Interaction of Clostridioides difficile infection with frailty and cognition in the elderly: a narrative review

Abstract

Purpose Clostridioides difcile infection (CDI) is the leading cause of antibiotic-related diarrhea and healthcare-associ‑ ated infections, afecting in particular elderly patients and their global health. This review updates the understanding of this infection, with focus on cognitive impairment and frailty as both risk factors and consequence of CDI, summa‑ rizing recent knowledge and potential mechanisms to this interplay. Methods A literature search was conducted including terms that would incorporate cognitive and functional impair‑ ment, aging, quality of life, morbidity and mortality with CDI, microbiome and the gut–brain axis. Results Advanced age remains a critical risk for severe disease, recurrence, and mortality in CDI. Observational and quality of life studies show evidence of functional loss in older people after acute CDI. In turn, frailty and cogni‑ tive impairment are independent predictors of death following CDI. CDI has long-term impact in the elderly, leading to increased risk of readmissions and mortality even months after the acute event. Immune senescence and the aging microbiota are key in susceptibility to CDI, with factors including infammation and exposure to luminal microbial products playing a role in the gut–brain axis. Conclusions Frailty and poor health status are risk factors for CDI in the elderly. CDI afects quality of life, cogni‑ tion and functionality, contributing to a decline in patient health over time and leading to early and late mortality. Narrative synthesis of the evidence suggests a framework for viewing the cycle of functional and cognitive decline in the elderly with CDI, impacting the gut–brain and gut–muscle axes.