Despite being a major cause of death in the United States, and particularly for the elderly and long-term care residents, sepsis rarely gets much attention.
Every year, tens of thousands of nursing home residents die from severe sepsis. This life-threatening reaction is often the result of nursing home-acquired infections and injuries that are not diagnosed or treated properly – or even acquired directly due to neglect.
“This is an enormous public health problem for the United States,” according to Dr. Steven Simpson of the Sepsis Alliance. “People don’t go to a nursing home so they can get sepsis and die.”
What Is Sepsis?
Sepsis is an extreme reaction to an infection and a medical emergency. This life-threatening condition happens when the body responds to infection by damaging its own tissues.
Also called septicemia, sepsis is the start of a dangerous chain reaction. For reasons not well understood, the body may switch from fighting an infection and attack itself instead. This exaggerated response triggers widespread inflammation. It can cause whole-body tissue damage including multiple-organ failure.
Sepsis is sometimes called “blood poisoning” but this is a misleading and inaccurate term. Sepsis is not an infection; it’s the body’s life-threatening response to an infection.
The major inflammation of sepsis can cause the blood to clot too quickly and too much. This prevents tissue from receiving blood flow and nutrients. Sepsis may result in:
- Low blood pressure
- Leakage from blood vessel linings
- Tiny clots in the body that prevent nutrients from reaching organs
Stages of Sepsis
If it is not treated quickly, sepsis can develop into more serious stages.
What are the 3 stages of sepsis?
- Sepsis. It may be diagnosed if someone meets criteria for at least two systemic inflammatory responses with a suspected or known infection.
- Severe sepsis. Severe sepsis is diagnosed if there is acute organ dysfunction or damage including acute kidney dysfunction or respiratory failure.
- Septic shock. Septic shock is a type of severe sepsis that causes acute cardiovascular dysfunction. The sepsis survival rate drops with the severity of the response. Septic shock is the most fatal stage of sepsis.
How Common Is Sepsis in Nursing Homes?
A groundbreaking investigation by KHN and the Chicago Tribune into cases of sepsis in nursing homes revealed just how common sepsis in elderly long-term care residents is – and the horrifying toll.
The report found thousands of cases nationwide alleging nursing home patients endured painful, stressful treatments and hospitalization for sepsis that should never have developed. There were over 8,000 nursing home lawsuits filed between 2010 and 2018 alleging failure to prevent or treat bedsores and serious infections.
While sepsis cases are not tracked closely, one federal report found acute nursing care for sepsis is the top reason nursing home residents are transferred to a hospital. This report also noted that these cases resulted in the patient’s death far more often than other conditions.
After analyzing data related to nursing home residents who died after being transferred to a hospital, KHN found 25,000 nursing home residents suffered sepsis every year with a Medicare treatment cost of $2 billion per year.
In Illinois alone, the analysis found that 6,000 nursing home residents every year are hospitalized for sepsis with a mortality rate of 20%.
Nationwide, poor infection control is one of the most common nursing home citations. 72% of nursing homes in the country were cited for failing to have or follow an infection control program between 2015 and 2018. 37% of nursing homes nationwide have been cited for pressure sore risks or failure to properly treat them.
What Causes Sepsis? | Common Nursing Home Sepsis Causes
Sepsis can be a response to any type of infection including viral or bacterial infection. Any type of infection can lead to sepsis and it isn’t known why some people develop this life-threatening response. Sepsis is most common among very young children and seniors, people with serious or chronic illnesses, and people with poor immune systems.
Over 60% of cases of severe sepsis occur in people 65 and older. Nursing home residents are 6x more likely to have sepsis when admitted to an emergency room compared to non-nursing home residents in the same age range.
Most cases of sepsis involve bacterial infections. According to John Hopkins, these infections most often develop into sepsis:
- Escherichia coli (E. coli)
- Staphylococcus aureus (staph or MRSA)
- Certain types of Streptococcus (strep)
A small handful of infection types are usually associated with sepsis. What causes sepsis in elderly people varies from what usually causes septicemia in younger people due to the unique risk factors of older adults.
Sepsis in Elderly People – Many Risk Factors for Sepsis Infection
Sadly, sepsis in the elderly is incredibly common and nursing home residents are at an even higher risk than older adults living in the community.
Research like the major REGARDS-Sepsis study identified a number of risk factors for sepsis with the Severe Sepsis Risk Score (SSRS). Risk factors are assigned 1 to 5 SSRS points:
- Chronic lung disease: 5 points
- 75 or older: 4 points
- Peripheral artery disease: 3 points
- Diabetes: 3 points
- Male: 3 points
- Current tobacco user: 2 points
- White race: 2 points
- Previous stroke: 2 points
- Coronary artery disease: 2 points
- Deep vein thrombosis (DVT): 2 points
- Atrial fibrillation: 2 points
- Hypertension: 1 point
- Obesity: 1 point
Recent research has even validated that the REGARDS Severe Sepsis Risk Score can be useful at identifying who is at very high risk of suffering severe sepsis.
The elderly are predisposed to septicemia due to a variety of risk factors including age and specific health conditions. Many chronic conditions make older adults more susceptible to developing infections. The immune system also becomes weaker with age and less effective at fighting infection.
Chronic Health Conditions
Most nursing home residents have at least one chronic health condition. The REGARDS-Sepsis study found chronic illnesses are one of the biggest risk factors for developing sepsis. The risks from each chronic condition are also additive – the septicemia risk increases with every new condition the patient has.
The REGARDS-Sepsis study found:
- Chronic kidney, lung, or heart disease more than doubles the risk of sepsis.
- Diabetes increases the sepsis risk by 71%.
- A previous stroke increases the sepsis risk by 85.
The risk of developing these chronic health conditions increases with age. About 25% of seniors 65 and older have diabetes. High cholesterol and high blood pressure, also common among the elderly, make it harder to manage diabetes. If not well controlled, diabetes can lead to a variety of other conditions including heart disease.
One theory about the link between chronic diseases and sepsis is conditions like stroke and diabetes cause chronic inflammation and damage to the cells lining blood vessels. Over time, the mechanisms that cause diseased arteries can make the immune system hypersensitive.
Medical Treatment & Medications
It isn’t just the chronic illnesses that increase the risk of sepsis in elderly people; the treatments themselves can increase the risk. Many medications to manage chronic illness suppress the immune system.
Major risk factors for developing sepsis include:
- Recent hospitalization
- The use of catheters or breathing tubes
- Previous treatment with antibiotics or corticosteroids
Pneumonia refers to a lower respiratory tract infection. There is a very strong link between pneumonia and sepsis in elderly people. It’s the most common infection that leads to sepsis.
While it can be caused by a viral or fungal infection, pneumonia is usually bacterial. The most common form is pneumococcal pneumonia caused by Streptococcus pneumoniae, a bacteria present in all our noses and throats. Older adults often develop pneumonia because they cannot clear secretions from the lungs which then go into the bronchial tubes.
Nursing home acquired pneumonia (NHAP) is considered a type of hospital-acquired pneumonia. It’s one of the primary causes of hospitalization and mortality among frail nursing home residents and pneumonia is the second most common infection among nursing home residents.
The prevalence and risk of uncomplicated pneumonia alone makes septic pneumonia in elderly nursing home residents a major concern. Pneumonia occurs in about 1 to 2 residents for every 1,000 days of nursing home residence. About 1 out of 20 people 85 and older will develop pneumonia every year.
Nursing home residents are at increased risk of pneumonia for many reasons including limited mobility, difficulty swallowing, the use of feeding tubes, malnutrition, urinary incontinence, and certain medications.
Long-term care residents also face an increased risk of infection due to close living quarters and shared quarters with other residents also susceptible to infection.
There is a 13% to 41% mortality rate for nursing home residents hospitalized with pneumonia.
Pneumonia can cause serious complications including:
- Pleurisy or inflammation of the membrane of the lungs
- Lung abscesses
- Acute respiratory distress syndrome (ARDS) caused by severe lung damage which causes respiratory failure
- Bacteremia which occurs when the infection enters the bloodstream in the lungs and spreads. This blood infection in elderly people has a high fatality rate.
Urinary Tract Infections (UTIs)
Urinary tract infections are incredibly common and occur in about 10 out of 25 women and 3 out of 25 men at some point in their life. UTIs are the second most common type of infection and the second leading cause of sepsis in the elderly. About 30% of all infections in nursing homes are UTIs.
Sepsis from UTI is very uncommon in otherwise healthy, younger people. However, sepsis from UTI in elderly people is common due to the risk factors explained above.
When a UTI causes septicemia, it’s called “urosepsis.” Urosepsis in elderly people is most common among women, people who have a urinary catheter, and people with high blood sugar.
Urinary tract infections are harder to recognize in the elderly. The symptoms are more serious and very different. Older adults may experience common UTI symptoms like a frequent, intense urge to urinate, foul-smelling or cloudy urine, and a burning sensation while urinating. However, the elderly may also experience:
- Sudden incontinence
- A change in their ability to perform basic daily tasks
- Decreased mobility
- Reduced appetite
A UTI turned septic can be challenging to recognize if the initial urinary tract infection went unnoticed. About 25% of sepsis cases in adults are urosepsis. About 10% to 30% of severe sepsis or septic shock cases involve urosepsis.
Urosepsis has a mortality rate of 25% to 60% for all patients, but the elderly have an increased risk of mortality.
Pressure sores, bedsores, or decubitus ulcers are a common and potentially fatal injury common in nursing home residents who are frail or bedridden. These wounds have minor damage to the skin but they may quickly develop through four stages to a deep open wound that reaches bone or muscle.
Bedsores are common in nursing homes with the CDC estimating up to 28% of residents develop pressure ulcers. It’s estimated that pressure ulcers cause 60,000 deaths every year. Nearly 80% of these deaths are in people who are 75 and older.
Bed sores and sepsis are tied together as sepsis is a life-threatening complication of an advanced pressure sore. While not all bedsores can be prevented, most are avoidable. CMS considers stage 3 and stage 4 bedsores to be “never events” which are serious, costly, and preventable medical errors that should never happen.
If a loved one develops serious pressure ulcers or sepsis from bed sores, it may be the result of nursing home negligence.
Signs and Symptoms of Sepsis & Sepsis Symptoms in Elderly People
It’s crucial to know the early signs of sepsis because it is a life-threatening condition that requires immediate medical attention. Unfortunately, the signs of septicemia can be challenging to recognize in seniors.
Classic symptoms of sepsis include:
- Temperature above 101 degrees (or lower than 96.8 degrees)
- High respiratory rate (above 20 breaths per minute)
- Increased heart rate (over 90 bpm)
Severe sepsis symptoms may include:
- Signs of cognitive impairment such as confusion or disorientation
- Reduced alertness
- Slurred speech
- Pale, cold extremities
- Intense pain or discomfort
- Extreme sleepiness
- Skin that is discolored, clammy, cold, or mottled
- Repeated vomiting
- Diminished urination
- Loss of appetite
- Sepsis rash
The signs of septic shock include all the above with low blood pressure.
What are the first signs of sepsis?
A high fever is often the first sign, especially combined with a known infection like pneumonia, UTI, respiratory infection, or an open wound. It’s crucial to understand that the signs of sepsis in elderly people may be different.
Septicemia Rash – What Does a Sepsis Rash Look Like?
A common sign of septicemia is a hemorrhagic rash or septicemia rash. This rash looks like a patch of very small spots of blood similar to pinpricks. The spots will get larger and take on a bruised appearance if untreated. Eventually, the bruises will form into a large, discolored area of purple or reddish skin.
Sepsis Symptoms in Elderly Patients Are Hard to Recognize
Older adults often have different sepsis symptoms than younger people. Confusion and cognitive problems are very common septicemia symptoms in elderly people. This sign can be missed by medical teams unfamiliar with the patient’s normal mental status.
While fever is the most common sign of septicemia, 30-50% of older adults with sepsis do not have a fever.
Symptoms of sepsis from UTI in elderly patients can also be different. Urosepsis symptoms generally include the above symptoms as well as UTI symptoms. However, many older adults do not experience the urgency, frequency, or pain of a UTI. Confusion can be the first sign of a UTI and resulting urosepsis.
Sepsis Recovery Time in Elderly Patients
Sepsis prognosis in elderly patients is very challenging. While mild sepsis has an average recovery period of 3-10 days across all age groups, severe sepsis recovery can take one more or longer and it’s much more dependent on the organs damaged and the severity.
Nearly 50% of survivors of severe sepsis experience post-sepsis syndrome with short-term or long-term effects.
Many also experience recurring sepsis and rehospitalization. Around 40% of seniors discharged after sepsis treatment in the hospital are hospitalized within 90 days, usually for a new case of sepsis.
Can sepsis return after antibiotics? Yes. Even with proper treatment, surviving sepsis increases the risk of another sepsis event.
What Is the Sepsis Survival Rate & Mortality Rate?
About 50% of people who develop sepsis survive, but this varies by age, the stage of sepsis, and the organs affected. Most people survive mild sepsis, but septic shock has a survival rate of just 60%. The septic pneumonia survival rate is even lower at 49% in patients with pneumonia who develop septic shock.
The sepsis mortality rate ranges from 3.2 to almost 20 deaths per 100,000 people depending on the state according to the CDC. However, the sepsis survival rate depends on many factors, particularly age.
Sepsis survival rate by age shows that seniors are at a much higher risk of death. Seniors account for nearly 75% of sepsis-related deaths. The sepsis mortality rate is higher for males compared to females and for non-Hispanic black males compared to any other race.
Sepsis Mortality Rate by Age
- 65 and older: 277.4 deaths per 100,000
- 65 to 74: 150.7 deaths per 100,000
- 75 to 84: 331.8 deaths per 100,000
- 85 and older: 750 deaths per 100,000
Seniors 85 and older are 5x more likely to die from sepsis than seniors who are 65 to 74.
Long-Term Effects of Sepsis in Elderly Patients
Even with prompt and adequate sepsis treatments, it can lead to many life-changing and long-term effects:
- Post-traumatic stress disorder (PTSD)
- Chronic fatigue and pain with neuropathy or myopathy
- Organ dysfunction
- Recurrence of sepsis
- Cognitive impairment
- Post-sepsis syndrome (PSS) which comes with a high rate of reinfection and rehospitalization, decreased physical function, cognitive disability, and poor quality of life.
About 40% of seniors are hospitalized within 3 months of their initial sepsis, usually due to another sepsis episode. Sadly, there is a high mortality rate among older adults who are discharged from the hospital after septicemia. About 22% to 70% of septic patients die within 2 years of discharge.
Sepsis in elderly people is also associated with a threefold increase in serious cognitive decline after surviving. It’s estimated that septicemia is responsible for about 20,000 new cases of dementia every year.
For many, sepsis leads to recurring infection, rehospitalization, and rapidly declining health with no “true” recovery.
Is Sepsis Nursing Home Neglect?
Can you sue a nursing home for sepsis? Yes, if your loved one developed sepsis due to the nursing home’s negligence.
One of the core duties of nursing homes is the duty to give residents sufficient medical care. Nursing homes should:
- Follow a plan to prevent infection
- Develop and follow care plans for each patient
- Assess patient needs at admission and regularly
- Recognize symptoms and changes in a patient’s health
- Properly treat medical conditions
- Ensure patients are transferred to a hospital when necessary
Sadly, most cases of sepsis in elderly nursing home residents can be avoided. Bedsores are usually avoidable when staff perform adequate measures like adjusting patients’ positions regularly and checking for pressure ulcers. If bedsores are not recognized and treated promptly and allowed to worsen, it can be due to neglect. A nursing home can be held liable for negligence that causes a patient to develop bed sores and sepsis.
Nursing homes should be adequately staffed with staff trained to recognize and respond appropriately to changes in a patient’s condition such as a fever or low temperature or sudden changes in cognitive function. The facility may be liable if inadequate staffing, training, or other forms of negligence prevented a resident’s condition from being treated appropriately.
How a California Nursing Home Neglect Lawyer Can Help
Has your loved one developed sepsis in a nursing home due to neglect? A nursing home sepsis lawsuit can help you hold the facility accountable and provide financial resources for your loved one’s care. Grieving families who have lost a loved one due to neglect can also pursue damages for wrongful death from sepsis.
Cases involving nursing home abuse and neglect are complicated as it can be challenging to prove liability. The experienced California nursing home neglect lawyers at Berman & Riedel, LLP can help you explore your options and seek justice.
Our San Diego law firm specializes in nursing home abuse and neglect and accepts cases throughout California. We have extensive experience with cases of neglect involving bedsores, infection, and sepsis and recently secured a $500,000 verdict for a case in which a bedsore left untreated resulted in sepsis and wrongful death.
Contact our law office today to schedule a free consultation with a California nursing home neglect attorney to discuss how we can help you.