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In the beginning, it didn’t seem all that worrisome. Doris Conly’s 89-year-old mother, Yolanda, woke up on a Friday and didn’t feel very well, though she wasn’t in pain — nothing that set off any alarms. Two days later, she couldn’t walk to the car to drive to her doctor, so she was taken to a hospital by ambulance. That Friday, just a week after her initial symptoms, she died from sepsis brought on by a bladder infection. “That’s how fast it happened,” recalls Conly. “My mom was an older woman, but she was in good health, very independent, and saw her doctor for regular checkups. We were in shock.”
Sepsis is a complication that happens when your body tries to fight off an infection, be it pneumonia, a urinary tract infection or something like a gastrointestinal infection. The immune system goes into overdrive, releasing chemicals into the bloodstream to fight the infection. That causes a kind of chain reaction, causing dangerous inflammation throughout the entire body. “Things get out of whack and you end up with something more serious than the infection itself,” says Anthony Fiore, M.D., chief of epidemiology research and innovations at the Centers for Disease Control and Prevention (CDC). Left untreated, sepsis can lead to septic shock, with a drastic drop in blood pressure that can cause heart or respiratory failure, stroke and organ failure.
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Sepsis is sneaky — and also deadly. The numbers are eye-opening: According to the CDC, about 1.7 million Americans get sepsis every year, and 270,000 will die from the illness; that’s one person every two minutes. One-third of those who die in a hospital have sepsis. What’s more, says Chirag Choudhary, a critical care physician at Cleveland Clinic and cochair of the medical center’s enterprise sepsis steering committee, “Many of those who survive a sepsis hospitalization are left with a decreased quality of life, with life-changing effects, such as post-traumatic stress disorder, chronic pain and fatigue, organ dysfunction, amputations, and cognitive and functional impairments.” They are also more likely to end up back in the hospital and to have to rely on caregivers.
Serious stuff, to be sure. Yet public awareness of sepsis is low. A 2018 Sepsis Alliance Awareness Survey found that 35 percent of Americans had not heard of sepsis, and the signs and symptoms are not well known outside of health care settings. Consider this your primer to a potentially life-threatening condition.
Anyone can get sepsis, at any age, but older people are most at risk. People over age 65 make up nearly 60 percent of sepsis cases. In fact, sepsis appears to be the most common reason older adults are admitted to an intensive care unit. “As we age, our immune system becomes less effective at fighting infections,” says Choudhary. “And with every infection comes a risk of developing sepsis.” Also, individuals over age 65 are more susceptible to chronic illnesses, which increase the odds of sepsis-triggering infections — the most common being pneumonia, followed by UTIs. “As people age, they may develop cancer, diabetes, kidney disease, heart failure or chronic obstructive pulmonary disease,” says Choudhary. “It’s not unusual to see an elderly person with two or more chronic diseases taking medications to treat these conditions that further suppress the immune system.”
What’s more, infections can be hard to identify in older people, making it a challenge to get a prompt diagnosis and appropriate treatment. For example, fever, the most common sign of sepsis, is absent in approximately 30 to 50 percent of older adults with infections. Another sign of sepsis, mental status, may go unnoticed if a medical team or caregivers aren’t familiar with a patient’s mental status prior to admission. “If a patient comes in confused, with just a little bit of a fever, it’s important to know if that person was playing bridge the day before or if they have already been displaying signs of dementia,” says Fiore. “That can be hard to determine, especially if someone arrives in an ambulance, without accompanying family.” UTIs can also be tricky. The usual symptoms of a urinary tract infection are burning, frequency, urgency or pain. But in older individuals, according to Choudhary, the first sign of a UTI may be a change in mental status. They may become confused or disoriented, so the infection could be present — and left untreated — for a long time before it is noticed.
Beware the breeding grounds
According to the CDC, most cases of sepsis start outside a health care setting, but bedridden patients — particularly those being treated in an intensive care unit or in nursing homes — can be particularly vulnerable. A recent federal report found that care related to sepsis was the most common reason given for transfers of nursing home residents to hospitals, and noted that such cases ended in death “much more often” than hospitalizations for other conditions. In Illinois, about 6,000 nursing home residents a year who were hospitalized had sepsis, and 1 in 5 didn’t survive, according to an analysis by Definitive Healthcare, a private health care data firm.
“There are many infections and antibiotic-resistant infections in these settings and transmission from patient to patient and from health care providers occurs,” says Choudhary. Research has shown that poor hygiene — say, a lack of handwashing or improper handwashing — is the No. 1 cause of people hospital-acquired infection. Health care providers not wearing gloves when providing care and not changing gloves between patients also puts patients at increased risk. Other culprits: pressure sores and exposure to invasive devices, such as catheters and breathing tubes, both a breeding ground for germs and bacteria.
The high rate of sepsis among the older population has consequences for the health care system and is expecting to worsen with an aging population. A CDC evaluation found that 7 in 10 patients with sepsis had recently used health care services or had chronic conditions requiring frequent care. According to a 2016 study from the Healthcare Cost and Utilization Project (HCUP) and the Agency for Healthcare Research and Quality that analyzed billings from 2013, sepsis is responsible for nearly $24 billion in annual costs, making it the most expensive condition to treat in the U.S. health care system.
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Timing is everything
Sepsis ranges from mild to severe, but the earlier you begin treatment, the better the outlook. But “less than 1 percent of Americans can correctly identify the most common symptoms of sepsis,” says Choudhary.