Guest Blog by Kelly Koeppel on behalf of Aging.com. Kelly Koeppel is an author, editor, and digital marketing specialist. Koeppel has written for numerous national web publications on the topics of mental health and aging.

What Is Clostridioides difficile?

As the global population ages, it has become crucial to understand the specific health challenges faced by senior citizens. One area of concern is the impact of aging on gut health and the increased susceptibility of older adults to Clostridioides difficile (C. diff) infections. In recent years, C. diff infections have become more prevalent, particularly among the elderly, resulting in significant morbidity.

C. diff is a bacterium that is found in the digestive tract of many people. The bacterium does not usually cause any harm as long as the intestinal microbiome is in good health. However, when the gut’s natural balance of bacteria is disrupted, it can grow out of control and produce toxins that harm the body. Maintaining good gut health and eating a balanced diet that is rich in fiber promotes the growth of healthy bacteria in the gut and is crucial to preventing CDIs. 

Symptoms of C. diff Infection in Seniors

One of the most common symptoms of CDI is diarrhea, which can become watery, and may have a foul odor. Seniors with CDI may also experience abdominal pain, bloating, and cramping. Loss of appetite is also common and can lead to weight loss if not managed promptly.

CDI can also cause inflammation in the colon, leading to colitis, which can cause more severe symptoms such as fever, vomiting, and severe abdominal pain. In some cases, CDI can lead to a life-threatening condition called toxic megacolon, which is a severe inflammation of the colon that can cause it to expand, leading to a rupture.

Seniors who have been treated with antibiotics are at a higher risk of developing CDI. Antibiotics not only kill the harmful bacteria, but also the beneficial ones that keep the gut healthy and balanced. This provides an opportunity for C. diff to proliferate and cause an infection. Seniors in long-term care facilities may also be at higher risk due to the close proximity of individuals and the potential for environmental contamination.

Watery Diarrhea

Watery diarrhea, common in gastrointestinal infections like C. diff, results from excessive water in the stool. Seniors experiencing this should promptly seek medical help due to the risk of severe dehydration and electrolyte imbalance, which is especially hazardous given potential existing health issues or medications that alter body fluid balance. This symptom could also indicate a severe C. diff infection, leading to acute abdominal pain, nausea, fever, and possibly toxic megacolon, a life-threatening condition.

Loss of Appetite

Clostridioides difficile infection can cause discomfort, pain, and nausea, making it difficult for seniors to eat. For seniors, loss of appetite can lead to unintended weight loss and malnutrition, which can have serious consequences for their health and well-being. Malnutrition can weaken the immune system, impair cognitive function, and increase the risk of falls and fractures. 

Nausea/Vomiting/Abdominal Pain/Distention

Nausea, vomiting, abdominal pain, and distention can be extremely uncomfortable for anyone, but they can be particularly concerning for seniors. These symptoms can be caused by a variety of factors, including gastrointestinal issues, infections, and even certain medications.

Fever/Chills/Dehydration

Fever, chills, and dehydration are common symptoms that often occur together and can be a sign of an underlying health issue. These symptoms can sometimes be mild and resolve on their own, but in some cases, they can be severe and require medical attention.

Fever is a common symptom of many illnesses, including infections caused by bacteria, viruses, and other pathogens. A fever is defined as a body temperature that is higher than normal, typically above 100.4 degrees Fahrenheit. Fevers can cause chills, which are sensations of coldness, sometimes accompanied by shivering and goosebumps.

Severe Disease Manifestations

Severe diseases can stem from infections like Clostridioides difficile (C. diff), causing severe symptoms such as toxic megacolon, watery diarrhea, and appetite loss. C. diff often proliferates due to antibiotic treatment, disrupting gut bacteria balance and causing Clostridioides difficile-associated disease (CDAD), which recurrently affects vulnerable long-term care populations.

CDAD is typically treated with fecal microbiota transplantation (FMT) from healthy donors, reducing recurrence and improving clinical outcomes. However, the effectiveness and safety of FMT require further research. Additional measures include antimicrobial stewardship programs, improved hygiene, environmental cleaning, and gastric acid suppression therapy.

Risk Factors for Clostridioides difficile

Several risk factors contribute to CDIs, including residence in long-term care facilities or hospitals due to increased antibiotic exposure and environmental contamination. Gastrointestinal surgery and failure of healthcare workers to follow appropriate preventive measures can further spread C. diff.

Underlying health conditions in seniors, like inflammatory bowel disease, gastric acid suppression, or history of gastrointestinal surgery, create a gut environment conducive to C. diff, enhancing infection chances.

Preventing and managing C. diff is challenging in seniors, especially in healthcare settings, due to the bacterium’s rapid spread and the higher vulnerability of patients in these locations.

Senior citizens are particularly susceptible to C. diff infections due to several factors:

1. Antibiotic exposure: The use of broad-spectrum antibiotics, which disrupt the gut microbiome, is a major risk factor for C. diff infections. Senior citizens often require antibiotics for various health conditions, making them more vulnerable to C. diff colonization and infection.
2. Comorbidities and weakened immune system: Aging is often accompanied by comorbidities and a weakened immune system, making older adults more susceptible to infections. Chronic diseases, such as diabetes, kidney disease, and cancer, along with immunosenescence (age-related decline in immune function), increase the likelihood of C. diff infection.
3. Prolonged hospitalization and healthcare settings: Senior citizens frequently require hospitalization or reside in long-term care facilities, where C. diff is prevalent. These settings facilitate the transmission of C. diff due to close contact, increased antibiotic usage, and the potential for contaminated surfaces.

Age-related risk factors

Primary risk factors for C. diff in seniors include antibiotic use, which disrupts gut flora by eliminating both harmful and beneficial bacteria, making seniors, often on multiple medications, more susceptible to C. diff. Age-related risk factors include conditions affecting the digestive system, such as inflammatory bowel disease, gastric acid suppression, gastrointestinal surgery history, and immune system changes that make seniors more prone to infections.

Long-Term Care Facility Stay

Long-term care facilities, harboring a high concentration of vulnerable individuals, often exhibit higher prevalence of C. diff infections compared to other healthcare settings.

Reducing these risks requires preventative measures such as stringent environmental cleaning, good hand hygiene, and antimicrobial stewardship programs. Regularly cleaning frequently-touched surfaces with appropriate disinfectants is crucial. Staff and visitors must practice hand hygiene, including frequent hand washing and use of alcohol-based hand rubs.

Antimicrobial stewardship programs ensure judicious antibiotic prescription, reducing their misuse and thus the risk of C. diff infections.

Preventing Clostridioides difficile Infections

Another way to prevent CDIs is to eat a balanced diet that is rich in fiber and promotes the growth of healthy bacteria in the gut. Seniors should focus on consuming fruits, vegetables, whole grains, and lean proteins to support gut health. In addition, limiting the intake of processed foods and saturated fats can help reduce inflammation and promote a healthy gut microbiome.

Regular exercise is also beneficial for maintaining gut health. Exercise can reduce inflammation and improve gut motility, which helps move food through the digestive system and can prevent the buildup of harmful bacteria.

Treatment for Clostridioides difficile

When it comes to treating CDIs, there are a few different options that healthcare providers may consider. The most common treatment for CDIs is antibiotics, which are effective at killing the harmful bacteria causing the infection. However, they also kill off the beneficial bacteria in the gut, which can lead to recurrent infections.

To address this issue, fecal microbiota transplantation (FMT) has become an increasingly popular treatment option. FMT involves transplanting bacteria from the stool of a healthy donor into the gut of the patient. This helps to restore the balance of the gut microbiome and can be a highly effective treatment for recurrent CDIs.

In addition to FMT treatments, patients with CDIs should receive supportive care to manage their symptoms. This may include rehydration therapy for diarrhea and electrolyte imbalances, as well as nutritional support to help the gut microbiome recover.

Ultimately, the choice of treatment for CDIs will depend on the severity of the infection, the patient’s medical history, and other factors. Healthcare providers will work with patients to determine the most appropriate treatment plan to effectively manage the infection and prevent recurrence.

Conclusion

The aging process impacts gut health, making senior citizens more susceptible to C. diff infections. The decline in microbial diversity, alterations in bacterial composition, and weakened intestinal barrier contribute to this vulnerability. Understanding these factors is crucial for developing preventive strategies, such as antibiotic stewardship, probiotic/prebiotic interventions, hygiene practices, and immunization. By addressing the specific needs of the elderly population, we can mitigate the burden of CDIs and improve the overall health and well-being of senior citizens.