Infection in Frailty: Recognising the Hidden Dangers
By Dr. Kirsten Protherough, GP and Chair of the Community Hospital Association Founder of CareBoodle & Home Visit Healthcare
Infection in older adults living with frailty is often subtle, dangerous, and easily missed. Unlike younger people, those with frailty rarely mount a strong fever or show obvious signs of illness.
For carers and professionals supporting this group, early recognition is critical—but it requires a shift in mindset and training.
Why Infections Are Different in Frailty
Frailty is a state of increased vulnerability where the body has less reserve to respond to stress. Infections, even minor ones, can lead to rapid deterioration. A simple UTI or chest infection might cause:
- Sudden confusion or delirium
- A fall
- Refusing food or fluids
- Increased sleepiness or ‘not being themselves’
- Worsening mobility or continence
These are red flags, not just “ageing.” They often represent a DELIRIUM either Hypoactive (more sleepy) or Hyperactive (more active, restless and agitated)
The Most Common Infections in Frailty
- Urinary Tract Infections (UTIs) Not always associated with pain or burning. Instead, watch for increased confusion, incontinence, or falls.
- Respiratory InfectionsMay present with a slight cough or just reduced appetite and energy. Oxygen levels might drop before the person feels short of breath. Older adults often can have issues with swallowing and this exacerbates risk of a pneumonia – particularly an “Aspiration pneumonia”.
- Skin Infections Look for red, warm area, especially around the legs or pressure points. Cellulitis can be missed in darker skin tones or confused with other causes of redness.
- Gastrointestinal Infections Can cause dehydration quickly. Look for reduced urine output, dry mouth, or light-headedness when standing.
What Carers Should Do
- Trust your instincts: If something feels “off,” it probably is.
- Check observations: If available, record temperature, pulse, blood pressure, oxygen saturations, and blood sugar.
- Use early warning tools like RESTORE2 if trained.
- Escalate early: Share concerns with a GP, frailty advice line, or urgent care team.
Supporting Recovery
Once an infection is treated, frail older adults often need support to regain their baseline. Consider:
- Encouraging fluids and nourishing food
- Gentle mobility to prevent deconditioning
- Monitoring for signs of worsening or complications
- Reviewing medications with a healthcare professional
Preventing Future Infections
- Good mouth care and hydration
- Prompt treatment of constipation
- Keeping warm in winter and cool in summer
- Timely vaccinations (flu, COVID, shingles, pneumonia)
Final Thoughts
Having a comprehensive older adult health assessment can help clients and their loved ones recognise signs of infection sooner for prompt treatment.
https://homevisithealthcare.co.uk/comprehensive_geriatric_assessments/
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