Mission & Objectives
Over the past century, human life expectancy has increased dramatically. Persons older than 85 years are the fastest growing segment of the population and it has been estimated an increase to 7.3 million by 2020. A projection for old (65-79 years) and very old persons (> 80 years) that will be in developed countries through 2060, suggested percentages of 15% and 9%, respectively. Due to the high frequency, the different epidemiology, the atypical clinical presentation and the age-related modifications in drug metabolism that complicate the treatment, infections in the elderly represent a major challenge for physicians. There are many different factors that contribute to the high frequency: the “immunosenescence” caused by changes in the cellular and humoral immunity, anatomic and physiological modifications, comorbidities, poor functional status and malnutrition, repeated hospitalisations and stay in long-term care facilities.
The most common infections affecting older people are due to pyogenic bacteria and include urinary tract infections, pneumonia, endocarditis, bacteraemia, diverticulitis and skin and soft tissue infections. Nosocomial bacterial infections are particularly frequent among the elderly. Persons older than 65 are hospitalised more than three times the rate for persons of all ages and are frequently exposed to invasive procedure with placement of devices such urinary catheters and joint prosthesis. Of particular concern is the risk of infections due to antimicrobial-resistant strains, such as methicillin-resistant Staphyloccoccus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamases producing Gram-negative bacteria that is likely to be increased up to 8-time in residents of nursing homes (NH) or long term-care facilities (LTCFs) due to uncontrolled usage of empiric antimicrobial therapy.
Among viral infections, influenza is extremely frequent among the elderly and severe and fatal complications occur more frequently than in other ages. Relapsing herpes zoster might also substantially impact quality of life of the elderly population.
Of clinical relevance in such population is also tuberculosis, whose proportion among the elderly is increasing. Most of the knowledge of tuberculosis was gained from studies on young adults. Tuberculosis in elderly people may exhibit a different course with atypical presentation leading to an increase in morbidity and mortality in these patients.
Finally, in the last decades, the proportion of HIV-infected patients who are ?50 years of age has increased due to improved survival of younger individuals and increasing rates of infection among older persons. Compared with age-matched HIV-uninfected individuals and with younger HIV-infected individuals, HIV-infected people ?50 years have a higher rate of comorbidities such as cardiovascular disease, metabolic disorders, osteoporosis, non-HIV cancers, hepatic and renal impairments. The toxicity of long-term antiretroviral therapy further exacerbates the problem. The decreased immunological responses among older persons and their increased susceptibility to medical comorbidities have led international AIDS societies to give special recommendations for antiretroviral therapy in old population.
Another important issue to define in the elderly population is the prevention of infections. The use of infection control practices and vaccines may pose special problems. For example, contact isolation in hospitalised patients, a common infection control measure, may be associated with higher risks of adverse effects like pressure ulcers and/or psychological syndromes.
Therefore, the aims of ESGIE will be as the following:
1. To produce multicenter data on the epidemiology, clinical presentations, therapeutic management and prevention of infections in the elderly. Specific topics will be:
- community acquired infections
- infections associated with the use of devices
- antibiotic-resistant infections
- infections acquired in long-term care facilities and nursing homes
2. To study the pharmacological parameters of antimicrobial agents influenced by age-related metabolism, and to analyse drug interactions and adverse effects
3. To promote multidisciplinary management of infections in the elderly and global exchange among people who have special experience and/or interest in this field
4. To promote awareness among the scientific community about the complex management of infections in the elderly (through education courses, scientific sessions in congresses and diffusion of scientific publications), with special attention to general practitioners
5. To analyse the effectiveness of measures aimed at reducing spread of infections among the elderly and specifically assess the role of infection control measures in long-term care facilities and nursing homes, with special attention to the adverse effects of these measures in the elderly
6. To cooperate with other international organisations focusing on the elderly population in multidisciplinary initiatives