Title: Decision support for detecting infections in frail elderly: Development of early detection of infection scale(EDIS)
Older adults who live in residential aged care are especially vulnerable to infection because of physical and cognitive decline, as demonstrated during the Covid-19 pandemic. Signs and symptoms of infection are often lacking or atypical, while specific ones, especially failure to present fever are absent. Consequently, aged residents experience increased antibiotic usage, clinical complications, hospital admission, and mortality. Monitoring signs and symptoms using decision support tools is one approach that could help improve early detection ensuring timely treatment and effective care. In this presentation, we describe the development of the decision support tool EDIS (Early detection of infection scale) for standardized assessment to detect infection in frail elderly early on. EDIS is based on interviews with nursing or care assistants (NA), who provide most of the daily individual care. Therefore, they have opportunity to observe changes that might be early signs and symptoms of infection. In the interviews NA used the expression he / she is not as usual to lower normal body tempera who is usually worried becomes apathetic, the resident who usually speaks uninhibited becomes silent. The expression "he / she seems to be ill", was more a statement of general signs and symptoms of illness, such as temperature assessed as fever, respiratory tract symptoms, urinary tract symptoms, wound infection etc. Also, as frail elderly may have lower normal body temperature it is reasonable to assume also lower temperature in fever. Therefore, EDIS use an increase of at least 1°C increase from individual normal temperature and feeling of illness/change in behaviour, as temperature in fever. EDIS has recently been clinically validated and a preliminary analysis shows that NA’s observations together with at least 1°C increase from individual normal temperature can facilitate detection of suspected infection early on.