Chapter 15: Infection & Immunity in Older Adults

As the human body ages, the immune system undergoes significant physiological shifts, including the atrophy of the thymus and a diminished capacity for T-cell and B-cell responses, which weakens the body’s ability to distinguish between self and nonself. These changes often result in "masked" clinical presentations where typical signs of infection, such as high fever or pronounced inflammation, are absent or atypical, making early detection a primary nursing challenge. The text explores various factors that further compromise immunocompetence, such as protein-energy malnutrition, trace element deficiencies in iron and zinc, and psychosocial stressors like depression, bereavement, and social isolation. Major health threats discussed include influenza and pneumonia, which represent significant causes of death in the elderly, as well as the rising and often underdiagnosed incidence of HIV in older populations. The chapter also details the management of autoimmune conditions like systemic lupus erythematosus and rheumatoid arthritis, alongside the prevention of dangerous nosocomial pathogens such as Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), and Clostridium difficile. Nursing management is centered on meticulous assessment, the promotion of annual vaccinations, nutritional support, and the implementation of rigorous hygiene standards to prevent the spread of infection in both community and institutional settings.