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Practice Practice Pointer

Diagnosis and management of sepsis in the older adult

BMJ 2023; 382 doi: (Published 14 July 2023) Cite this as: BMJ 2023;382:e075585
  1. Steve Goodacre, professor of emergency medicine1,
  2. Gordon Fuller, consultant in emergency medicine2,
  3. Simon Conroy, consultant geriatrician; honorary professor of geriatric medicine, University College London; honorary consultant geriatrician, University College Hospitals London3,
  4. Clint Hendrikse, associate professor and head of division4
  1. 1School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, UK
  2. 2Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  3. 3Central and North West London NHS Foundation Trust, London, UK
  4. 4Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to: S Goodacre s.goodacre{at}

What you need to know

  • Diagnosing sepsis in older adults is difficult, with organ dysfunction often reflecting comorbidities rather than a dysregulated response to infection

  • The term sepsis should not be used to describe uncomplicated infection and should ideally be limited to cases with organ dysfunction consequent upon a dysregulated host response

  • Frailty and comorbidities are key determinants of outcome in older adults with sepsis

  • Management needs to take into account frailty, comorbidities, patient values, and the limited applicability of available evidence and guidelines

Sepsis is a common cause for hospital admission that carries a high risk of death.1 In 2021-22, over 100 000 emergency admissions with sepsis were reported in England and Wales, with a mean patient age of 71 years.2 Adults admitted to hospital with sepsis are typically older and often have multimorbidity and functional limitations.3 Increasing degrees of frailty are associated with increased mortality in older people hospitalised for any reason,4 and illness severity and frailty synergistically increase the risk of death.5

Clinicians caring for older adults with sepsis need to understand how frailty and comorbidities complicate the diagnosis and management of suspected sepsis.6 Guidelines for managing sepsis789 draw on substantial evidence from critical care, but one single-centre retrospective cohort study found that only 10% of 251 adults meeting the diagnostic criteria for sepsis were referred to critical care.3 We therefore need to adapt existing guidelines or develop guidelines that are relevant to patients whose frailty and comorbidities mean that they are not referred to critical care.

In this article, we outline a holistic approach to the management of sepsis in older adults that promotes individualised patient management, taking into account frailty, comorbidities, patient values, and the limited applicability of available evidence and guidelines. We define older adults as those aged over 65 …

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