N212 GERO LECTURE 2022 (MISSED) PARMA CH20

Chapter 15 - Infection Learning Objectives  Describe alterations in the immune system related to aging.  Describe nutritional factors that influence immune status.  Describe psychosocial factors that influence immune status.  Describe the effect of lifestyle factors on immune status.  Describe the effect of medications and drugs on immune status.  Identify strategies to prevent nosocomial or community-acquired infections.  Incorporate nutritional, psychosocial, and lifestyle factors into a nursing care plan. Introduction  Infection is one of the 10 most common causes of death in older adults  The presentation of infections in older adults is often masked, which can lead to delayed treatment  The immune system functioning is important for maintaining health, so a clear understanding of age-related changes is crucial The Chain of Infection  For infection to occur, there must be a reservoir of an infectious disease, a portal of entry, and a susceptible host  Zoonoses: infectious diseases passed from other animal species to humans  Nosocomial infections: acquired in the hospital  Community acquired: acquired outside the health care facility Age-Related Changes in the Immune System  As age increases, so does production of auto antibodies causing an increase in autoimmune disease  Atrophy of the thymus  Skin becomes more fragile and prone to breakdown or abrasion  Illness seen in older adults may be a direct consequence of changes in both cell-mediated and antibody-mediated immune response Factors Affecting Immunocompetence  Nutritional factors  Critically important to immune function  Protein-energy (caloric) malnutrition  Iron and trace element deficiency  Decreased zinc levels lead to an increase in the number of infections and an increase in the needed healing time  Psychosocial factors  Chronic and acute stress, depression, bereavement, and social relationships  Nutritional and dietary status is critical to immune function  One third of individuals older than age 65 have nutritional deficiencies  Risks associated with the development of a nosocomial infection include poor nutrition, unintentional weight loss, low serum albumin levels, decreased fluid intake, poor oral hygiene, and altered mental status  Factors contributing to inadequate nutrition include altered taste, social isolation, physical inability to prepare food, altered absorption, and poverty  Deprivation of protein and energy nutrients has been shown to result in alteration in immune function  Depression Page 1 of 21 N212 GERO LECTURE 2019.09.19 INFECTION, MUSCULOSKELETAL  Has been associated with decreased immune capacity  Medications  Many drugs given for therapeutic purposes have an immunosuppressant effect  Herbs  Selected herbs can be harmful and can negatively affect the immune system Common Problems and Conditions  Immune deficits seen in older adults make this population more vulnerable to both infection and cancer  Common infections in older adults include influenza, pneumonia, tuberculosis, urinary tract infections, and shingles Influenza and Pneumonia  Influenza and pneumonia are ranked as the seventh leading cause of death  Most effective measure to control influenza is the vaccination of persons at high risk  Long-term care facilities provide an ideal setting for the spread of influenza  Community-acquired pneumonias are caused by bacteria: Streptococcus pneumoniae or pneumococcal pneumonia  Pneumococcal vaccine is recommended for everyone over the age of 65  50% of pneumonia is viral  Major host factors associated with community-acquired pneumonia: advanced age, smoking, alcohol abuse, chronic lung disease, recent history of viral upper respiratory tract infection, and neurologic disease Cancer  Neoplasms occur with greater frequency in older adults  Common types include lung cancer, breast cancer, and prostate cancer  Presence of the cancer reveals presence of decreased immune response  Cancer and cancer treatment can induce additional immune deficits Autoimmunity  Older adults with autoimmune diseases are more likely to take immunosuppressant drugs as treatment for disease processes, and still risk immune deficits that accompany aging  Criteria for identifying autoimmune disease  Evidence of autoimmune reaction  Determination that immunologic findings are not secondary to another condition  Lack of other identified causes for the disorder Autoimmune Diseases  Systemic lupus erythematosus  Can affect many parts of the body: joints, skin, kidneys, heart, lungs, blood vessels, and brain  Rheumatoid arthritis  An inflammatory polyarthritis of unknown cause  Autoimmune hepatitis  Unknown etiology; characterized by progressive destruction of liver parenchyma, leading to hepatic fibrosis and cirrhosis HIV in Older Adults  31% of persons living with H