Changes related to ageing make people susceptible to infections and complicate diagnosis.
Diminished cell-mediated immunity and partly also humoral immunity
Long-term diseases, age-related physiological changes and many medications
Typical symptoms of infections (such as fever) are often absent or are non-specific (e.g. difficulty walking, confusion). Even a mild infection may cause some organ decompensation.
Pneumonia
Predisposing factors for pneumonia Pneumonia in old age include impaired cough reflex, impaired functioning of the pharynx, obstructive pulmonary diseases, immobilization and heart failure.
The temperature of a patient with pneumonia may be normal and cough may be completely absent. Pneumonia may manifest as impaired general condition and functioning, confusion, or chest pain.
During an influenza epidemic secondary bacterial pneumonia, often caused by staphylococci, is common. In this case cefuroxime is a justifiable antimicrobial choice.
The length of treatment for pneumonia is usually 10 days.
In prolonged lung infection, the possibility of malignancy as well as of tuberculosis should be kept in mind (Mycobacterium tuberculosis, nucleic acid detection).
Urinary tract infections and pyelonephritis
Women are predisposed to urinary tract infections Urinary Tract Infections because of factors such as age-related atrophy of the mucosa or prolapses, men because of prostate hyperplasia. The most important external factor predisposing for urinary tract infection is cathetrization. An indwelling catheter should always be removed as soon as possible.
The cause of recurrent infections should be defined and treated.
Prophylactic pharmacotherapy should be avoided. In exceptional cases it can be considered for a specific period with, e.g., trimethoprim as single dose at night for 6-12 weeks. Nitrofurantoin and quinolones are not used for prophylactic treatment.
Treatment should always be based on symptoms and a bacterial culture of an appropriately collected sample. Treatment should not be started only on the basis of a smell combined with suspicion of an infection.
Symptomless bacteriuria of the elderly is common and should not be treated without some specific (dysuria, frequency) symptoms suggestive of an infection. Symptomless bacteriuria should not be accepted as the reason for the patient's weakened general condition either.
Because the sense of visceral pain decreases with ageing, acute appendicitis and cholecystitis, for example, may be difficult to diagnose. They may silently lead to perforation or acute abdominal catastrophe.
Diverticulosis and diverticulitis are most often age-related diseases.
Plasma CRP and blood leukocyte count, repeated clinical examination and exclusion of infections affecting other organs and eventually abdominal CT scan help to reach the correct diagnosis.