Pyrexia in Infection in the Elderly

Abstract

This prospective study investigated the common belief that pyrexia is frequently absent in elderly patients with infection. Oral temperature was closely monitored using both a mercury and an electronic thermometer in 150 ill elderly patients (mean age 81 years) of whom 80% were new admissions to this Unit. A scoring system was devised, based on investigation results and excluding temperature, to assess objectively the likelihood of infection. Seventy-one patients (47%) had 'definite' infection: 95% were pyrexial. A further eight of the nine patients with probable infection were pyrexial. There were no significant differences in mean temperature or other indices of infection between those who died of their infection and those who survived. Ten per cent of all pyrexias were detected only on the electronic thermometer, not on mercury measurement. In 12% of pyrexial patients, the pyrexia first appeared more than 12 h after temperature measurement started. With effective monitoring, pyrexia is detectable in the vast majority of infected elderly patients.

Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long‐Term Care Facilities: 2008 Update by the Infectious Diseases Society of America

“…5 Thus, LTCF residents may have typical or atypical presentations of infection. [27][28][29][30] For example, Brooks et al 31 found ''typical'' symptoms and signs of UTI, such as fever (30%; absolute temperature criterion for fever was not defined), were not sensitive indicators of infection in LTCF residents. In contrast, persons with respiratory tract infection (RTI) more often presented with classic manifestations (cough, 75%; fever, 62%; and rales, 55%).…”

Nosocomial Febrile Illness in the Elderly

“…This temperature threshold was chosen because elderly patients with serious bacterial infectionsmaypresentwithonlyminortemperatureelevations. 18,19 The duration of the febrile episode was defined as the number of consecutive days with a body temperature higher than 37.8°C. The duration of hospitalization before and after the onset of fever was noted for each case.…”

Fever in the Elderly

“…In one study [9], 10% of fevers that were caught by electronic thermometers were missed by mercury-glass thermometers, and 95% of elderly patients with "definite" infection had fever that was defined as an oral temperature 137.2ЊC. The definition of "definite infection" was based on a scoring system, which appropriately did not have temperature as a criterion.…”