Your dad had a urinary tract infection last week, and the doctor started him on antibiotics. Today he's breathing fast, his skin feels clammy, and he's mixing up your name. He insists he's fine. You aren't sure whether this is just a bad day or something much worse.
Trust that feeling. Sepsis is the body's overactive and extreme response to an infection, and it's a life-threatening medical emergency1. Adults 65 or older are one of the groups most likely to develop it1, and the early signs can look like ordinary confusion or tiredness. This guide explains what families should watch for, what happens in the hospital, and how to support a parent afterward. It's general information, not medical advice. When in doubt, get help right away.
What sepsis is
Sepsis happens when an infection your parent already has sets off a chain reaction throughout the body1. The symptoms aren't caused by the germs themselves. Instead, chemicals the body releases to fight the infection cause the harm2. Left unchecked, these immune signals trigger widespread inflammation, blood clots and leaky blood vessels, so blood flow to the organs drops and they are starved of oxygen and nutrients3.
In the worst cases, blood pressure falls, the heart weakens and the person moves toward septic shock, where the lungs, kidneys and liver can quickly fail3. Sepsis is a leading cause of death in hospitals. The CDC estimates that at least 1.7 million adults in the United States develop sepsis each year, and at least 350,000 die as a result3. You may also hear it called septicemia, blood poisoning or septic shock, though doctors use these terms in slightly different ways2.
Why older adults are at higher risk
Anyone with an infection can develop sepsis, but some people are more likely to, including1:
- Adults 65 or older.
- People with chronic conditions such as diabetes, lung disease, cancer and kidney disease.
- People with weakened immune systems.
Sepsis most commonly affects infants and older adults2. It is often more dangerous in people with a weak immune system or a long-term illness2. Many older parents have more than one of these risks at the same time. Recent surgery, a urinary catheter, an IV line or a skin wound adds more, since each gives germs a way in2.
Infections that can lead to sepsis
Bacterial infections cause most cases of sepsis, but viral infections such as flu or COVID-19 and fungal infections can cause it too3. The infection is often in the lungs, stomach, kidneys or bladder1. In older adults, the infections families should know about include:
- Pneumonia. A lung infection is one of the most common starting points2. See pneumonia in older adults.
- Urinary tract and kidney infections. An upper urinary tract infection can lead to what's sometimes called urosepsis2. See UTIs in older adults.
- Skin infections and bedsores. Cellulitis and pressure ulcers can both be sources2. See bed sores.
- Infections after surgery or a hospital stay. IV lines, surgical wounds and drains are common sites for people in or recently home from the hospital2.
Sepsis can even begin with a small cut that becomes infected, and sometimes it occurs in people who didn't know they had an infection1. That's why an older parent who seems to be getting worse instead of better during any infection deserves a closer look.
Signs of sepsis in older adults
Sepsis can cause one or more of these symptoms1:
- Rapid breathing and heart rate.
- Shortness of breath.
- Confusion or disorientation.
- Extreme pain or discomfort.
- Fever, shivering or feeling very cold.
- Clammy or sweaty skin.
Other signs include lightheadedness from low blood pressure, a skin rash or mottled skin, and a low body temperature instead of a fever2. In older adults, a change in mental status and very fast breathing may be the earliest signs2. Your parent may seem sleepy, unusually agitated, or simply not themselves.
Because many of these signs can be caused by other conditions, sepsis can be hard to recognize early, even for doctors1. It's even harder when a parent already has dementia, since new confusion may be blamed on the disease. You know your parent's normal better than anyone. A sudden change from that normal is worth reporting. See end-of-life signs in dementia for how infections affect people with advanced dementia.
When to call 911
Sepsis can progress rapidly and unpredictably3, so this is not a time to wait for a morning appointment. If your parent lives in assisted living or a nursing home, ask staff to call the nurse and the doctor now, and ask whether your parent should be sent to the hospital. Bring or send a current medicine list, recent test results if you have them, and any advance directive.
How sepsis is diagnosed
To check for sepsis, the care team will ask about symptoms, check temperature, blood pressure, heart rate and breathing, and order lab tests that look for infection or organ damage1. They may also order an X-ray or CT scan to find where the infection is1.
Blood tests often confirm the infection, but a blood test may not show it if your parent has already been taking antibiotics2. Other tests may check blood gases, kidney function, blood clotting and white blood cells2. Tell the team about your parent's usual thinking and energy, any recent infections, surgery or hospital stays, and every antibiotic taken in the past few weeks.
How sepsis is treated
A person with sepsis is admitted to the hospital, usually to the intensive care unit2. Fast treatment matters. Antibiotics are usually given through a vein and need to be started as quickly as possible2. Other treatment may include12:
- Oxygen to help with breathing.
- IV fluids to keep blood flowing to the organs.
- Treating the source of the infection.
- Medicines that raise blood pressure.
- Dialysis if the kidneys fail, or a breathing machine if the lungs fail.
- Sometimes surgery to remove tissue damaged by the infection.
There is no single specific treatment for sepsis beyond fighting the infection and supporting the organs while the body recovers3. That's why early care makes such a difference.
Supporting your parent in the hospital
An ICU stay is frightening for families. You can still help. Ask the team who your main contact is and when the doctors usually round, so you can be there or call. Keep a notebook of updates, questions and medicine changes. Older adults in the ICU often develop delirium, so familiar voices, glasses, hearing aids and a clock or calendar in view can help your parent stay oriented.
Make sure the hospital has your parent's advance directive and knows who the health care agent is. If your parent can't speak for themselves, that person will be asked about treatments such as a breathing machine or dialysis. See power of attorney for an elderly parent and advance directive vs. living will. Ask whether your parent is an inpatient or under observation, since that affects Medicare coverage for rehab later. See Medicare observation status.
Recovery after sepsis
Sepsis is often life threatening, especially for people with a weak immune system or a chronic illness2. For those who survive, damage caused by reduced blood flow to the brain, heart and kidneys may take time to improve, and some people have long-term problems with these organs2. Sepsis is also one of the main reasons people are readmitted to the hospital3.
Many older adults come home weaker than before, with less stamina, poor appetite, trouble sleeping, or problems with memory and concentration. Some feel anxious or low. These changes often improve slowly over weeks or months, but report them to the doctor rather than assuming they're just age. See depression in older adults.
- Plan the discharge. Ask what help your parent will need at home. See hospital discharge planning.
- Consider rehab. A short skilled nursing or rehab stay can rebuild strength. See skilled nursing facility vs. nursing home.
- Arrange home health if needed. See does Medicare pay for home health care.
- Book a follow-up visit. Within a week or two, and bring the hospital discharge papers.
- Watch for a new infection. Fever, fast breathing, new confusion or a wound that looks worse means calling the doctor the same day.
- Prevent falls. Weakness raises fall risk. See fall prevention.
Lowering the risk of sepsis
The best way to prevent sepsis is to prevent infections and treat them early1. Steps that help include:
- Vaccines. Getting all recommended vaccines lowers the risk2. Ask the doctor about flu, pneumococcal, COVID-19 and other shots.
- Managing chronic conditions. Keeping diabetes, lung and kidney disease under control1.
- Good hygiene. Handwashing for your parent, caregivers and visitors1.
- Wound care. Keep cuts clean and covered until they heal1, and check skin for redness or sores, especially in a parent who spends much of the day in bed or a chair.
- Catheters and IV lines. Ask whether they can come out as soon as they're no longer needed, since prompt removal helps prevent infections2.
- Hydration and nutrition. Fluids and good meals help the body fight infection. See dehydration in older adults.
Finish every course of antibiotics as prescribed, and call the doctor if an infection isn't improving within the time they expect.
Sepsis in nursing homes and assisted living
Residents of nursing homes and assisted living often have several risk factors at once: older age, chronic illness, catheters, wounds and close contact with others. When you tour or review a community, ask how staff check for early signs of infection, how often vital signs are taken when a resident is sick, how quickly a nurse is called for new confusion or fast breathing, and how families are notified. In a nursing home, ask how infections and pressure sores are prevented. See how to choose a nursing home and nursing home care plan meetings.
Questions to ask the doctor
- What infection caused the sepsis, and has it been treated?
- Were any organs affected, and what follow-up do they need?
- Which warning signs mean we should call you or go back to the hospital?
- Does my parent need rehab, home health or extra help at home?
- Which vaccines does my parent still need?
- Are any medicines, catheters or lines raising the risk of another infection?
Planning ahead
For a frail parent or one with advanced illness, sepsis can be a turning point. Once your parent is stable, it's a good time to talk with them and their doctor about goals of care, which treatments they would want if they became very sick again, and whether palliative care could help4. Put those wishes in writing with an advance directive5. See hospice vs. palliative care.
