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82 Cards in this Set
- Front
- Back
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How does the incidence of acute infections for non-hospitalized ambulatory elderly patients compare to children and younger adults?
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Incidence of acute infections is less in ambulatory elderly person than in children and younger adults
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How does the risk of severe complications of infections for elderly patients compare to children and younger adults?
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Elderly are at increased risk for more severe complications of infections such as hospitalization or death
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"Infection is the primary cause of death in 1/3 of individuals aged 65 years or older" True or False?
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TRUE
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What is the risk of nosocomial infections in Hospitalized elderly (aged 70-90)?
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They have a 2-5 fold increase in nosocomial infections
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What portion of long term care facility residents in the US, Canada and Italy reported to use antibiotics during a study period of 1 year?
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between 47-79%
[of which 40-50% were inappropriate] |
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What are examples of higher morbidity and mortality with infections in the elderly?
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Kidney infection 5-10 times higher,
Appendicitis 15-20 times higher, Cholecystitis 2-8 times higher, Endocarditis 2-3 times higher, Pneumonia is 3 times higher, Sepsis is 3 times higher |
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What are the morbid events of Pneumonia infections in older patients?
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Extra pulmonary site of infections, delayed resolution, decline in functional status, abnormal gas exchange
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What are the morbid events of Urinary Tract Infections in older patients?
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Sepsis, Recurrence, Urinary Incontinence
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What are the morbid events of Endocarditis infections in older patients?
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Heart Failure
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What are the morbid events of Appendicitis/Cholecystitis/Diverticulitis in older patients?
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Perforation, Gangrene, Abscess, Sepsis
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What are the morbid events of Herpes Zoster infections in older patients?
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Post Herpetic Neuralgia
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"Age is an Independent risk factor for infections in the elderly" True or False?
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FALSE
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What are examples of Chronic Diseases that increase the risk of infections in the elderly?
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CV disorders, Hypertension, Chronic Pulmonary Disease, Diabetes Mellitus, Dementia
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"Impaired immunity correlates more with disease burden than chronologic age" True or False?
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TRUE
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What is the definition of Immunosenescence?
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The failure weakening of the body's defense systems(innate/adaptive) in old age
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What are the body's defense mechanisms?
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1) Innate Immune System
2) Adaptive Immune System |
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What are examples of the body's Innate Immune System?
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1) Physical/Anatomical Mechanisms: prevent pathogen entry
2) Nonspecific Defensive Cells: Phagocytes, Eosinophils, NKCs, Proteins (Interferons, complement system) |
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What are examples of the body's Adaptive Immune System?
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Antibody targeted defenses from antigen recognition to long term immune memory
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What are examples of Inadequate Defense Mechanisms of the body?
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1) Decreased gastric acidity
2) Prostatic enlargement 3) Weakening of pelvic floor 4) Loss of elastic tissue from lung 5) Dampened neural reflexes 6) Increased bacterial adherence to mucosal cells 7) Decreased mucous production 8) Poor ciliary action |
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What are the physical/anatomical changes in the elderly that increases the susceptibility of Pneumonia?
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1) Reduced mucocillary transport
2) Reduced cough reflex 3) Reduced elasticity of alveoli 4) Reduced airway patency 5) Poor ventilation |
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What are the physical/anatomical changes in the elderly that increases the susceptibility of UTI?
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1) Neurogenic bladder with increased residual urine
2) Enlarged prostate (BPH) 3) Increased vaginal pH secondary to estrogen depletion post menopause 4) Incomplete emptying of the bladder |
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What are examples of Immunosenescence in the Innate Immune System?
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i) Impaired cellular immunity
ii) Neutrophil and macrophage phagocytosis is often decreased iii) Decreased cytokine production |
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What are examples of Immunosenescence in the Adaptive Immune System?
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i) Thymus gland atrophy (decreased T-cell populations which reduces Vaccine response)
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What are examples of Functional impairment changes that make the elderly at increased susceptibility of Infections?
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1) May be bedridden and incontient of urine and feces
2) Unable to feed themselves or care for their personal needs 3) They may develop pressure sores, need indwelling urethral catheter and aspirate with attempted feeds |
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What are examples of Sensory Deficits that make the elderly at increased susceptibility of Infections?
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Cough reflexes and pain sensations may be impaired
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What are the common infections in Healthy community dwellers?
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i) Respiratory Tract Infections
ii) UTIs iii) Intra-abdominal sepsis iv) Tuberculosis v) Infective endocarditis |
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What are the common infections in ill Hospitalized patients?
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i) UTIs
ii) Aspiration Pneumonia iii) Skin/Soft tissue infections iv) Septic Thrombophlebitis |
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What are the common infections in frail, nursing home residents?
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i) UTIs
ii) Pneumonia iii) Skin/Soft Tissues iv) Gastroenteritis |
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Which of the infections are common in All residents (community, hospitals, nursing home residents)?
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i) Respiratory Tract Infections
ii) UTIs |
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How does the diversity of pathogens differ in the elderly?
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Pathogens are more diverse and heterogenous in elderly
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How do the most common pathogens differ between the Young and Elderly for Pneumonia?
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Young: Strep Pneumonia, Mycoplasma pneumonia
Elderly: Strep Pneumonia, Staph Aureus, Hemophilius Influenzae, Gram neg bacilli |
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How do the most common pathogens differ between the Young and Elderly for UTI?
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Young: E.coli
Elderly: E.coli, Proteus sp, Klebsiella sp |
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How do the most common pathogens differ between the Young and Elderly for Endocarditis?
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Young: Strep Viridians
Elderly: Strep Viridians, Strep Bovis, Staph Aureus, Enterococcus sp |
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"The isolation of Gram negative rods is more frequent in older adults" True or False?
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TRUE
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How do the clinical manifestations of infections differ in the Elderly?
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The elderly often have nonspecific and atypical signs and symptoms of infections
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What are examples of the nonspecific and atypical signs of infection in the Elderly?
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Anorexia, Fatigue, Weakness or change in functional capacity, acute delirium or change in mental function, tachypnea, orthostatic hypotension, false
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How frequent is Fever in serious infections for the Elderly?
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May be absent in 25% of elderly with serious infections
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What are some of the reasons why Fever is blunted in the Elderly?
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1) Decreased pyrogen production
2) Decreased response to pyrogens 3) Lower baseline temperature 4) Impaired immunity |
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What constitutes a Fever in the elderly?
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Lower than standards for younger adults (>38oC)
1) Oral Temperature >37.8oC 2) Persistent oral temperatures >37.2oC on more than two occasions |
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What are the clinical manifestations of infections in the elderly?
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1) Pain
2) Decline in Mental Status 3) Local Inflammation 4) Leukocytosis: May be blunted and only measurable as a slight shift to the left |
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What are the Atypical/Nonspecific presentations of the elderly?
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i) Confusion
ii) Depression iii) Falls iv) Incontinence v) Decreased activities of daily livings |
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What are the Geriatric Giants in the elderly?
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i) Incontinece
ii) Immobility iii) Instability (falls and syncope) iv) Intellectual Impairment (delirium & dementia) |
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What are examples of Antimicrobials that are excreted renally?
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Cloxacillin, Ceftriaxone, Azithromycin, Doxycycline, Moxifloxacin
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"Adverse events due to antibiotic usage in the elderly is more common AND associated with Increasing morbidity" True or False?
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TRUE
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What adverse reaction of Aminoglycosides occurs more often in the elderly?
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Renal and 8th nerve dysfunction (responsible for balance and hearing)
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What adverse reaction of Vancomycin occurs more often in the elderly?
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Renal dysfunction
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What adverse reaction of Quinolones occurs more often in the elderly?
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Seizures and hallucinations, Prolonged QT interval and Torsade, Tendontis
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What adverse reaction of Nitrofurantoin occurs more often in the elderly?
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Skin and Lung Reactions (Eosinophillic Pneumonia)
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What adverse reaction of Minocycline occurs more often in the elderly?
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Confusion, Hepatic Toxicity
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What adverse reaction of Macrolides occurs more often in the elderly?
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GI Cramps, Prolonged QT interval
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What is the relationship between Macrolides and Cardiac Issues?
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There is an increased risk of Cardiac Death (shown in multiple studies in various populations with varying increased risk rates)
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What are the drug interactions of Erythromycin and Ciprofloxacin?
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Induces toxicity of Theophylline, Calcium Channel Blockers, Statins, Antifungals , Digoxin
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What are the drug interactions of Metronidazole?
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Increases phenytoin levels
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What are the drug interactions of Septra, Amoxicillin, Tetracyclines and Cephalosporins?
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Increases anticoagulant effect of Warfarin
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What are the drug interactions of Ampotericin B?
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Can induce Hypokalemia which may precipitate digoxin toxicity
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What are the drug interactions of Fluroquinolones and Tetracyclines?
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Impaired Absorption with Cations (Mg, Ca, Fe)
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What are the drug interactions of Macrolides and Fluroquinolones?
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Increased risk of Torsades with other QT prolonging medications
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Why are the elderly at a higher risk of UTIs?
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1) Decreased urine flow
2) Decreased immune response 3) Prostate Disease |
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"UTI is the most common illness in adults age 65 and over" True or False?
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TRUE
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"Above the age of 80, men are more likely to develop UTI than females" True or False?
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False;
Women are twice as likely to develop than males |
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What are the common bacteria for UTIs in the elderly?
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Most common bacteria is gram negative bacilli
(E.coli, Enterobacter, Klebsiella, Proteus) |
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What are the resistant bacteria for UTIs in the elderly?
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Resistant organisms are implicated more frequently including
( Pseudomonas, Enterococcus, Coag-negative Staph, Group B Strep) |
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What are the symptoms of UTIs in the elderly?
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1) Cognitive Deciine
2) Pus or blood in urine 3) Foul smelling urine 4) Dysuria 5) Lower abdominal pain 6) Worsening urinary urgency |
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Why is Nitrofurantoin inappropriate in the elderly?
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Because it is inappropriate at ClCr <60 ml/min (40-50ml/min)
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How common is Asymptomatic Bacteruria in the Elderly?
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Present in 50% of elder women and 15-40% of elder men
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"We should treat Asymptomatic bacteria in all elderly patients" True or False?
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False;
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Why is screening/treatment of Asymptomatic bacteria unnecessary in the elderly?
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1) No significant change in symptomatic infection rate
2) No change in incontinence symptoms |
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"Treatment is usually not recommended if the patient is Asymptomatic, UNLESS they have WBCs in the urine" True or False?
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FALSE
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How much of the pneumonia/influenza related death occur in adults 65 and older?
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90%
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What are the common pathogens for Pneumonia in the elderly?
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Strep pneumonia, Staph aureus, H.influenzae, Gram negative bacilli
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What are the atypical pathogens for Pneumonia in the elderly?
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M.catarrhalis, Legionella, Mycoplasma
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What are the indicators of Poor prognosis for Pneumonia in the elderly?
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1) Decreased functional status
2) Altered mental status 3) Increased number of comorbidities 4) Aspiration Pneumonia (more frequent in elderly, poor oral hygiene increases risk)) 5) Renal Failure 6) Poor nutritional status |
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What is the significance of PSI scores for Pneumonia?
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PSI >91 = Treat in hospital,
PSI <90 = Treat as outpatient |
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What are common causes of Aspiration Pneumonia?
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i) Neuromuscular conditions
ii) Lowered level of consciousness iii) Severe GERD iv) Chronic respiratory conditions |
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Why is Herpes Zoster more common in the elderly?
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Likely due to Immunosenesnce
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What is Herpes Zoster Opthalmicus?
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Involvement of the trigeminal nerve; can result in vision loss and requires ophthalmologist referral
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What is the Zostavax Vaccine's Effect according to BCCDC and CDC?
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Reduces risk of shingles by ~50%,
Reduces risk of Post Herpetic Neuralgia by ~67% |
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What is the Zostavax Vaccine's Effect according to RxFiles?
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Efficacy for prevention of shingles is highest in patients 60-69 years old & decreases with increasing age
(NNT: 364 patients vaccinated; 1 PHN case was prevented & 6 shingle cases were prevented over ~3 years) |
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What is the effect of the Zostavax Vaccine on the incidence of Shingles?
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Unvaccinated: 550/10,000
Vaccinated: 275/10,000 |
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What is the effect of the Zostavax Vaccine on the incidence of Post Herpetic Neuralgia?
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Unvaccinated: 70/10,000
Vaccinated: 25/10,000 |
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What is the effect of the Zostavax Vaccine on the incidence of Herpes Zoster Opthalmicus ?
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Unvaccinated: 55-137/10,000
Vaccinated: 26-69/10,000 |
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What is the effect of the Zostavax Vaccine on the incidence of Vision Impairment?
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Unvaccinated: 22-55/10,000
Vaccinated: 11-28/10,000 |
