Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Crit Care Med. Feb 4, 2012; 1(1): 23-30
Published online Feb 4, 2012. doi: 10.5492/wjccm.v1.i1.23
Severe sepsis and septic shock in the elderly: An overview
Prashant Nasa, Deven Juneja, Omender Singh
Prashant Nasa, Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
Author contributions: Nasa P, Juneja D and Singh O designed and wrote the manuscript.
Correspondence to: Deven Juneja, DNB, FNB (Critical Care), Consultant, Department of Critical Care Medicine, Max Super Speciality Hospital, 1, Press Enclave Road, Saket, New Delhi 110017, India.
Telephone: +91-9818290380 Fax: +91-40-66462315
Received: June 3, 2011
Revised: October 20, 2011
Accepted: December 30, 2011
Published online: February 4, 2012

The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.

Keywords: Elderly patients, Intensive care units outcome, Severe sepsis