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On the morning of May 4, 2014, 72-year-old Sharley McMullen of Manhattan Beach, California would enter the hospital for the treatment of a simple stomach ulcer. She would never leave alive.
Hours after her surgery, McMullen spiked a high fever that would send her to the intensive care unit, fighting for her life.
On her medical chart, a doctor scribbled “CRKP,” a cryptic abbreviation for Carbapenem-Resistant Klebsiella pneumoniae —one of the world’s most lethal superbugs. The warning was so dire, the doctor made sure to underline it three times in red.
Doctors tried antibiotic after antibiotic to fight the infection. But after five-weeks in intensive care, McMullen died.
But here’s the strange part…
Sharley McMullen’s death certificate does not mention a word about the deadly infection she caught in the hospital. Instead, her doctor wrote that McMullen had died from, quote: “respiratory failure and septic shock caused by her ulcer.” An intentional coverup?
Find out… this week on Parents Are Hard To Raise
Many signs and symptoms of infection that are common in younger adults, particularly fever and leukocytosis (which is an elevation in the white blood cell count), present less frequently or not at all in older adults.2,3 A change in mental status or decline in function may be the only symptom in an older patient with an infection.
Now let’s talk about fever for a moment…
Unlike babies who can spike a fever from the slightest bit of inflammation—like when they are teething—frail older adults tend to have poorer body temperature response.
For this reason elevations in body temperature of 2°F (1.1°C) from their normal baseline temperature should be considered a Significant Fever.
Fevers higher than 101°F (38.3°C) often indicate severe, life-threatening infections in older adults, and Geriatricians suggest hospitalization should be considered for these patients.
- Normal respiratory rate for older adults is 12 to 18 breaths per minutefor those living independently. For those in a long term facility, it’s slightly higher—16-20 breaths per minute.
- In either case, anything above 25 breaths per minute shows cause for concern.
The most common sites for infections in older adults are the urinary tract, the respiratory tract, the gut and the skin.
We’ll talk more about each of these in detail in episode 23 … but for now, here’s an overview of what to look for…
- an acute change in his or her ability to perform day to day activities;
- subnormal temperature;
- increased pulse rate;
- increased respirations;
- unexplained dehydration;
- poor appetite; and finally
- fatigue with increased aches and pains.
For specific infections you might want to look for these things:
- Increased mucus
- Abdominal pain
- Chest pain
- Generalized weakness
- Loss of appetite
- New onset of incontinence
- Pain with urination
- More frequent urination
- Suprapubic pain (Pain in the lower abdomen-just above the groin area)
- Blood in the urine, or a darker, more concentrated urine, or an offensive odor to the urine.
- Skin infection
- Pain, tenderness or,
If you notice any of these symptoms, get a complete medical evaluation to determine the source of the infection and any other acute medical problems. Do it right away. Don’t put it off.
Why is this so important?
The risk of sepsis— an overwhelming infection that enters the bloodstream— is higher in the elderly. The longer these types of symptoms go untreated, the more likely the bacteria will find its way into the bloodstream.