Sepsis is a medical emergency. This article is for education only. It is not a diagnosis or a substitute for emergency care. If you suspect sepsis, call 911 or go to the nearest emergency department immediately. Do not wait to see whether the person improves.
“She just isn’t acting like herself.”
That may be the first thing a family notices. Mom seems confused after returning home from rehabilitation. Dad suddenly cannot get out of his chair after being treated for a urinary tract infection. A normally alert older adult becomes unusually sleepy, weak or short of breath.
Families may understandably assume their loved one is tired, dehydrated or simply having a difficult recovery day. In an older adult, however, sudden changes like these can be warning signs of sepsis—even when there is no high fever.
Knowing what to watch for and acting quickly could save a life.
What Is Sepsis?
Sepsis is the body’s extreme, life-threatening response to an infection. It occurs when the body’s response begins damaging its own tissues and organs. Without prompt medical treatment, sepsis can lead to organ failure and death.
According to the Centers for Disease Control and Prevention, approximately 1.7 million adults in the United States develop sepsis each year. At least 350,000 people who develop sepsis die during hospitalization or are discharged to hospice.
Most cases begin before the person arrives at the hospital. That makes awareness especially important for families, caregivers, home-care professionals, senior-living staff and anyone supporting an older adult after a hospital or rehabilitation stay.
Why Are Older Adults More Vulnerable to Sepsis?
Anyone can develop sepsis, but adults age 65 and older face substantially greater risk. Sepsis Alliance reports that older adults are approximately 13 times more likely to be hospitalized with sepsis than younger adults.
Several factors can increase an older adult’s vulnerability:
- The immune system may respond less strongly to infection.
- Chronic health conditions can make recovery more difficult.
- Symptoms may be subtle or mistaken for normal aging.
- Recent hospitalization, surgery or rehabilitation can increase infection risk.
- Urinary catheters, wounds and other medical devices create additional risks.
- Memory or communication changes may make symptoms harder to identify or report.
Infections that lead to sepsis frequently begin in the lungs, urinary tract, skin or gastrointestinal tract. Pneumonia, a urinary tract infection, an infected wound or another seemingly localized infection can sometimes progress into sepsis.
What Are the Warning Signs of Sepsis in an Older Adult?
Possible warning signs include:
- New confusion or disorientation
- Sudden or extreme weakness
- Rapid or difficult breathing
- Unusual sleepiness or difficulty waking
- Fever, shivering or feeling very cold
- An unusually low body temperature
- Clammy or sweaty skin
- A fast heart rate or weak pulse
- Severe pain or discomfort
- A sudden fall or inability to walk normally
- A rapid decline over several hours
- A strong sense that the person is extremely ill
Not everyone will experience every symptom. In an older adult, a sudden change from the person’s normal behavior or abilities may be more important than any single temperature reading.
Can Sudden Confusion in an Older Adult Be a Sign of Sepsis?
Yes. Sudden confusion or delirium can be an early warning sign of infection and sepsis in an older adult.
A person experiencing a sudden mental change may:
- Become disoriented in familiar surroundings
- Stop recognizing familiar people
- Become unusually agitated or fearful
- Have difficulty answering simple questions
- Say things that do not make sense
- Become withdrawn or less responsive
- Sleep considerably more than usual
- Become difficult to wake
Even someone living with dementia can experience a noticeable departure from their usual behavior. Family members and regular caregivers often recognize this difference because they know how the person normally communicates, moves and responds.
Do not automatically assume a sudden mental decline is “just dementia,” medication-related or part of getting older. It requires prompt medical evaluation.
Can an Older Adult Have Sepsis Without a Fever?
Yes. The absence of a fever does not rule out sepsis in an older adult.
Older bodies do not always produce the classic fever-and-chills response associated with infection. An older adult’s normal temperature may also be lower, so a seemingly ordinary reading could still represent a meaningful change from that person’s baseline.
An unusually low temperature or feeling extremely cold can also be concerning.
Families should not wait for a temperature of 100.4°F when an older adult has new confusion, rapid breathing, severe weakness, clammy skin or a sudden decline.
What Does Sepsis From a UTI Look Like in an Older Adult?
A urinary tract infection does not always cause burning, urgency or obvious pain in an older adult. The first noticeable changes may be confusion, weakness, loss of appetite, incontinence, unusual sleepiness or a fall.
A UTI does not automatically mean someone has sepsis. However, a known or suspected UTI combined with rapid breathing, extreme weakness, significant mental decline, an unusually high or low temperature, or a rapidly worsening condition requires emergency medical attention.
Do not dismiss a sudden decline as “just a UTI.”
Remember TIME
Sepsis Alliance uses the TIME reminder to help families recognize possible sepsis:
- T — Temperature: Higher or lower than normal
- I — Infection: A known or suspected infection
- M — Mental decline: New confusion, sleepiness or a significant behavioral change
- E — Extremely ill: Severe weakness, pain, difficulty breathing or a sense that something is seriously wrong
TIME is a reminder, not a diagnostic test. A person does not need to have every symptom before receiving emergency care.
When Should You Call 911 for Possible Sepsis?
Call 911 or seek emergency care immediately when an older adult has a sudden or rapidly worsening combination of symptoms, particularly:
- New confusion, delirium or difficulty waking
- Trouble breathing or unusually rapid breathing
- Very high or unusually low body temperature
- Shivering, sweating, or cold and clammy skin
- Extreme weakness, dizziness or fainting
- Severe pain or discomfort
- A known or suspected infection accompanied by a rapid decline
- Concerning symptoms following hospitalization, surgery or rehabilitation
- Concerning symptoms in someone with a wound, catheter or weakened immune system
Do not wait for every symptom to appear, and do not wait for a high fever.
When speaking with emergency responders or emergency-department staff, say clearly:
“I’m concerned this could be sepsis.”
Be prepared to explain:
- What changed
- When the change began
- How quickly the person declined
- Whether there is a known or suspected infection
- Whether the person recently stayed in a hospital, rehabilitation facility or skilled nursing facility
- Whether the person recently had surgery, a wound or a catheter
- What medications or antibiotics the person is taking
Why the Transition Home Deserves Special Attention
The first days following a hospital or rehabilitation discharge can be overwhelming. A family may be managing new prescriptions, wound care, mobility limitations, medical equipment and follow-up appointments at the same time.
In Central Texas, the person coordinating that care may not live nearby. An adult daughter in Austin may be checking on a parent in Temple. A Georgetown family may be managing a discharge from a Round Rock rehabilitation facility. A spouse in Marble Falls or along the Lake Travis corridor may face a long drive when new symptoms appear.
Families throughout the region—from Waco and Belton through Greater Austin to Kyle, San Marcos and New Braunfels—may also receive care from several different hospitals, rehabilitation providers and home-based services. Those distances and handoffs make a clear discharge plan especially important.
Before leaving the hospital or rehabilitation facility, ask:
- What condition or infection is being treated?
- What changes should we expect during recovery?
- Which warning signs require calling the doctor?
- Which symptoms require calling 911?
- Who should we contact with questions after discharge?
- Have any medications changed?
- When should the prescribed antibiotics be completed?
- Has home health been ordered?
- Does the person need nonmedical help at home?
- Is the current living environment still safe?
The SIS Hospital-to-Home resource explains common post-discharge services, including home health, home care and hospice, and provides additional questions families can ask before returning home.
What If More Support Is Needed After Recovery?
A hospitalization involving sepsis can leave an older adult weaker than before. Some people experience reduced mobility, difficulty completing daily activities, memory changes or greater dependence on family members during recovery.
That does not automatically mean the person needs to move. It does mean the family should reassess the support needed now rather than relying on what was sufficient before the hospitalization.
Depending on the person’s condition, the next step might involve:
- Physician follow-up
- Home health nursing or therapy
- Nonmedical home care
- Medical equipment
- Medication-management assistance
- Transportation
- Caregiver support
- Respite care
- Short-term rehabilitation
- A different senior-living environment
Families can use the Central Texas Senior Care Directory to learn about local home care, home health, medical equipment, transportation, geriatric care management and caregiver-support resources.
For broader information about planning and paying for senior care, visit the SIS Senior Care Resources page.
Trust the Change You See
Family members and regular caregivers often notice subtle changes before anyone else.
You know how your loved one normally communicates, walks, eats, sleeps and responds. If something changes suddenly—especially following an infection, hospitalization or rehabilitation stay—trust what you are seeing.
Sudden confusion, severe weakness, a fall or rapid breathing should not be dismissed as normal aging.
If you suspect sepsis, call 911 and tell emergency responders:
“I’m worried this could be sepsis.”
Frequently Asked Questions
What is often the first sign of sepsis in an older adult?
There is no single first sign. New confusion, unusual sleepiness, sudden weakness, rapid breathing or a noticeable departure from the person’s normal behavior may be early warnings.
Does an older adult need to have a fever to have sepsis?
No. Older adults can develop a serious infection or sepsis without a high fever. An unusually low temperature can also be concerning.
Can a UTI cause confusion in an older adult?
Yes. A urinary tract infection may present with confusion or other behavioral changes in an older adult. Sudden confusion can have many other serious causes, however, so the person needs prompt medical evaluation.
Can sepsis develop after a hospital or rehabilitation stay?
Yes. Sepsis can develop from an infection following hospitalization, surgery, rehabilitation, wound care or the use of a medical device such as a catheter. New or rapidly worsening symptoms require immediate attention.
Should I drive someone to the hospital if I suspect sepsis?
Sepsis can worsen rapidly. Call 911 when the person is confused, difficult to wake, having trouble breathing, fainting, extremely weak or declining quickly. Emergency responders can begin evaluating and supporting the person during transport.
Sources & Further Reading
Centers for Disease Control and Prevention — About Sepsis
Definition, risk factors, warning signs and national statistics emphasizing that sepsis is a medical emergency.
https://www.cdc.gov/sepsis/about/
CDC — Get Ahead of Sepsis
Public education about recognizing infections, identifying possible signs of sepsis and seeking medical care quickly.
https://www.cdc.gov/sepsis/
CDC MMWR — Sepsis-Related Death Rates Among Adults Age 65 and Older
National data showing how sepsis-related death rates increase substantially with age among older adults.
https://www.cdc.gov/mmwr/volumes/72/wr/mm7238a5.htm
Sepsis Alliance — Sepsis and Aging
Information about the increased risk of sepsis among older adults and how confusion or mental decline may be an early warning sign.
https://www.sepsis.org/sepsisand/aging/
The BMJ — Diagnosis and Management of Sepsis in the Older Adult
Clinical review explaining how sepsis in older adults may present through confusion, falls, immobility and other nonspecific changes rather than classic symptoms.
https://www.bmj.com/content/382/bmj-2023-075585
Central Texas Senior-Care Resources
Senior Industry Services (SIS)
Senior-care resources, professional networking, education and Senior-AI for Central Texas.
https://seniorindustryservices.com/
Senior-AI
Ask senior-care questions and discover resources for seniors, families, caregivers and professionals across Central Texas.
https://senior-ai.ai/
SIS Hospital-to-Home Resources
Information to help Central Texas families understand post-hospital care, discharge needs and available support.
https://seniorindustryservices.com/hospitaltohome/
Central Texas Senior Care Directory
Find home care, home health, medical equipment, transportation, caregiver support and other local senior-care resources.
https://seniorindustryservices.com/senior-care-directory/
Oasis Senior Advisors Austin & Central Texas
No-cost, confidential guidance for families navigating Hospital-to-Home, After-Rehab and changing senior living and care needs throughout Central Texas.
https://www.oasissenioradvisors.com/austin-central-tx/
John Brown, CSA
CEO, Oasis Senior Advisors Austin & Central Texas
Founder, Senior Industry Services (SIS)
Hospital-to-Home | One Call. Many Solutions.