Understanding the Use of Antibiotics in Seniors

U.S. Antibiotic Week is November 18 to 24, an annual observance highlighting the steps everyone should take to improve antibiotic prescriptions and use. Antibiotics can indeed save lives and are vital tools for treating many common and serious infections, such as those that can result in sepsis. But at least 28 percent of antibiotics prescribed in outpatient settings in this country are unnecessary; each year, enough prescriptions are written to provide five out of every six people one antibiotic prescription, according to the CDC. Any time you use antibiotics, they can cause side effects and contribute to antibiotic resistance, which happens to be one of the most urgent threats to public health. If you have a senior loved one in hospice in San Mateo and elsewhere, you will find today’s blog of interest.

Seniors in particular have to watch out for overuse and side effects, as these can result in even more dire complications in the elderly population. Common infections such as urinary tract infections, skin and soft tissue infections, and lower respiratory tract infections frequently occur in the elderly; but the diagnosis of infection isn’t always obvious. Symptoms of infection in seniors may not include the typical signs, like fever and chills that clinicians typically rely on to make a diagnosis, says ScienceDirect.

Oftentimes, symptoms mimic normal signs of aging, or they could be non-specific such as when pneumonia also presents with confusion. Seniors may also have fever without any apparent infection, which further complicates the decision to administer antibiotics. And when you add inaccurate history taking into the mix due to cognitive impairment, along with physical examinations that may be hampered by lack of cooperation, you can see where over-prescribing of antibiotics can take place.

Recognizing the Problem

Antibiotic-resistant bacteria are mainly the result of the over-prescription or inappropriate prescription of antibiotics. During the last 10 years, antibiotic use frequency has decreased, mostly in children, but the prevalence in older adults continues to rise. Because about one-half of prescribed antibiotics are inappropriate or unnecessary, it is important for physicians to prescribe such medications only when indicated, says Today’s Geriatric Medicine.

Physicians often prescribe antibiotics for upper respiratory infections, even though most of these types of infections are viral in nature and won’t respond to antibiotics. There are many common justifications for this, such as diagnostic uncertainty, concern for patient satisfaction, and severe illness. It’s vital, then, that physicians validate patient concerns and communicate their findings only after a complete physical exam and testing. Alternative solutions for antibiotics could include suggesting over-the-counter remedies or giving a delayed prescription (whereby a prescription is given to a patient that can be filled at a later date if symptoms don’t improve).

In hospice, however, this can be difficult when the quality of life and comfort is the primary goal. Infections are indeed prevalent at the end of life, and it is tough to prove antibiotic overuse. However, these drugs may be providing little to no benefit for those whose life expectancy is measured in just days or weeks, as there’s really no way to know if the antibiotics are working or benefiting patients with symptoms, points out ACP Hospitalist.

Benefits and Risks of Antibiotics in Hospice

That being said, antibiotics for hospice patients may bring some benefits. Infections are painful, to be sure, and treatment provides some degree of relief, particularly when it comes to urinary tract infections or oral thrush. In addition, there’s the potential to prolong life, at least by a bit. Research shows people can live a little longer with antibiotics use but have a higher symptom burden and lower quality of life with treated infections. For many, though, the tradeoff is worth it for patients who want a few more days to say goodbye, attend a son’s wedding, or get their affairs in order.

There are risks, though. Data suggests that palliative care may be better than the sole use of antibiotics when it comes to relieving symptoms associated with infection. Even when the risks of antibiotic use are on the low side, they can be fairly significant to frail patients. For example, intravenous antibiotics infused with saline can result in fluid overload, while drug interactions can complicate care.

Antibiotics also have nervous system side effects, such as confusion and agitation, with research showing patients receiving antibiotics for pneumonia having a lower quality of life than those who were not treated. Additionally, antibiotics can also harm seniors in hospice by prolonging the dying process.

In the end, the patient’s goals of care are what should be guiding any decision about antibiotic use.

Contact Pathways Home Health and Hospice

To learn more about our hospice program, please contact us at 888-978-1306. Your loved one is assigned to a whole hospice care team, which includes doctors, nurses, and social workers who all work in conjunction with the patient’s best interests in mind.