Diagnostic challenges and opportunities in older adults with infectious diseases

Area of Science:

• Geriatrics
• Infectious Diseases
• Internal Medicine

Background:

• Infections pose a significant health risk to the aging population.
• Antimicrobial resistance necessitates accurate and timely diagnosis of infections in older adults.
• Urinary tract infections, pneumonia, and bacteremia are common and challenging infections in this demographic.

Purpose of the Study:

• To highlight the diagnostic challenges of common infections in older adults.
• To emphasize the importance of appropriate diagnostic strategies in the context of antimicrobial resistance.
• To guide clinicians in the effective diagnosis of infections in the elderly population.

Main Methods:

• Review of diagnostic approaches for common infections in older adults.
• Comparison of diagnostic yields in older versus younger patients for bacteremia.
• Assessment of noninvasive diagnostic strategies for urinary tract infections and pneumonia.

Main Results:

• Blood culture yield is comparable in older adults with bacteremia, but ordering triggers may need adjustment.
• Diagnosing urinary tract infections is complicated by asymptomatic bacteriuria and catheter use, but a combined noninvasive approach is effective.
• Bedside pulse oximetry and urinary antigen testing aid pneumonia diagnosis in older patients.

Conclusions:

• Older adults present unique diagnostic challenges for infections.
• A comprehensive approach combining history, physical examination, and minimally invasive tests is crucial for accurate diagnosis.
• Effective diagnosis can limit the empirical use of antibiotics in this population.