ABSTRACT
Infectious diseases are a leading cause of morbidity and mortality in the frail nursing home population and are also a leading cause of transfer from a long-term care facility (LTCF) to an acute care facility. Higher morbidity and mortality rates in older patients result in part because of diminished physiologic reserves and altered host defenses brought on by aging and comorbidities. This problem is magnified in the long-term care setting population because of debility due to chronic disease. Elderly patients in long-term care institutions are typically prescribed multiple medications, which coupled with changes in pharmacology of drugs, including antibiotics, increase the risk for adverse drug interactions. As mentioned above, nursing home residents with infections are frequently transferred to acute care hospitals, and their hospitalization may be complicated by nosocomial infection and iatrogenic illness. In recent years, colonization and infection by antimicrobial-resistant pathogens and antibiotic-associated infections, such as Clostridium difficile, occur commonly both in the acute care hospital and in LTCFs. Once hospitalized, the elderly are more likely to undergo invasive procedures and are more likely to suffer complications from a given procedure. Only prevention and control of infectious diseases, including addressing the problem of antibiotic resistance as well as rapid diagnosis and the timely initiation of appropriate empiric antimicrobial therapy, will reduce the impact of infectious diseases on the long-term care population. Unfortunately, atypical presentation and variability of diagnostic testing and other factors may lead to increased morbidity and mortality from infection by causing delays in diagnosis and therapy in a population that can least afford diagnostic and treatment delays.
