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5th Edition of

Singapore Nursing Research Conference

March 24-26, 2025 | Singapore

Nursing 2023

Marta Sund Levander

Speaker at Singapore Nursing Research Conference 2023 - Marta Sund Levander
Linkoping University, Sweden
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.
Audience Take Away:

  • EDIS makes it easier for first line caregivers to systematically assess changes in health conditions in fragile elderly people.
  • Observation can be communicated in a standardized way further in the care process.
  • EDIS contributes to the decision not staying at the wrong level of care.


Marta Sund Levander, RN,Ph.D, Senior Associate Professor, senior researcher and lecturer at the Medical Faculty Linköping University, Sweden. She teaches nursing students at the undergraduate, specialist, and advanced levels. She has several years of clinical and research experience as a specialized nurse, especially in critical care, eldercare, infection control, and research and development. Her research area is assessment and evaluation of body temperature and its clinical implications, such as signs and symptoms of infection in critically ill, frail elderly and children. She has published about 45 papers in scientific journals and popular science papers and textbooks for health professional students and clinical practice. She is a member in the international expert group ISO ISO/TC 121/SC 3/JWG 8 "Clinical thermometers".