The critically ill older patient with sepsis: a narrative review

Abstract

Sepsis is a significant public health concern, particularly affecting individuals above 70 years in developed countries. This is a crucial fact due to the increasing aging population, their heightened vulnerability to sepsis, and the associated high mortality rates. However, the morbidity and long-term outcomes are even more notable. While many patients respond well to timely and appropriate interventions, it is imperative to enhance efforts in identifying, documenting, preventing, and treating sepsis. Managing sepsis in older patients poses greater challenges and necessitates a comprehensive understanding of predisposing factors and a heightened suspicion for diagnosing infections and assessing the risk of sudden deterioration into sepsis. Despite age often being considered an independent risk factor for mortality and morbidity, recent research emphasizes the pivotal roles of frailty, disease severity, and comorbid conditions in influencing health outcomes. In addition, it is important to inquire about the patient's preferences and establish a personalized treatment plan that considers their potential for recovery with quality of life and functional outcomes. This review provides a summary of the most crucial aspects to consider when dealing with an old critically ill patient with sepsis.

Keywords: Infection outcomes; Intensive care; Old; Sepsis; Very old.

Fig. 1

Incident sepsis cases by age group and underlying cause category, both sexes, all locations, 2017. Bars represent 95% uncertainty intervals. Reproduced from (1). Published under the CC BY 4.0 license

Fig. 2

Percentage of all sepsis-related deaths in each underlying cause category, by age group and for both sexes, in 2017. Bars represent 95% uncertainty intervals. Reproduced from (1). Published under the CC BY 4.0 license

Fig. 3

Risk factors for sepsis in older adults. Older adults face an elevated risk of sepsis due to several factors, including aging itself, comorbidities, and a weakened immunity. The interplay between their general health and sepsis severity significantly influences both short- and long-term outcomes, emphasizing the need for comprehensive assessment and personalized treatment strategies

Fig. 4

Clinical picture in older patients may be ambiguous

Fig. 5

Triage considerations for the older septic patient. HRQoL Health-Related Quality of Life, TLT Time Limited (ICU) Trial