Common Infections in the Elderly - Part 2 - Respiratory & Gastrointestinal

By Anna Hazard

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Part 1 : Urinary Tract & Lung Infections

Introduction

Two other types of infections common within the elderly are respiratory infections (comprising the mouth. nasal cavity, pharyx/larynx/trachea, bronchi and lungs) and gastrointestinal infections (comprising the GI tract - mouth, pharynx, esophagus, stomach, intestines, rectum, and anus - as well as the liver, pancreas, and gallbladder) both of which tend to flare up often and spread quickly through institutionalized group settings where seniors can often be found such as nursing homes, rehab centers, and hospitals.
 
Bacterial or viral infections are the most widespread, but seniors comprise a disproportionate amount of patients suffering from fungus based infections within the skin & lungs due to their overall weaker immunities and tendency towards activities that expose themselves to fungal spores.

Infections

Respiratory Infections

• Pneumonia & Influenza (Flu)
  • Death from the flu occurs primarily in the elderly, with more than 60% of all seniors over age 65+ being admitted at least once to the hospital with pneumonia (which often originally develops from an influenza infection). The influenza & pneumonia combination is the 6th leading cause of death in the USA with seniors over 65+ comprising 90% of the mortality rates. Influenza by itself is responsible for more than $1 billion in annual Medicare costs with 80 - 90% of its deaths occurring in seniors.
  • The most common causes of pneumonia within older adults include Streptococcus pneumoniae, respiratory viruses, Haemophilus influenzae, gram-negative bacilli and Staphylococcus aureus.​

• Pneumococcus (Streptococcus pneumoniae)
  • The most common cause of pneumonia in seniors, this gram negative bacteria normally resides without any symptoms in the respiratory tract & nasal cavities of healthy carriers. However, it can become pathogenic and spread within vulnerable patients such as the elderly or those with repressed immune systems.
  • Streptococcus pneumoniae can also cause meningitis, bronchitis, sinusitis, septic arthritis and the inflammation & infection of other parts of the body.

• Fungal Pneumonia (Endemic mycosis)
  • Endemic mycoses is caused by fungal species that are present within the soil of certain regions. Infection can take hold while the patient is taking part in outdoor activities such as gardening (a popular past time amongst retirees).
  • Strains that pose a particular threat to seniors within the USA include Histoplasma capsulatum and Blastomyces dermatitidis (found within humid areas such as the Ohio and Mississipi river valleys) and Coccidioides immitis (south west deserts). In particular,  Coccidioides immitis infections (also known as Valley Fever) are currently highest amongst people who are age 65+.
  • While more common as a skin infection, pulmonary sporotrichosis can also develop within the lungs.

• Risks & Causes
  • Seniors are more vulnerable to respiratory infections due to diminishing lung capacity and a decreased cough reflex & airway obstruction that often comes with age. In addition, the elderly remain more susceptible due to weakened immunities and the increased chance of having other chronic conditions (such as diabetes or cardiopulmonary disease) that can lead to major complications. Seniors tend to be more exposed to airborne diseases due to many being present in group settings such as nursing homes, adult day care, or assisted living.

• Prevention
  • Like with other forms of infection handwashing & good hygiene (especially when it comes to teeth, dentures, & other dental health) are a good method for preventing initial infection.
  • Older adults benefit greatly from vaccination, early detection, and aggressive treatment.
  • The annual flu vaccines are 58 percent effective in reducing the flu with a decrease of 39 to 69% in death rates of seniors. Four antiviral agents (amantadin, rimantadine, zanamivir, and oseltamivir) can be used to prevent or treat influenza when taken within 48 hours of infection & onset of symptoms.
  • In addition some types of pneumonia can be prevented with a pneumococcal vaccine.

• Symptoms
  • Classic symptoms such as chills & fever, cough, muscle aches, and sore throat may not be as readily apparent or present within seniors.
  • Other non-respiratory symptoms such as confusion, malaise, delirium, and rapid onset of headache may be seen with infected seniors instead. Older adults may also develop a persistent weakness that can last for many weeks.
  • Delayed  antibiotic treatment due to non-specific symptoms not being recognized within infected seniors is one of the leading causes to their higher mortality rates.

Gastrointestinal Infections

• Gastrointestinal infections are viral, bacterial or parasitic infections that cause inflammation in the stomach and the small intestine. These types of infections are among the most common  in long term care facilities such as nursing homes & rehab centers where they pose a particular danger to the elderly who are already more vulnerable to dehydration.

• Helicobacter pylori
  • Common bacterial infection amongst the elderly as many people may be infected for years without any symptoms. It's symptoms include fever, nausea and upper abdominal pain. May lead to long-term illness such as gastritis, ulcers, or gastric tumors whose complications are more common within the elderly than in younger patients.

• Clostridium difficile (c. diff)
  • Seniors over 65+ comprise over 2/3rds of the patients diagnosed with this bacterial infection & is the 19th leading cause of death in seniors. It primarily affects people in hospitals and long-term care facilities as c/ diff infections are often triggered by antibiotic treatments for other infections that end up suppressing healthy gastrointestinal flora, thus seniors being treated for other diseases are particularly vulnerable.
  • C. difficile is normally found in about 30-70% of healthy individuals, however other beneficial gut bacteria keeps it in check. Infection takes place within the colon with the main symptom being painful diarrhea.

• Stomach Flu (Norovirus)
  • This virus, commonly called the stomach flu or food poisoning, is the cause of  nearly 50% of all gastroenteritis outbreaks worldwide and is the most common cause in aged care facilities. It spreads particularly fast in confined spaces such as nursing homes or assisted living centers.
  • It causes inflammation of the stomach and intestines with symptoms that include sudden diarrhea, vomiting, nausea and stomach pain, as well as fever, headache and body aches.

• Risks & Causes
  • Changes in digestion that become more prominent with age such as decreased production of gastric acid, decreased gastrointestinal flora, and decreased intestinal motility (especially associated with medication side effects) puts seniors at increased risk for gastrointestinal infections.
  • Gastrointestinal infections can also be further aggravated by antibiotic treatments that kill off beneficial bacteria within the gut. 

• Prevention
  • Handwashing as well as good hygiene is the best defense against gastrointestinal infections, especially when it comes to the handling of food & drinks.
  • All foods should be cooked to their recommended temperatures & properly stored to avoid proliferation of bacteria & viruses.
  • Antibiotics should be used sparingly to cut down the risk of suppressing beneficial gut bacteria. Probiotics may be used in conjunction to help maintain the balance.

• Symptoms
  • Symptoms vary depending upon the exact infection, but common signs include abdominal pain & nausea.

Further Information

Oxford Academic [1, 2, 3, 4] | American Family Physician | Semantic Scholar | BMJ | National Foundation for Infectious Diseases | National Center for Biotechnology Information [1, 2, 3] | Medscape | Alliance for the Prudent Use of Antibiotics | Norovirus.org