John Cascone: Recognizing Sepsis in the Senior and Elderly

About John Cascone: Dr. Cascone, is a Board Certified Internal Medicine and Infectious Disease Physician. His internal medicine residency was done at the University of Kansas and infectious disease follow up at the University of Missouri, Columbia. He is the Medical Director of nursing homes in southwest Missouri. His medical practice includes the care of residents in long term care facilities, infectious disease consultations and telemedicine and infectious disease services to rural facilities. He has a special interest in the diagnosis and treatment of sepsis, C diff, colitis, staphylococcus aureus, antimicrobial stewardship, and pressure ulcers. He lives in Joplin, Missouri with his family. 

In this episode, Steve and John Cascone discuss:

1. What is Sepsis?

  • Sepsis is the body’s, often deadly, response to infection.

2. What kind of infection does this include?

  • These infections could be bacterial, viral, or fungal.

3. What are some common types of infections that you see in an elderly and senior population?

  • In elderly individuals the most common  types of infections that lead to sepsis are urinary tract infections, pneumonia, bacteremia, infections that involve artificial knees or hips, skin infections, pressure ulcers, skin tears, and even the use of antibiotics can cause a certain type of diarrhea that is infectious.

4. What exactly would constitute an infection and are there other types of infections which aren’t exactly clear or that don’t come out and appear as an infection initially?

  • Infections present differently in different people. In the elderly population, infections don’t present the way they do in younger or middle age groups of people. For instance, a young healthy woman may have a urinary tract infection, and that manifests itself as difficulty or pain with urination, maybe back pain and a low grade fever. In the elderly population, a urinary tract infection may manifest itself simply as confusion or a change in mental status.

5. What are some other types of symptoms that the injured senior community should be on the lookout for?

  • The most common signs or symptoms of sepsis in the elderly is a change in mental status, feeling under the weather, poor appetite, increased confusion, fatigue, and lightheadedness. 

6. What should be done if we notice those symptoms with a loved one?

  • Take your loved one to the hospital and have them evaluated in the emergency room. Time is of critical importance in the survival of sepsis. The longer we wait, the mortality or the or the risk of death starts to climb. The sooner sepsis is recognized and treated, the likelihood of survival and getting through it is much improved. 

7. When someone has dementia or Alzheimer’s, how do you distinguish between regular signs of Alzheimer’s or dementia as opposed to them having mental confusion that is indicative of an infection? Are there other symptoms that we should be looking for?

  • Dementia is a risk factor and contributes to the atypical presentation of sepsis. Patients are sleeping more, they don’t want to eat, they’re not interacting at all. Their skin may feel warm or it’s flush. They have some sweating, their mucous membranes or their tongue is dry, changes in their bowel movements, or not making urine. These are all things we must look for in patients who are not able to tell us they are not feeling well.

8. How do you differentiate between just regular symptoms of Alzheimer’s as opposed to septic confusion?

  • If there’s an Alzheimer’s patient who doesn’t typically have behaviors, and now they’re having behaviors that could change a condition that needs to be evaluated. If they typically had behaviors and the behaviors are worse, or they’re not occurring anymore because the patient is not interacting as much. That’s also a changing condition. When in doubt, the loved one or caregiver at home should always bring the patient to the ER.

9. If your elderly loved one is showing signs of mental confusion, are you losing time if you don’t have them seen immediately? 

  • That is correct. In the case of sepsis, for every hour that passes, that a patient does not get appropriate antibiotic therapy, the mortality goes up by 7.8%. Time is critical to survival.

10. What is the mortality rate for the aging senior population when they’re coming in with sepsis? Is it higher than the rest of the population? 

  • Yes, it is. It’s much higher.

11. What are some tests that the medical professionals do in the ER or at a medical facility that they do to determine whether or not you have sepsis?

  • Ask loved ones about changing conditions. How’s the person been acting? We check vital signs. What’s the blood pressure, is the heart rate fast? What’s the respiratory rate?

12. When you say respiratory rate do you mean how many breaths per minute they’re taking?

  • Exactly. Normal breaths per minute, is approximately 14 to 20 above 20 breaths per minute is considered a warning sign, and a pulse above 90 beats per minute, is considered a warning sign.

13. Do Doctors start treatment right away without even waiting for the lab tests to come back, because if you wait, that person could go into septic shock?

  • Doctors make an educated assessment, a clinical diagnosis of what we think is going on. We get antibiotics on board, we get fluids running,  and then as the data starts coming in, we can start pulling back but we don’t want to miss that. opportunity to treat our patients. If we don’t give them antibiotics, we don’t provide fluid resuscitation with IV fluids, then we have a high risk of a poor outcome.

14. What is a blood pressure that someone should be concerned about as far as sepsis? 

  • If the systolic or top number is below 100 and or the bottom number is under 60 or 65. It’s a concern and they should be evaluated emergently. 

15. If you had to give two or three action steps if people are suspecting sepsis, what would those tips be?

  • Get your vaccinations, your flu shot, and your pneumonia shot. Keep a list of all the medications you take in your wallet. If your loved one is not acting normally, or you just don’t feel like things are right, take them to the hospital and have them evaluated urgently. Do not delay.


“Dad’s not acting himself is analogous to having chest pain. The mortality from sepsis is equivalent, if not greater than the mortality from an acute myocardial infarction or heart attack. “ —  John Cascone

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Show notes by Podcastologist: Kristen Braun

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