Sepsis, Frailty and Dementia

In early September, I posted a study on the Changing Aging blog about the nature of “frailty”, a condition that is somewhat ill-defined, yet carries real prognostic significance for older adults (http://changingaging.org/2010/09/03/power-up-friday-what-is-frailty/).

A newly published study (Iwashyna et al., Journal of the American Medical Association 10-27-2010) looks at another risky condition that contributes to both physical and cognitive frailty: sepsis. This multi-center study defined sepsis as an infection that is associated with some type of organ dysfunction, such as heart, liver, lungs, kidneys or brain. (I think a presumption is that the infection is not just localized, but has spread to cause far-reaching effects, though the presence of bacteria in the blood is not specifically called out here.)

What was found among older adults with moderate-to-severe sepsis (average age 77 years) was a 3-fold increase in the development of moderate-to-severe cognitive impairment and a 1.5-fold increase in functional limitations. The most significant functional limitations were walking ability, getting into bed, and several integrative tasks, like paying bills, grocery shopping and using the telephone. This greatly increased people’s care needs and the risk of nursing home placement as well.

The authors suspect that the chronic inflammation of sepsis is at play here, a mechanism that has also been postulated in most cases of dementia. But there is much more to figure out about what changes occur and how.

Another question that should follow this study is, “What else can we do to minimize the risks?” At this point, little has been found to greatly improve these cases of severe sepsis. Standard anti-inflammatory treatments like steroids haven’t panned out. Giving antibiotics and supporting blood pressure and organ function are key, but one feels that we need to do more in order to truly change the prognosis.

Attacking the process of inflammation will probably need to go beyond steroids to more sophisticated targeting of specific mediators of inflammation.

For now though, all we can do is treat the condition as best we can, knowing that a person’s life course has shifted and preparing for more support down the road.

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