Perceptions of Relatives about Symptoms and Signs in Older Adults with Sepsis: A Cross-Sectional Study

Sepsis is a common health condition in older adults that may present with typical or atypical symptoms and signs. The perception of warning symptoms and signs by relatives is important in their decision to seek hospital medical treatment. This cross-sectional study was conducted to explore the symptoms and signs of sepsis in older adults as perceived by their relatives, the awareness of symptoms and signs of sepsis, and the duration from the symptom onset to hospital arrival at a tertiary care hospital in Bangkok, Thailand. Seventy-seven dyads of older adults with sepsis and their relatives were recruited. Data were collected using the Personal Information of Older Adults and Relatives Questionnaire and the Symptoms and Signs of Sepsis Questionnaire. Descriptive statistics and Fisher’s exact test were used to analyze the data. Results revealed that both typical and atypical symptoms and signs occurred in older adults with sepsis. The top five typical presentations were drowsiness/deep sleep, rapid breathing, fever, chilling, and difficulty breathing. The top five atypical presentations were malaise or fatigue, loss of appetite, signs of dehydration, comorbidity  exacerbations, and decreased activities of daily living. Atypical presentations were the most common presentations that relatives were unsure of and did not recognize as sepsis. The majority of older adults with sepsis (72.7%) arrived at the emergency department within 24 hours of the onset of symptoms or signs. There was no significant difference between the number of participants arriving at the emergency department within ≥24 hours, classified by typical and atypical presentations. These findings point to the important role of relatives to be proactive in the management of sepsis in older adults, starting at home. Nurses should teach relatives about early detection and timely seeking of medical care in hospitals. A system of telehealth consultations through phone or video calls should be established to facilitate healthcare-seeking decisions prior to clinical deterioration.