Doctors lack reliable ways to diagnose infections in elderly patients, because standard tests often fail in people over 80. As the population ages, older adults face higher risks from invasive infections, antibiotic resistance, and vaccine failure, yet they are routinely excluded from the studies that design diagnostic tools. This project will test whether existing biomarkers—such as C-reactive protein and newer gene-signature tests—work accurately in older people, and if they do not, will search for new gene signatures optimised for this age group. The researcher will also map how ageing alters the body’s transcriptomic response to infection, identifying genes and biological pathways that could inform future vaccines or immunotherapies. If successful, the work could lead to diagnostic tests that reliably distinguish infection from other causes of illness in frail older patients, reducing unnecessary antibiotic use and improving treatment decisions. This is primarily fundamental science on age–host–pathogen interactions, but similar work on immune biomarkers has already changed how sepsis is diagnosed in younger adults—extending that knowledge to the oldest patients could have direct, practical consequences for clinical care.
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As our population ages, we face a growing burden of infectious diseases in the elderly. This group are particularly vulnerable to invasive infection, anti-microbial resistance and antibiotic-related side effects and less responsive to vaccination. Accurate diagnosis of infection in the elderly, to guide appropriate prescribing, is hampered by non-specific clinical presentations, comorbidities and inadequate diagnostics. Despite these challenges, the elderly are often overlooked in infectious diseases research. Focused studies are needed urgently. Biomarkers that measure components of the host immune response to infections are deployed in clinical practice but data on their utility in the elderly are limited. Novel gene and protein-based biomarkers are being translated into diagnostic tests and look promising, but they have been studied predominantly in younger adults. Immunological function changes with old age. Understanding the impact of older age on the performance of host-based diagnostics as well as the wider host response to infection are this project's aims. I will assess how older age affects the performance of biomarkers of infection, including in those aged >80 years. Commonly used preexisting biomarkers (e.g. C reactive protein) as well as published gene signature-based novel biomarkers will be included. If suboptimal performance is confirmed in the elderly, I will discover new gene signatures for infection, optimised for performance in this cohort. I will also investigate the impact of old age on transcriptomic responses to infectious diseases, aiming to identify genes and biological pathways of interest for future studies on age-host-pathogen interactions, with relevance for vaccine and immunotherapy development.
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