Sepsis in older people

The national Sepsis Clinical Care Standard notes that in older people the commonly recognised signs and symptoms of sepsis are often absent, that older people are more likely to have reduced immunity, and that hypothermia, delirium and falls in frail people are more likely ². A guideline for long-term care adds that fever, as usually defined, is absent in more than half of residents with a serious infection ⁸.

The standard is built around that question, and it encourages patients and families to ask it ². It treats a high level of family or carer concern as a reason to investigate ².

The standard’s primary settings are ambulance services, hospitals and urgent care centres. It also lists aged care homes and general practice as settings where it is relevant ².

The standard says that when signs of organ dysfunction caused by infection are present, appropriate antimicrobials should start within 60 minutes. That target sits in a standard whose primary settings are hospitals, ambulance services and urgent care centres ².

The same standard asks clinicians to talk with the patient and their carer about goals of care, and says that care for people receiving palliative or end-of-life care should align with their own healthcare directives ². For a resident who wants active treatment, suspected sepsis is an emergency. For a resident whose plan is comfort-focused, care where they live may be the better path. Both are legitimate choices, and the plan should say which applies before the night it is needed.