Gastroenteritis in Old-Aged People

Introduction

Gastroenteritis is characterized by inflammation of the stomach and intestinal lining, often accompanied by symptoms like vomiting and diarrhea. Gastroenteritis in old aged individuals is a significant concern, given the global increase in the population aged 65 years and older. Elderly people are susceptible to gastroenteritis and food-borne infections due to several factors, including changes in immune response, alterations in gastrointestinal physiology, the use of immunosuppressive or acid-suppressive medications, and the presence of comorbid conditions associated with aging. Notably, elderly individuals residing in long-term care facilities are at a higher risk of food-borne diseases.

What Causes Gastroenteritis in Elderly?

Gastroenteritis in elderly individuals can stem from various sources. These sources are described below.

• Sources of Infection: Gastroenteritis in the elderly is primarily acquired from other infected individuals and contaminated foods. Infections can also be contracted due to poor personal hygiene, contaminated living environments or water, or contact with infected pets.

• Norovirus: The most common cause of gastroenteritis in both older people and the general population is norovirus. Noroviruses are highly contagious and can spread rapidly in close-knit communities. Transmission can occur through physical contact with an infected person or surfaces they have touched. Nursing homes are especially vulnerable to outbreaks of norovirus, which are frequently caused by inadequate hygiene protocols. The risk of becoming infected with norovirus is significantly increased when a person is exposed to the feces or vomit of another person who is already infected with the virus.

• Bacterial Infections: Gastroenteritis in the elderly can also be caused by bacterial infections of the stomach and intestines. Food-borne illnesses, or food poisoning, are frequently the cause of these infections. Poorly prepared or stored food can become contaminated by bacteria like E. Coli and salmonella. Once this contaminated food is consumed, it can infect the digestive system, leading to gastroenteritis. Nursing homes are at higher risk for food-borne gastroenteritis outbreaks due to centralized food preparation.

• Viral Gastroenteritis: Viral gastroenteritis is extremely common and affects all age groups worldwide. The most common cause of viral gastroenteritis in adults, including the elderly, is known to be norovirus.

What Are the Symptoms of Gastroenteritis in the Elderly?

The symptoms of gastroenteritis in the elderly can include:

• Watery diarrhea, which is typically nonbloody. The presence of bloody diarrhea usually suggests a more severe infection.

• Nausea and vomiting or a combination of both.

• Stomach cramps and abdominal pain.

• Occasional muscle aches or headaches.

• A low-grade fever.

Additionally, in more severe cases, gastroenteritis in the elderly may lead to:

• High fever.

• Bloody stool.

• Dehydration, which can be identified by signs like excessive thirst, dry mouth, deep yellow urine, or reduced urine output, as well as severe weakness, dizziness, or lightheadedness.

These symptoms typically start to manifest within 24 to 72 hours after infection. If an elderly person with viral gastroenteritis experiences certain warning signs, it is advisable to seek medical attention, which may include:

• Inability to keep liquids down for 24 hours.

• Prolonged vomiting lasting more than two days.

• Vomiting blood.

• Dehydration, characterized by excessive thirst, dry mouth, deep yellow urine, or little to no urine output, as well as severe weakness, dizziness, or lightheadedness.

• Presence of blood in bowel movements.

Although gastroenteritis is sometimes referred to as stomach flu, it is distinct from influenza as it primarily affects the intestines, not the respiratory system.

How Long Does Gastroenteritis Last in Seniors?

The duration of gastroenteritis in seniors can vary depending on the underlying cause. In cases of viral gastroenteritis, symptoms typically manifest within one to three days after infection. These symptoms can vary in intensity from minor to severe. Typically, seniors may experience symptoms for a brief period, lasting only a day or two. However, in some instances, the symptoms may persist for a longer duration, with the potential to endure for up to 14 days, according to one source, and up to 10 days, according to another source. As a result, variables like the specific virus that caused the infection, the person's general health, and their immune system response affect how long gastroenteritis lasts in seniors.

What Are the Complications of Gastroenteritis in the Elderly?

Complications of gastroenteritis in the elderly include:

• Dehydration: The most common and dangerous complication, particularly in the elderly. Symptoms may include excessive thirst, dark urine, and weakness.

• Long-term Effects: Gastroenteritis can disrupt gut bacteria, potentially leading to irritable bowel syndrome. Rare complications may include ulcerative colitis, aortic aneurysm, or reactive arthritis.

What Is the Treatment of Gastroenteritis in Old Aged People?

The treatment of gastroenteritis in old aged individuals focuses on symptom relief, avoiding complications, and supporting the body's recovery:

Symptom Relief:

• Over-the-counter Loperamide and Bismuth subsalicylate may help decrease stooling episodes but should be used cautiously, allowing time for virus elimination.

• Bismuth subsalicylate can reduce the severity of abdominal cramping.

• Antibiotics are generally not needed.

Oral Rehydration:

• Begin oral rehydration as soon as the individual can sip clear liquids or ice chips.

• Encourage fluid intake once vomiting has stopped.

• Re-establish fluid and electrolyte balance with fruit juices, sports drinks, broths, and caffeine-free soft drinks.

• Avoid high-sugar beverages as they may exacerbate diarrhea.

• Small, frequent servings of liquids are better tolerated.

Dietary Management:

• Gradually introduce bland and easily digestible foods like applesauce, bananas, rice, toast, noodles, and potatoes.

• Avoid alcohol, caffeine, and fatty foods until full recovery.

• Consider temporary avoidance of lactose-containing foods if lactose malabsorption is present.

• Other treatments like Nitazoxanide, antisecretory agents, toxin-binding agents, and probiotics have shown promise but require further research for widespread use.

Self-Care and Hydration:

• For a few hours, refrain from eating solid foods.

• Sip on clear fluids like water, clear soda, broths, or non caffeinated sports drinks frequently.

• Gradually reintroduce bland, easy-to-digest foods.

• Avoid dairy, caffeine, alcohol, nicotine, and highly seasoned foods.

• Ensure plenty of rest to recover strength.

In cases of viral gastroenteritis, no specific medical treatment is available, as antibiotics are ineffective against viruses. The primary focus is on self-care measures, hydration, and a gradual return to solid foods while avoiding potential irritants.

Conclusion

To conclude, gastroenteritis poses a significant risk to elderly individuals. While mild cases of gastroenteritis often require only symptomatic treatment, more severe and complicated cases, typically involving vulnerable populations such as the elderly, can lead to severe dehydration and hypovolemia. It is essential to focus on both prevention through robust infection control measures and the need for further research to better address the unique challenges within long-term care facilities.