Chronic Care Management and Infections in Older Adults
Infections at any age are discomforting and potentially life-threatening. For older adults, infections may lead to complications for existing complex health conditions, chronic discomfort and poor health, and a greater risk of hospitalization or even death. One in three deaths of persons over the age of 65 is directly associated with an infectious disease. Symptoms and diagnosis are often more difficult because the typical signs can be misread or not frequently observed. A sudden change in mental status or decline in physical function may be the only visible sign in an older patient with an infection.
Older adults are more likely to have a weakened immune system which can increase the risk for onset of infection and its level of impact. Older patients with two or more chronic diseases such as diabetes, malnutrition, heart disease, dementia, lung disease, or deteriorating skin conditions are most vulnerable to harsh effects of an infection.
The overuse of antibiotics and the rise of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), for example, are of increasing concern for older patients. Most older patients will be exposed to either MRSA, VRE or another bacterium that causes infection while hospitalized or in an institutional setting. Residents of long-term care facilities, nursing homes or hospitals with poor hygiene and prevention controls have the highest risk of death and disability from an infectious disease. MRSA, VRE and other bacterial infections cannot be treated by traditional antibiotics such as penicillin, amoxicillin, and methicillin. According to the CDC, 63% of bacteria don't respond to traditional antibiotics.
The most common infections among older adults include:
- Urinary Tract Infections (UTI): The use of catheters, chronic dehydration, or uncontrolled diabetes can increase the risk of UTIs or the onset of urinary incontinence in older patients.
- Elderly Skin Infections: Changes to aging skin and its ability to heal and resist disease increase the risk for viral infections like herpes zoster (shingles), pressure ulcers, bacterial or fungal foot infections (which can be more common in those with diabetes), and cellulitis.
- Bacterial Pneumonia: More than 60% of adults over the age of 65 are hospitalized because of bacterial pneumonia and bacterial related cardiopulmonary disease.
- Influenza and pneumonia: In the U.S, combined, influenza and pneumonia is the sixth leading cause of death with older adults contributing ninety percent (90%) of this mortality.
- Gastrointestinal Infections (GI): Age-related digestive changes and absence of gastrointestinal flora, or suppressed healthy gastrointestinal flora due to antibiotic treatments can increase the risk for diarrhea, reoccurring nausea, ulcers or gastritis, upper abdominal pain, and frequent fever.
CCM and TCM Care Managers can also educate family members and caregivers about the signs and symptoms of common infections. Some of these may include disorientation, chills/fevers, rashes, skin abscess, constant headaches and muscle aches, and chest pain. Care Managers can remind older patients and their caregivers to be aware of typical staph infections and to lower risk of exposure through hand washing, hygiene, and hydration.
Remaining alerted to significant changes in mental status, visible discharge or overall health in older patients can help identify infections early which increase the chance for successful treatment. Infections are preventable, and CCM and TCM care teams can work with providers, caregivers, and patients to lower risk and promote greater wellness and quality of life.
About the Author
Joseph F. West, ScD, is a population health and data analytics leader with over 10 years of research and enterprise consulting experience. He is a recognized leader in the development of outcomes-based healthcare. Joseph has served as Chief Population Health Officer, Senior Epidemiologist, Program Director, and Adjunct Assistant Professor. As a consultant and content creator, his current work focuses on population health management (PHM), health information technology (HIT), care coordination innovation, and healthcare risk management.