifesaving.If you are worried about the potential for developing sepsis, either for yourself or a loved one, reach out to your local Home Instead office to discuss arranging home care so there is always a trained professional around to help.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.

Michelle Tennant, Clinical Governance Lead

I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 5 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.