Older adults may manifest acute illness with atypical signs and symptoms, including those that are non-localizing; however, most nursing-home residents with acute infection will also exhibit some localizing signs and symptoms of infection. Non-infectious explanations for non-localizing signs or symptoms of changes in condition should be ruled out first. Some of these changes may include:

• Changes in medication,
• Acute or chronic dehydration,
• Unrecognized/undertreated pain,
• Constipation,
• Sleep deprivation and
• Misuse of assistive devices

A period of careful, active monitoring, during which vital signs and nursing assessments are performed more frequently and the affected resident is encouraged to take oral hydration and appropriate analgesia, can be effective in avoiding unnecessary testing and treatment of the resident. A very interesting article was published in CambridgeCore (Cambridge University Press) on December 9, 2020, that discusses the reliability of non-localizing signs and symptoms as indicators of the presence of infection in nursing-home residents. Although their findings vary somewhat from what our current practice is, the article is well written and makes a lot of sense. We often do jump to the conclusion that a resident has an infection because they “aren’t themselves”. Then we order labs, ongoing monitoring for infection, etc. when indeed it might be something as simple as dehydration or unmet needs. Worth the read, take a look! Stay the course, stay strong, stay well, mask up and stay tuned!