Diagnosis and management of sepsis in the older adult

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 …