Why infections in older adults look nothing like you’d expect

(Aging Untold) — When an older adult suddenly seems off or experiences unexpected mood swings, families often assume it’s normal aging or dementia. But infections in older adults rarely present with the classic symptoms younger people experience. Behavioral changes and confusion can be the only warning signs before a treatable infection becomes life-threatening.

Recognizing infections

“The first thing I would tell you is to pay extreme attention to the norm of the person you’re taking care of, because the classic symptoms that we normally see, like the high fevers or temperatures and all that and the chills, usually are not there,” Dr. Rhea Rogers, a board-certified physician, said. “You might even see a normal temperature or even sweating, but a lot of times, the biggest thing that you tend to see in older people are behavioral changes or confusion.”

“When you start seeing heart rates go up and shortness of breath and rapid breathing and blood pressure going down and severe weakness, and can’t hardly stand or chest pain, then you got to call for help because their window of infection is very short to not get them back,” Rogers said.

Sam Cradduck, a gerontologist, said falls are also a sign of infection.

“When you start seeing an increased number of falls and instability in their gait and the way they walk, you’ve got to really be careful that there’s not an infection going on,” Cradduck said.

Amy O’Rourke, an aging expert, noted an unexpected benefit in what people have learned about the spread of infection in recent years.

“There’s an upside to COVID, believe it or not. COVID raised the bar on people’s awareness of infection spread. So wearing a mask, washing your hands, distancing from people,” O’Rourke said.

She noted people not shaking hands during church services.

“I think doing those mechanical, physical things and then act fast. If you suspect something, get medical help immediately,” O’Rourke said.

“You need to have an advocate or somebody with you when the doctor starts evaluating you, because you need a spokesperson to say, this is not normal, that they were this way yesterday and they’re this way today. So please investigate further,” O’Rourke said.

Key takeaways

Watch for unusual behavioral changes, not fever

Classic infection symptoms like high fever and chills often don’t appear in older adults. Instead, confusion, hallucinations and sudden personality changes are the warning signs that something is wrong."

Common infection sites to monitor

Skin infections are particularly prevalent in older adults. Check the back of the heel where shoes rub, pressure points on hips and the coccyx area, shoulders, elbows and ears, Cradduck said. Oral infections from ill-fitting dentures also pose significant risks.

Urinary tract infections are the most common culprit

Irinary tract infections frequently cause confusion and hallucinations in older adults. When behavioral changes appear suddenly, a UTI should be investigated immediately, Cradduck said.

The sepsis danger window is extremely short

“Unfortunately, we do lose many in our aged community to sepsis, which is just when that infection gets into the bloodstream,” Cradduck said. “I’ve seen people with treatable urinary tract infections and pneumonias that we lose because we didn’t respond early enough.”

The weakened immune system in older adults means the point of no return arrives quickly, Rogers said.

Prevention starts with building resilience

“One of the biggest things that you can do is to try to build resilience so you have the cells to fight anything,” Rogers said.

She said nutrition, movement, stress management and sleep, along with hydration, are the foundation.

Maintain basic infection control practices

Hand washing remains the most effective way to reduce transmission. Keep older adults clean and dry, especially if they spend extended time in chairs or beds. Check pressure points regularly for early signs of skin breakdown.