Infection in older people

Question 1

Is sepsis more common in older or younger patients?

Answer 1

• older
• 9 times more likely in older patients
• older patients are essentially more susceptible to all infections

Question 2

If an elderly patient presented with asymptomatic bacteriuria, would we treat them with antibiotics?

Answer 2

• no
• patient may have had this for a long time, antibiotics may make no difference
• can sterilise the urine, but returns in 50% of patients

Question 3

How can an impaired cough reflex increase the risk of infection?

1 - reduces aspiration
2 - impaired ability to cough up micro-organisms and sputum
3 - increased immune response
4 - all of the above

Answer 3

2 - impaired ability to cough up micro-organisms and sputum

Question 4

How can a dry mouth and skin increase the risk of infection?

1 - no saliva to neutralise pathogens
2 - reduced immune cells in the skin such as langerhans cells
3 - no oils and sweat to stop pathogens
4 - increased risk of broken skin and infection
5 - all of the above

Answer 4

5 - all of the above

Question 5

How can PPI increase the risk if infection?

1 - increased acid secretion damages oesophageal
2 - increased acid secretion increases risk of peptic ulcers
3 - reduced acid section to kill pathogens
4 - all of the above

Answer 5

3 - reduced acid section to kill pathogens

Question 6

How can benign prostatic hyperplasia increase the risk of infection?

1 - urine is retained, increasing risk of infection
2 - increased urine output increases risk of infection
3 - increased glucose in urine
4 - all of the above

Answer 6

1 - urine is retained, increasing risk of infection

Question 7

Does the immune cell number increase or decrease in ageing?

Answer 7

• decrease
• T cells specifically can reduce, meaning an inability to detect novel antigens and activate B cells, meaning less antibodies

Question 8

Ageing is typically associated with inflammation. Which 2 cytokines specifically can be raised?

1 - IL-6
2 - TNF-a
3 - IL-8
4 - IF-4

Answer 8

1 - IL-6
2 - TNF-a

Question 9

Ageing is typically associated with inflammation, specifically IL-6 and TNF-a. Which of the following conditions can be exacerbated by inflammation in the elderly?

1 - Autoimmune disease
2 - Alzheimer’s
3 - Cardiovascular disease
4 - all of the above

Answer 9

4 - all of the above
- these are all already associated with inflammation, so can be made worse

Question 10

Which of the following do elderly patients present with if they have an infection?

1 - Delirium
2 - Lethargy
3 - Falls
4 - Anorexia
5 - Immobility
6 - all of the above

Answer 10

6 - all of the above

Question 11

Which of the following are increased in the elderly?

1 - Infected pressure sores
2 - Intra-abdominal abscess (bowel cancer / diverticulitis)
3 - Biliary infections
4 - Soft tissue infections including septic arthritis
5 - all of the above

Answer 11

5 - all of the above

Question 12

Even if a patient is infected do they always present with a high temperature?

Answer 12

• no
• up to 50% can have a blunter febrile response

Question 13

Can cognitive impairment make treatment difficult?

Answer 13

• yes
• need a good history to treat, but if cognitively impaired this is difficult

Question 14

Is the severity of a patients illness always reflected in the patients symptoms and clinical presentation?

Answer 14

• no
• for example, guarding is often not present in the elderly with GI perforation

Question 15

Which of the following is NOT one of the 3 things a patient with SEPSIS needs to be given?

1 - antibiotics
2 - oxygen
3 - fluids
4 - steroids

Answer 15

4 - steroids

Question 16

Which of the following is NOT one of the 3 things we need to take out of a patient with SEPSIS?

1 - blood culture
2 - spinal tap
3 - measure lactate levels
4 - monitor fluid levels

Answer 16

2 - spinal tap

Question 17

Which of the following is NOT typically an associated health care related infection?

1 - Clostridium. Difficile
2 - Haemophilus influenzae
3 - Methicillin-resistant Staphylococcus aureus (MRSA)
4 - Extended Spectrum Beta-Lactamase (ESBL)

Answer 17

2 - Haemophilus influenzae

Question 18

Although there are lots of problems that can occur due to sepsis, which of the following are the most common complications of sepsis?

1 - AKI (exacerbated by antibiotic therapy)
2 - Arrhythmias (AF is very common)
3 - Cardiac dysfunction
4 - Type 2 myocardial infarction (often caused by hypoperfusion)
5 - all of the above

Answer 18

5 - all of the above

Question 19

Are vaccines as effective in older populations as younger populations?

Answer 19

• no
• reduced immune system means vaccinations are less effective
• Flu vaccine efficacy = 30-40% in over 65s vs 80% in under 65s

Question 20

Is the influenza vaccine still a good vaccine to give older people despite a reduced efficacy?

Answer 20

• yes
• mortality risk outweighs reduced efficacy
• high flu incidence and mortality
• shown to reduce mortality, morbidity and hospitalisation

Question 21

The pneumococcal vaccination has a reduced efficacy >65 y/o patients. However, it is still affective at reducing the risk or the effects of which of the following?

1 - pneumonia
2 - meningitis
3 - sepsis
4 - all of the above

Answer 21

4 - all of the above

Question 22

Do autoimmune conditions increase or decrease in the elderly?

Answer 22

• slight increase
• body not as affective at distinguishing between self and foreign antigens

Question 23

Does the risk of cancer increase with age?

Answer 23

• risk increases