Infectious Diseases
among Older Adults: Perspectives of a Microbiologist
By the
year 2050, individuals over the age of 65
will represent 20 percent of the
United States population (Ortman,
Velkoff, & Hogan, 2014). As the
population increasingly ages, the U.S healthcare
system will continue to feel the burden of this vulnerable age group. As
a microbiologist, I have learned to appreciate
that the diagnosis of infectious diseases in the elderly can
prove to be rather challenging. In turn, any
delay in the treatment of these
infections can result in an increased incidence of morbidities and mortality for
this demographic. To make
matters worse, the elderly are
especially vulnerable and at an
increased risk of acquiring these
infections.
There are several reasons why the geriatric
population tends to be more prone to infectious diseases. As people age, it becomes more common for these patients to suffer from multiple
chronic conditions which can predispose them to infections. Older adults also have a diminished immune system which prevents the body from mounting the
response necessary to fight off infection (Yoshikawa, 2000). In addition to a weakened immune response, certain factors such as the thinning of skin, stretching of the urothelium, and a decline in
mucociliary clearance can disrupt the natural barriers meant to protect an individual from infections
(Boling, Hobgood, & Chandekar,
2017). Frailty and cognitive impairments are risk factors that decrease
an older patient’s ability to get
around and maintain personal hygiene. Malnutrition and adverse drug
interactions can impact the overall wellness of these individuals leading to even more risk of infections (Kaye, 2011).
Geriatric patients typically do not present to clinicians with the usual signs and
symptoms of infection contributing
to further delays in diagnosis and
treatment. Fever and increased white
blood cell count are symptoms that may
not occur in the elderly but are often seen in younger patients. For many of these patients, the only sign of infection is cognitive impairment or
confusion which can easily be dismissed as a normal part of the aging process. Because older patients
manifest in atypical ways, clinicians need to
familiarize themselves with these nonspecific presentations. Symptoms
such as anorexia, weakness, urinary retention, and weight loss may be the only
signs of
the presence of
an infectious disease in the elderly (Boling et al, 2017). Clinicians need to
spend more time with their older patients and perform a thorough
assessment including an interview of family
members in order to better identify
those at risk for infections (Mouton et al, 2011). Educational opportunities and
workshops focusing on geriatric care would be beneficial to providers who will continue to see older patients as these Baby Boomers
continue to age.
In addition
to diagnostic challenges, the
treatment of infectious diseases has
also proven to be problematic for
clinicians. The recent increase in drug-resistant bacteria has especially
affected this age group due to their
increased exposure to these
organisms in hospitals or long-term healthcare facilities. These bacteria can
colonize patients and be spread from person-to-person creating an increased
risk for active infections. Infection
control processes, such as hand hygiene and proper PPE, can help to combat
the spread of these organisms and
further protect the elderly; a point which has become glaringly obvious with
the current COVID-19 pandemic. I feel the transmission of infectious diseases can be decreased by
focusing on public health policies for the
elderly and increasing vaccination availability. In order to help
protect the elderly from COVID-19, it is critical that a vaccine be developed. Unfortunately, this is not an easy task and side effects including effectiveness of the
vaccine need to be considered before
distribution.
References:
Boling, P., Hobgood, S., & Chandekar,
R. (2017). Hospital infection control: geriatrics unit. Retrieved from
Kaye, K.S. (2011).
Comorbidities, metabolic changes make elderly more susceptible to infection. Retrieved from
Mouton, C.P., Bazaldua, O.V., Pierce, B., & Espino, D.V. (2015). Common infections in older
adults. Retrieved from
Ortman, J.M., Velkoff,
V.A., & Hogan, H. (2014). An aging nation: the
older population in the United States. Retrieved
from https://www.census.gov/prod/2014pubs/p25-1140.pdf
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