The short answer
- Some signs mean 999 or A&E straight awayBreathing very fast, new confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, a rash that does not fade when pressed, or any worry that it could be sepsis.
- A normal temperature does not rule it outThe NHS says a high temperature is less common in older adults. NICE tells clinicians that older or very frail people may not develop one.
- Ask the question out loudThe UK Sepsis Trust asks families to say "Could it be sepsis?" to the call handler, the paramedic or the doctor.
- Knowing what is normal for them helps the clinicianNICE asks clinicians to pay particular attention to the family, for example when they describe a change from the person's usual behaviour.
General information from the NHS, NICE and the UK Sepsis Trust, not medical advice. If you are worried about somebody now, ring 999 rather than reading on.
What sepsis is
Sepsis is the body reacting badly to an infection
An infection usually stays where it started: in the chest, the bladder or a cut. Sepsis is what happens when the body's response to that infection starts to harm the body itself.
The NHS page on sepsis explains that the exact cause is not known, and that the immune system is thought to overreact to an infection and start to damage the body's organs. Any type of infection can lead to it. Bacterial infections are the most common cause, and the NHS names chest infections (pneumonia), urinary tract infections, abdominal infections and skin infections, including infected wounds. Sepsis usually develops quickly, over a few hours, and it is treated in hospital, which is why the signs below matter more than the name.
Anyone can get sepsis. The NHS and NICE name the people for whom the chance is higher, or for whom it is more easily missed.
Being 75 or over, or frail
NHS and NICE
Dementia, or difficulty communicating
NHS and NICE
A catheter
NHS and NICE
A wound, a cut, a burn or a skin infection
NHS and NICE
An operation in the last six weeks
NICE
A weakened immune system
NHS and NICE
A chest or urine infection is not on these lists as a risk factor in itself, because it is the infection that sepsis grows from. That is why an older person who already has one, and is on antibiotics, still needs watching. If your relative is having treatment for cancer, care at home during cancer treatment explains why a temperature or feeling unwell is treated as an emergency. The wider guides in health conditions at home cover other illnesses that sit alongside these risks.
The signs
The signs that mean ring 999, and the ones that mean ring 111
These lists are set out as the NHS sets them out for an adult, in its own words. Keep this page, or the NHS page, somewhere you can find it quickly.
Sepsis in an adult: what to look for, and who to ring
Call 999 or go to A&E if an adult:
- is breathing very fast
- is confused, has slurred speech, or is not making sense
- has blue, pale or blotchy skin (on black or brown skin, this may be easier to see on the palms of the hands or soles of the feet)
- has a very high or very low temperature, feels hot or cold to the touch, or is shivery
- has a rash that does not fade when you press it
- has symptoms you are worried might be sepsis
The NHS adds: do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance, and bring any medicines the person takes.
Common symptoms of sepsis in adults include:
- confusion or slurred speech
- uncontrollable shivering
- muscle pain
- difficulty breathing
- blue, pale, grey or blotchy skin, lips or tongue
- a high or low temperature (a high temperature is less common in older adults)
- not peeing all day or peeing very little in the past 18 hours
A person with sepsis might not have every symptom. The NHS says to get medical help immediately if you think somebody might have sepsis, and a worry that it could be sepsis is itself on the 999 list above.
Ring NHS 111 or the GP surgery if:
- you are worried about an infection, and none of the signs in the red panel is there
- the person has had sepsis in the past 12 months and has symptoms of an infection, such as a very high temperature, or feeling hot, cold or shivery
If any sign in the red panel appears while you are waiting for a call back, ring 999 instead of waiting.
The first two panels quote the NHS sepsis page for adults. The first line of the third is the UK Sepsis Trust’s advice for a suspected infection, and the second is the NHS advice for anybody who has had sepsis in the last year.
Sudden confusion in an older person covers delirium, the confusion that comes on over hours or days, and its causes. Confusion together with any of the other signs on this board is a reason for 999.
In an older person
Confusion or a change in behaviour can be the first sign
Families expect an infection to bring a fever. In an older person it often does not, and the NICE guideline for clinicians spells out what shows instead.
| What you might expect | What NICE tells clinicians to take into account | |
|---|---|---|
| Temperature | A high temperature | People who are older or very frail may not develop a raised temperature. Fever, or a low temperature, is not to be relied on alone. |
| Thinking | Obvious confusion | Changes can be subtle, and in older people may show as a sudden change in what they can do for themselves. |
| Dementia | The dementia getting worse | In people with dementia, a change may show as a change in behaviour or irritability. |
| Heart rate | A racing pulse | Older people with an infection may not develop a raised heart rate. |
| Feeling ill | A clear complaint of pain | People with sepsis may simply feel very unwell, with nothing pointing to one place. |
Temperature
- What you might expect
- A high temperature
- What NICE tells clinicians to take into account
- People who are older or very frail may not develop a raised temperature. Fever, or a low temperature, is not to be relied on alone.
Thinking
- What you might expect
- Obvious confusion
- What NICE tells clinicians to take into account
- Changes can be subtle, and in older people may show as a sudden change in what they can do for themselves.
Dementia
- What you might expect
- The dementia getting worse
- What NICE tells clinicians to take into account
- In people with dementia, a change may show as a change in behaviour or irritability.
Heart rate
- What you might expect
- A racing pulse
- What NICE tells clinicians to take into account
- Older people with an infection may not develop a raised heart rate.
Feeling ill
- What you might expect
- A clear complaint of pain
- What NICE tells clinicians to take into account
- People with sepsis may simply feel very unwell, with nothing pointing to one place.
From NICE guideline NG253, suspected sepsis in people aged 16 or over, published November 2025. It replaced NG51, which was last updated in March 2024.
So the first thing you notice may be small: a mother who dresses herself every day and this morning cannot, or a husband with dementia who is suddenly short-tempered. NICE guideline NG253 asks clinicians to interpret a person's mental state against their normal function, and to treat changes as significant. Only the people who know that normal can tell them what it is. If your relative has dementia, dementia care at home covers the wider picture.
What to say
What to say when you ring, and what to have ready
The person on the phone cannot see your relative. What you tell them in the first minute decides how quickly help comes.
- 1
Ring 999 if any of the red signs are there
NowSay what you can see: breathing very fast, not making sense, blotchy skin. Do not drive them to A&E yourself; the NHS advice is to ask someone else to drive or call 999 for an ambulance. - 2
Ask "Could it be sepsis?"
First minuteThe UK Sepsis Trust asks the public to put this question to the call handler, the paramedic and the doctor. NICE tells clinicians to think "could this be sepsis?" when somebody has signs of an infection. - 3
Say what has changed, and when
NextDescribe the person as they normally are and how they are now: "She was talking normally at lunchtime and now she does not know me." Say if they have dementia, and then say what is new. - 4
Have the answers NICE asks for
While you waitHow often they have passed urine in the last 18 hours. Any recent fever or shivering fits. Whether they have seen a GP or been to hospital recently with an infection. Any catheter, wound or recent operation, and any antibiotics already started. - 5
Take their medicines with them
Before you leaveThe NHS asks you to bring any medicines the person takes. Take the boxes and the repeat prescription.
Day to day at home
What a family or a carer at home can watch for
None of this is clinical work. It is about noticing change early, and the people best placed to do that are those who see your relative every day.
What helps
- Knowing how they are on a good day: how they talk, walk, eat and how often they go to the toilet
- Writing down any change, with the date and time, so you can describe it on the phone
- Looking at a wound when the dressing is changed, and telling the nurse or GP if it looks worse or hurts more
- Checking a catheter bag is filling as usual, because peeing very little is one of the NHS symptoms
- Mentioning a cough, a urine infection or a course of antibiotics to anyone new who helps
- Acting on a feeling that something is wrong, even when you cannot name it
What to avoid
- Waiting for a high temperature before you ring
- Putting a sudden change down to age, tiredness or the dementia without asking
- Driving somebody with red signs to A&E yourself
- Waiting until the morning because you do not want to bother anyone
A written note turns "she has not been herself" into "she has eaten nothing since Tuesday and has not been to the toilet since breakfast". Keeping a care diary explains what to note and how to share it between the people who help. For a healing wound, wound care at home covers what a normal wound looks like, and catheter and stoma care at home covers the daily care of a catheter. Preventing infections at home covers hand washing and everyday habits.
After an infection or an operation, some families want somebody to see their parent every day while they recover, because a daily visitor notices on Wednesday what a weekly one would not see until Sunday. If that is what you need, search for carers near you and compare their rates and the hours they cover. Hourly care after a hospital stay covers the first weeks home.
PrimeCarers is an introductory service rather than an agency, and the carers are self-employed. Before a profile appears, every carer has an identity check, a right to work check, an enhanced DBS on the Update Service and an online interview, and every visit booked through PrimeCarers is insured, by the carer's own policy or by cover we arrange where they do not hold one. A carer is not a nurse, and we do not check training or qualifications, so any experience a carer describes is their own account for you to ask about. What a carer who visits every day brings is the same thing a family brings: they know what normal looks like, and they notice when it changes.
Questions
Questions families ask about sepsis
Yes. The NHS lists a high or low temperature among the symptoms and notes that a high temperature is less common in older adults. NICE tells clinicians not to rely on a fever or a low temperature alone to rule sepsis in or out, and that people who are older or very frail may not develop a raised temperature.
Ring 999, or go to A&E, if an adult is breathing very fast, is confused, has slurred speech or is not making sense, has blue, pale or blotchy skin, has a very high or very low temperature or is shivery, has a rash that does not fade when pressed, or has symptoms you are worried might be sepsis. The UK Sepsis Trust suggests 111 or the GP if you are worried about an infection without those signs.
You may not be able to, and you do not have to. NICE says a change in thinking can show as a change in behaviour or irritability in people with dementia, and asks clinicians to treat changes from the person's normal as significant. Describe what is different today, and ask whether it could be sepsis. Sudden confusion in an older person covers the difference between delirium and dementia.
It can. The NHS lists urinary tract infections among the most common causes, along with chest, abdominal and skin infections. An older person being treated for one still needs watching for the signs on this page, and the GP should hear if they are getting worse rather than better.