Early nonspecific signs and symptoms of infection in institutionalized elderly persons: perceptions of nursing assistants

Scand J Caring Sci. 2010 Mar;24(1):24-31. doi: 10.1111/j.1471-6712.2008.00680.x. Epub 2009 Nov 30.


Aim: To explore early nonspecific signs and symptoms of infection in elderly institutionalized individuals as described by nursing assistants.

Background: Nonspecific signs and symptoms and lack of specific ones are common in connection with infection in institutionalized elderly persons and contribute to a delayed diagnosis and treatment. In clinical care, the nurse makes notes on the individual status of the patient on a daily basis and decides whether to contact the physician or not. However, in Sweden nursing assistants provide most of the daily care and therefore have many opportunities to observe subtle changes that may be early signs of infection.

Method: Data were collected in 2006 from focus interviews with 21 female nursing assistants. The interviews were verbatim transcripted and analysed with qualitative content analysis for manifest content with no preconceived categories.

Findings: Nursing assistants' descriptions of nonspecific signs and symptoms of infection comprised two exclusive categories. Is not as usual described general signs and symptoms of discomfort related to possible infection, such as discomfort, unrestrained behaviour, aggressiveness, restlessness, confusion, tiredness and feebleness, and decreased eating. Seems to be ill was more distinctly related to signs and symptoms of established infection in general terms of fever and pain or more specifically related to pneumonia, urinary tract infection, skin infection, cold and eye infection.

Conclusion: Nursing assistants have a keen observational ability to detect early signs that might help to confirm suspected infections in elderly nursing home residents early on. Whether or not the cited categories are actual early signs and symptoms of infectious disease needs to be further investigated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attitude of Health Personnel
  • Bacterial Infections / diagnosis*
  • Bacterial Infections / epidemiology*
  • Humans
  • Institutionalization / statistics & numerical data*
  • Nursing Care*
  • Nursing Homes / statistics & numerical data*
  • Prevalence
  • Surveys and Questionnaires
  • Sweden / epidemiology
  • Time Factors