NICE guidance on Sepsis and older people
NICE Guidelines on Sepsis consider the context of the individual where children are concerned, and this is welcome. It is regrettable, however, that older people were also not given their due consideration.
60% of admissions to hospital with sepsis are over the age of 65 years (Angus DC et al, Crit Care Med 2001). Presentation in old age is often atypical, delaying diagnosis. Tachypnoea and delirium are more common presentations of sepsis over 75y, whereas tachycardia and hypoxia are less common (Iberti TJ et al, Cri Care Med 1993). The ‘Surviving Sepsis’ campaign rightly emphasizes the urgency of early management. In older people with sepsis, discerning underlying frailty and dementia should be equally urgent. These patients are especially high risk for delirium, and decision for catheterisation and invasive monitoring requires careful, individualised decision making to weigh up the delicate balance of benefit and harm. Greater importance ought to be given to early involvement of the family and geriatricians to enable optimal management.
Competing interests: No competing interests