Clinical applications of point-of-care ultrasound for infectious diseases in older adults.

Older adults with suspected infection pose diagnostic and therapeutic challenges due to immunosenescence, chronic low-grade inflammation that develops with advancing age (inflammaging), frailty, and frequent atypical presentations. Fever may be absent, focal signs are often subtle, and biomarkers lack specificity, leading to diagnostic uncertainty, delayed treatment, and frequent overuse of broad-spectrum antibiotics. Point-of-Care Ultrasound (POCUS) extends the physical examination at the bedside, enabling rapid integration of anatomical and functional data without exposing frail patients to unnecessary transfers or delays. This narrative review proposes a structured multi-organ POCUS protocol for elderly patients with suspected infection based on three pillars: (1) systematic identification of the infectious focus through a craniocaudal scan of lungs, pleura, hepatobiliary system, kidneys, spleen, peritoneal cavity, and heart; (2) haemodynamic assessment using an enhanced rapid ultrasound for shock and hypotension (RUSH) framework with dynamic parameters such as left ventricular outflow tract-velocity-time integral (LVOT-VTI) and venous congestion to guide individualised fluid resuscitation; and (3) ultrasound-guided source control. The Focused INfection Diagnosis-POCUS (FIND-POCUS) algorithm provides a rapid, reproducible bedside strategy requiring prospective validation.