A Study of Clinical Profile of Infectious Diseases in the Elderly

Vikram Londhey, Dedhia CR, Khot AA, Limaye CS

Vikram Londhey, Dedhia CR, Khot AA, Limaye CS

Abstract

Ageing is an inevitable physiological process. Gradual decline in functioning of various organ systems and an increase in the susceptibility and prevalence of diseases occurs in the geriatric population.
Aims and objectives
1. To study the clinical profile of infectious diseases in the elderly population.
2. To study the risk factors and co-morbid conditions present in the elderly population associated with mortality.
Material and methods
From November 2008 to October 2010, 100 patients aged > 60 years admitted in general medical wards and medical intensive care unit of ABC Hospital, Mumbai with evidence of infection were included. Data pertaining to demography, symptoms on admission, presence of co-morbidities, vital parameters, general and systemic examination was noted. Routine biochemical, serological and radiological investigations were carried out. Appropriate cultures and analysis of body fluids (blood, urine, pleural, cerebrospinal and ascitic fluid) were
done. The data was analysed using Chi square and Fisher’s test.
Results
In this study urinary tract infection was the most common infection (26%) followed by respiratory tract infection (23%) and malaria (21%). The mortality in these infections was 19.2%, 39.1% and 38.1% respectively. Fever was the most common symptom (58%) followed by altered sensorium (47%), breathlessness (36%), generalised weakness (26%), oliguria (22%) and cough (22%).
Conclusions
1) Symptoms on admission like altered mental status, generalised weakness and breathlessness and presence of diabetes mellitus and alcoholism were predictors of mortality.
2) Hypotension and dehydration were clinical findings associated with significant mortality.
3) Sepsis, renal failure, electrolyte imbalance, hyponatremia, metabolic acidosis, respiratory failure and hypoalbuminaemia were statistically significant predictors of mortality in elderly patients with infection.
4) Mortality was directly proportional to the number of organ systems involved.

References

1. Sanya EO, Abiodun AA, Kolo P, Olanrewaju TO, Adekeye K. Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria. Ann Afr Med. 2011;10(4):278-83.
2. Aggarwal V, Mathews P K, V Surekha, Sowmya S, Wilson PB. Profile of Geriatric Population Admitted with Pyrexia of Unknown Origin at a Tertiary Care Hospital in India. Journal of Indian Academy of Geriatrics.2012 Dec: Abstract I. Accessed on net www.jiag.com on 16th October2014
3. Crossley KB, Peterson PK. Infections in the elderly. Clin Infect Dis. 1996;22:209-15.
4. Norman DC. Special infectious disease problems in geriatrics. Clin Geriatrics. 1999;1:3-5.
5. Fraser D. Assessing the elderly for infections. J Gerontol Nurs. 1997;23:5-10
6. Avkan-Oguz V, Yapar N, Erdenizmenli N, Kuruuzum M. Effects of community-acquired infections on fever, leukocyte count and the length of stay in elderly, A cross-sectional study of 240 cases. Saudi Med J. 2006;27:368-72.
7. Yoshikawa TT. Ambulatory management of common infections in elderly patients. Infection in Medicine. 1991;20:37-43.
8. Williams GO. Vaccines in older patients: Combating the risk of mortality. Geriatrics. 1980;35:55-64.
9. Koivula I, Sten M, Makela PH. Risk factors for pneumonia in the elderly. The American Journal of Medicine. 1994;96: 313-20.
10. Valdez R, Narayan KM, Geiss LS, Engelgau MM. Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults. Am J Public Health. 1999;89:1715-21.
11. Maitra A. The Endocrine System. In, Kumar V, Abbas KA, Fausto N, Aster JC (ed). Robbins and Cotran Pathologic Basis of Disease, 8th edition. Philadelphia, Saunders, 2010;1146.
12. Gacouin A, Legay F, Camus C, Volatron A, Barbarot N, Donnio P et al. At-Risk Drinkers are at Higher Risk to Acquire a Bacterial Infection During an Intensive Care Unit Stay Than Abstinent or Moderate Drinkers. Crit Care Med. 2008;36:1735-41.
13. Marchick MR, Kline JA, Jones AE. The significance of nonsustained hypotension in emergency department patients with sepsis. Intensive Care Med. 2009;35:1261-64.
14. Himelstein D, Jones A, Woolhandler S. Hypernatremic dehydration in nursing home patients: An indicator of neglect. J Am Geriatr Soc. 1983;31:466-71.
15. Mahowald J, Himmelstein D. Hypernatremia in the elderly: Relation to infection and mortality. J Am Geriatr Soc. 1981;29:177-80.
16. Friedler RM, Kodfler A, Kyrokawa K. Hyponatremia and hypernatremia. Clin Nephrol. 1977;714:163-72.
17. Izaks GJ, Westendorp GJ, Rudi, Knook DL .The Definition of Anemia in Older Persons. JAMA. 1999;281:1714-17.
18. Angus DC, Linde-Zwirble WT, Lidicker J. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-10.
19. Angus D, Wax RS. Epidemiology of sepsis: An update. Crit Care Med. 2001;29:109-16.
20. Padkin A, Goldfrad C, Brady AR. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med.
2003;31:2332-38.
21. Brun-Buisson C, Meshaka P, Pinton P. EPISEPSIS: A reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med.
2004;30:580-88.
22. Martin GS, Mannino DM, Moss M. The Effect of Age on the Development and Outcome of Adult Sepsis. Crit Care Med. 2006;34:15-21.
23. Bruunsgaard H, Skinhoj P, Qvist J. Elderly humans show prolonged in vivo inflammatory activity during pneumococcal infections. J Infect Dis. 1999;180:551-54.
24. Gabriel P, Cakman I, Rink L. Overproduction of monokines by leukocytes after stimulation with lipopolysaccharide in the elderly. Exp Gerontol. 2002;37:235-47.
25. Yamamoto K, Shimokawa T, Yi H. Aging accelerates endotoxin- induced thrombosis: Increased responses of plasminogen activator inhibitor-1 and lipopolysaccharide signaling with aging. Am J Pathol. 2002;161:1805-14.
26. Ely EW, Wheeler AP, Thompson BT. Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med. 2002;136:25-36.
27. Stephan F, Cheffi A, Bonnet F. Nosocomial infections and outcome of critically ill elderly patients after surgery. Anesthesiology. 2001;94:407-14.
28. Ely EW, Evans GW, Haponik EF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Arch Intern Med. 1999;131:96-104.
29. Chelluri L, Pinsky MR, Donahoe MP. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA. 1993;269:3119-23.
30. Santacruz F, Barreto S, Mayor MM, Cabrera W, Breuer N. Mortality in elderly patients with acute renal failure. Ren Fail. 1996;18:601-5.
31. Gunnerson KJ, Saul M, He S, Kellum JA. Lactate vs. Non- Lactate Metabolic Acidosis: A Retrospective Outcome Evaluation of Critically Ill Patients. Critical Care. 2006;10:321.
32. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS et al. Lactic acidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. Emerg Med J. 2008;25:659-65.
33. Peralta R, Rubery BA, Langenfeld SC. Hypoalbuminemia: eMedicine Specialties, Critical Care, Medical Topics, Medscape; c1994-2010. [Updated: Apr 15, 2010]. Available from: http://emedicine.medscape.com/article/ 166724-overview. html.