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3 results

  • Chapter 23 - Serious infections in the elderly
  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 05 June 2016
  • Print publication: 23 June 2016, pp 331-343
  • View extract

    Summary

    As a host, older individuals suffer from changes in the adaptive and innate components of the immune system, leading to increased susceptibility to a number of serious infectious diseases. This reduced immunological competence, coupled with exposure to environments, such as health care facilities, that are rich with potential pathogens, further increase the risk of acquisition of infections that can be debilitating, if not lethal. Elder hosts may also manifest infectious diseases in less typical ways, delaying diagnosis and treatment. A full understanding of the infections that older persons are most at risk for—including bacterial infections (such as those of the urinary tract and the lungs) as well as viral infections (including influenza and herpes zoster)—are essential to the care of the elderly.
  • Chapter 24 - Human immunodeficiency virus in the elderly
  • from Section III - Care of the elderly by organ system
  • Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 05 June 2016
  • Print publication: 23 June 2016, pp 344-356
  • View extract

    Summary

    It is estimated that more than half of those living with human immunodeficiency virus (HIV) infection in the United States are now at least 50 years of age. Infection with HIV may be under-diagnosed in older persons, both because they may be perceived as being at lower risk for infection and because manifestations of HIV-related complications are mistaken for conditions associated with aging. The management of the HIV-infected older patient can be challenging due to comorbid diseases and polypharmacy. As HIV-infected persons are at increased risk for cardiovascular disease, certain malignancies, low bone density, as well as mental health disorders and substance abuse, successful medical care of these individuals requires careful attention to screening guidelines and a coordinated multidisciplinary approach.
  • 22 - Serious Infections in the Elderly
  • Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
  • Book: Reichel's Care of the Elderly
  • Published online: 19 May 2010
  • Print publication: 09 February 2009, pp 241-249
  • View extract

    Summary

    INTRODUCTION

    Diseases caused by infectious pathogens are a major cause of illness and death among the elderly. Many of the most serious infectious diseases have a predilection for those at the extremes of age – individuals with relatively deficient immune function. In addition, infections common to persons of all ages can be devastating when they occur in those of more advanced age. Elderly individuals also are frequently found in environments, such as hospitals and nursing facilities, where antibiotic-resistant organisms are prevalent and indwelling catheters breech the protection offered by an intact integument. On the other end of the functionality spectrum, many older individuals are active and may spend their postretirement years traveling to locales where they are exposed to exotic organisms. Similarly, many elders are sexually active and remain at risk for sexually transmitted infections, especially when establishing new intimate partnerships.

    Compounding their increase in risk of infection, older individuals may suffer from delays in diagnosis as their infections often present atypically. Infectious diseases in older persons frequently present without fever or leukocytosis and can be challenging to detect and localize – especially in those who suffer from cognitive impairments. Therefore, the diagnostic approach must be modified when the patient is elderly, and the clinician must appreciate the unique characteristics of this growing population.

    THE ELDER HOST

    Immune function changes with age and during advanced age can begin to falter. Both humeral and cellular immunity can wane during senescence.