1
|
Murakami N, Kabayama M, Yano T, Nakamura C, Fukata Y, Morioka C, Fang W, Nako Y, Omichi Y, Koujiya E, Godai K, Kido M, Tseng W, Wada T, Nakamura T, Hirotani A, Fukuda T, Tamatani M, Okuda Y, Ikushima M, Baba Y, Nagano M, Nakamura Y, Rakugi H, Kamide K. Actual conditions for returning home after hospitalization among older patients receiving home medical care in Japan: OHCARE Study. Geriatr Gerontol Int 2024; 24 Suppl 1:320-326. [PMID: 38267253 DOI: 10.1111/ggi.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To examine the actual conditions of older patients receiving home medical care after hospitalization over a period of 2 years in Japan. METHODS The study population included 102 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan over a period of 2 years. We investigated the actual conditions for returning home after hospitalization. RESULTS The median age of the 102 participants was 84 years, and 61 (59.8%) were women. In the group that returned home, 42 (55.3%) of the respondents desired to recuperate in a familiar place, as in advanced care planning (ACP). During the 2-year follow-up period, the group that did not return home had significantly more deaths. A multivariate analysis showed the association in the presence of ACP (odds ratio: 4.72, 95% confidence interval: 1.60-13.86) and cardiac disease (odds ratio: 0.25, 95% confidence interval: 0.08-0.76). The lack of ACP in the medical records when the patient was admitted to the hospital may have prevented the return home. CONCLUSION In older patients who had difficulty returning home after hospitalization, the lack of ACP in home medical care may have been an influencing factor. ACP could help continue with home medical care. Geriatr Gerontol Int 2024; 24: 320-326.
Collapse
Affiliation(s)
- Naoko Murakami
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Mai Kabayama
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tomoko Yano
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chika Nakamura
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuka Fukata
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chihiro Morioka
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Wen Fang
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yumiko Nako
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuki Omichi
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Eriko Koujiya
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Kayo Godai
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Michiko Kido
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Winston Tseng
- School of Public Health, University of California, Berkeley, California, USA
| | - Taizo Wada
- Osaka Home Medical Care Clinic, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
- Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Osaka, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
2
|
Mésinèle L, Pujol T, Brunetti N, Neiss M, Trivalle C, Souques C, Houenou-Quenum N, Verdier S, Simon P, Vetillard AL, Houdre J, Collarino R, Mary M, Vidal JS, Kahn JE, Guichardon M, Duron E, Baudouin E. Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults. BMC Geriatr 2023; 23:852. [PMID: 38093181 PMCID: PMC10720062 DOI: 10.1186/s12877-023-04581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The incidence of sepsis increases significantly with age, including a high incidence of bacterial infection in the old adults. Eosinopenia and the CIBLE score have been proposed in critically ill adults and in internal medicine wards. This study aimed to assess whether a low eosinophil count was associated with acute bacterial infection among hospitalized older adults, and to find the most efficient eosinophil count cut-off to differentiate acute bacterial infection from other inflammatory states. METHODS This was a prospective study from July 2020 to July 2022 in geriatric wards of the University Paul Brousse Hospital (Villejuif, France) including patients aged of 75 y/o or over suffering from fever or biological inflammation. Acute bacterial infection was assessed using biological identification and/or clinical and radiological data. RESULTS A total of 156 patients were included. Eighty-two (53%) patients suffered from acute bacterial infection (mean age (SD) 88.7 (5.9)). Low eosinophil count was independently associated with acute bacterial infection: OR [CI95%] 3.03 [1.04-9.37] and 6.08 [2.42-16.5] for eosinophil count 0-0.07 G/L and 0.07-0.172 G/L respectively (vs. eosinophil count > 0.172 G/L). Specificity and sensitivity for eosinophil count < 0.01 G/L and CIBLE score were 84%-49% and 72%-62%, respectively with equivalent AUCs (0.66 and 0.67). CONCLUSION Eosinophil count < 0.01 G/L is a simple, routinely used and inexpensive tool which can easily participate in antibiotic decisions for older adults. Further studies are needed to assess clinical benefits. TRIAL REGISTRATION The study was registered at Clinical trial.gov (NCT04363138-23/04/2020).
Collapse
Affiliation(s)
- Léa Mésinèle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Tom Pujol
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nicoletta Brunetti
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Marie Neiss
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Christophe Trivalle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Cecile Souques
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nadège Houenou-Quenum
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Sébastien Verdier
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Pauline Simon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Anne-Laure Vetillard
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Julie Houdre
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Rocco Collarino
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Morgane Mary
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Jean-Sébastien Vidal
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France
- Université Paris Descartes, INSERM, Paris, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, APHP, Ambroise Paré Hospital, Université de Versailles-Saint- Quentin en Yvelines, Yvelines, France
| | - Magali Guichardon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Emmanuelle Duron
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France
| | - Edouard Baudouin
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France.
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France.
| |
Collapse
|
3
|
How Are Older Adults Different Than Other Adults for Infections? INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
4
|
Sun Y, Ren G, Ren J, Shan W, Han X, Lian Y, Wang T, Wang Q. The Association Between Age and Prognosis in Patients Under 45 Years of Age With Anti-NMDA Receptor Encephalitis. Front Neurol 2021; 11:612632. [PMID: 33447251 PMCID: PMC7802749 DOI: 10.3389/fneur.2020.612632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
This study aims to evaluate the association between age and prognosis in patients with anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) under the age of 45 years. A retrospective study was conducted in patients younger than 45 years diagnosed as anti-NMDARE in four hospitals in China. Age at admission was divided into four categories: <15, 15–24, 25–34, 35–45 years. Neurological prognosis was evaluated using modified Rankin Scale. Adjusted multivariable logistic regression was used to analyze the association. The multivariable-adjusted odds ratios (95% confidence interval) of prognosis in anti-NMDARE across the categories of age were as follows: in males, 1.00 (reference), 4.76 (0.39–58.76), 13.50 (0.79–230.40), and 8.81 (0.36–218.39) (P for trend = 0.171); in females, 1.00 (reference), 7.27 (0.36–146.19), 20.08 (1.09–370.39), and 54.41 (1.60–1,849.10) (P for trend = 0.01). We concluded that the increasing age was associated with a poorer prognosis of anti-NMDARE in females but not males.
Collapse
Affiliation(s)
- Yueqian Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guoping Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Shan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tiancheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
5
|
Hansen MA, Samannodi MS, Castelblanco RL, Hasbun R. Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults. Clin Infect Dis 2021; 70:2377-2385. [PMID: 31294449 DOI: 10.1093/cid/ciz635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Encephalitis is associated with significant morbidity and mortality, with unknown etiologies in the majority of patients. Large prognostic studies evaluating elderly patients are currently lacking. METHODS We performed a retrospective cohort of encephalitis cases in 19 hospitals from New Orleans, Louisiana, and Houston, Texas, between the years 2000 and 2017. RESULTS A total of 340 adult (aged ≥17 years) patients with confirmed encephalitis were enrolled, and 194 (57%) had unknown etiologies. A cerebrospinal fluid polymerase chain reaction (PCR) for herpes simplex virus (HSV) and varicella zoster virus was done in 237 (69%) and 82 (24%) patients, respectively. Furthermore, an arboviral serology was done in 169 (49%) patients and measurements of anti-N-methyl-D-aspartate receptor antibodies were taken in 49 (14%) patients. A total of 172 out of 323 patients (53%) had adverse clinical outcomes (ACOs) at discharge. Older individuals (>65 years of age) had a lower prevalence of human immunodeficiency virus, had a higher number of comorbidities, were less likely to receive adjuvant steroids, were more likely to have a positive arbovirus serology, were more likely to have a positive HSV PCR, were more likely to have abnormal computerized tomography findings, and were more likely to have to have an ACO (all P values < .05). Prognostic factors independently associated with an ACO were age ≥65, fever, Glasgow Coma Scale (GCS) score <13, and seizures (all P values ≤0.01). CONCLUSIONS Encephalitis in adults remain with unknown etiologies and adverse clinical outcomes in the majority of patients. Independent prognostic factors include age ≥65 years, fever, GCS score <13, and seizures.
Collapse
Affiliation(s)
- Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Mohammed S Samannodi
- Department of Internal Medicine, University of Texas Health McGovern Medical School, Houston, Texas
| | | | - Rodrigo Hasbun
- Department of Internal Medicine, University of Texas Health McGovern Medical School, Houston, Texas
| |
Collapse
|
6
|
Fu CJ, Mantell E, Stone PW, Agarwal M. Characteristics of nursing homes with comprehensive antibiotic stewardship programs: Results of a national survey. Am J Infect Control 2020; 48:13-18. [PMID: 31447117 PMCID: PMC6935405 DOI: 10.1016/j.ajic.2019.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Antibiotic stewardship in nursing homes (NHs) is a high priority owing to intense antibiotic use and increased risk of adverse events. Updated Centers for Medicare and Medicaid Services regulations required NHs to establish antibiotic stewardship programs (ASPs). This study describes the current state of NH ASPs. METHODS A nationally representative survey of NHs was conducted in 2018. ASP comprehensiveness, infection preventionist (IP) training, participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) activities, and facility and staff characteristics were analyzed using weighted descriptive statistics and multinomial regression models. RESULTS Of 861 NHs, 33.2% (6-7) had "comprehensive" ASP policies, 41.1% (4-5) had "moderately comprehensive" ASP policies, and 25.6% (≤ 3) had "not comprehensive" ASP policies. Data collection on antibiotic use was most reported (91.4%), and restricting use of specific antibiotics was least reported (19.0%). Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy. DISCUSSION Immediately following Centers for Medicare and Medicaid Services regulation changes, a majority of NHs had moderately comprehensive or comprehensive ASPs. Rates for each policy and infection control-trained IPs increased from previous studies. CONCLUSIONS NH ASPs are becoming more comprehensive. Infection control training and partnerships with QIN-QIOs can support NHs to increase ASP comprehensiveness.
Collapse
Affiliation(s)
| | | | | | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY.
| |
Collapse
|
7
|
Park SY, Oh WS, Kim YS, Yeom JS, Choi HK, Kwak YG, Jun JB, Chung JW, Rhee JY, Kim BN. Health care–associated acute pyelonephritis is associated with inappropriate empiric antibiotic therapy in the ED. Am J Emerg Med 2016; 34:1415-20. [DOI: 10.1016/j.ajem.2016.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/05/2016] [Accepted: 04/08/2016] [Indexed: 11/16/2022] Open
|
8
|
Kang SJ, Jung SI, Wi Y, Jang M, Jang HC, Park KH, Chung D, Peck K, Song JH. Clinical characteristics and outcomes of community-onset acute pyelonephritis caused by Escherichia coli in elderly patients. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2013.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Lee CC, Hsu HC, Chang CM, Hong MY, Ko WC. Atypical presentations of dengue disease in the elderly visiting the ED. Am J Emerg Med 2013; 31:783-7. [PMID: 23399333 DOI: 10.1016/j.ajem.2013.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/12/2013] [Accepted: 01/13/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective was to compare the clinical characteristics of elderly and young adult patients with dengue in the emergency department (ED). METHODS Demographic characteristics, clinical presentation, disease severity, laboratory characteristics, and outcomes were analyzed prospectively as a case-control study. RESULTS Of the 193 adults with serologically confirmed dengue disease in 2007, 31 (16.1%) were elderly patients (aged ≥65) and 162 were young adults (aged <65). More dengue hemorrhagic fever (12.9% vs 2.5%, P = .02), a longer ED stay (13.3 vs 8.6 hours, P = .004), a longer hospital stay (7.4 vs 3.4 days, P < .001), a higher Simplified Acute Physiology Score II in the ED (29.7 vs 17.4, P < .001), and a higher rate of at least 1 comorbidity (61.8 vs 22.8%, P < .001) were found in the elderly. However, the length of the intensive care unit stay (elderly 0.7 vs young adults 0.3 day, P = .47) and the 14-day mortality rate (0% vs 0.6%, P = 1.00) were similar. Of note, in terms of clinical presentations of dengue in the ED, there were more elderly patients with isolated fever (41.9% vs 17.9%, P = .003) and fewer with typical presentation (41.9% vs 75.9%, P = <.001) than there were young adults. CONCLUSIONS The present study found a higher number of atypical presentations, a longer hospitalization, and a higher degree of clinical illness in elderly patients with dengue.
Collapse
Affiliation(s)
- Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | | | | | | | | |
Collapse
|
10
|
Gudiol F. Uso prudente de antibióticos y propuestas de mejora en los centros sociosanitarios. Enferm Infecc Microbiol Clin 2010; 28 Suppl 4:32-5. [DOI: 10.1016/s0213-005x(10)70040-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Francesc Gudiol
- Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Universidad de Barcelona, Barcelona, España.
| |
Collapse
|
11
|
Abstract
Approximately 70% of health care associated pathogens are resistant to one or more antibiotics. Experts maintain that most antimicrobial-resistant pathogens develop from antibiotic overuse and inappropriate antibiotic selection or treatment duration. Up to 70% of long-term care residents receive at least one course of an antimicrobial agent during a one-year period. Four types of infections occur most often among long-term care residents: urinary tract, respiratory tract, skin and soft tissue, and gastrointestinal tract, and outbreaks are common. Diagnostic uncertainty, failure to recognize fever's clinical manifestation in the elderly, treatment of asymptomatic bacteriuria, and bacterial colonization contribute to antibiotic overuse. Recent infection control guidelines recommend more targeted antibiotic utilization review. Recommendations are presented for implementing antibiotic utilization programs. Hand washing and other measures, such as droplet precautions, are discussed. Economic disincentives surrounding antimicrobial research are highlighted.
Collapse
Affiliation(s)
- Jeannette Y Wick
- National Cancer Institute, National Institutes of Health, Bethhesda, MD 20892, USA
| |
Collapse
|
12
|
Moore SM, Duffy E. Maintaining Vigilance to Promote Best Outcomes for Hospitalized Elders. Crit Care Nurs Clin North Am 2007; 19:313-9, vi-vii. [PMID: 17697952 DOI: 10.1016/j.ccell.2007.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents contemporary evidence regarding the promotion of a culture of caring for hospitalized older persons through nursing vigilance. A summary of the literature regarding the need for vigilance, what to be vigilant about, and how vigilance can be enhanced for hospitalized older persons is provided, as well as recommendations for practice, education, research, and policy. Evidence indicates that vigilance is enhanced by having nurses who have specialized knowledge to differentiate normal aging from abnormal pathology, and who use point-of-care information, electronic health records, patient care information systems, and computerized adverse events detection systems to monitor symptoms and outcomes and prevent errors. The use of specialized models of patient care and adequate nurse-patient staffing also have been shown to prevent errors and improve patient outcomes.
Collapse
Affiliation(s)
- Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | | |
Collapse
|
13
|
Geriatric Considerations in Restoration of Competence to Stand Trial: Two Cases of Impaired Cognition. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2007. [DOI: 10.1300/j158v07n02_06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
14
|
Abstract
As life expectancy continues to rise, the number of geriatric patients will increase and the percentages of geriatric patients seen in the emergency department will reflect those numbers. Emergency physicians are responsible for making immediate diagnoses and initiating expeditious treatment. Infectious diseases in the elderly are more prevalent, challenging to diagnose, and are associated with greater morbidity and mortality than with the younger patient population.
Collapse
Affiliation(s)
- Adeyinka Adedipe
- Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Dowling 1 South, Boston, MA 02188, USA
| | | |
Collapse
|
15
|
Abstract
Average life expectancy throughout developed countries has rapidly increased during the latter half of the 20th century and geriatric infectious diseases have become an increasingly important issue. Infections in the elderly are not only more frequent and more severe, but they also have distinct features with respect to clinical presentation, laboratory results, microbial epidemiology, treatment, and infection control. Reasons for increased susceptibility include epidemiological elements, immunosenescence, and malnutrition, as well as a large number of age-associated physiological and anatomical alterations. Moreover, ageing may be the cause of infection but infection can also be the cause of ageing. Mechanisms may include enhanced inflammation, pathogen-dependent tissue destruction, or accelerated cellular ageing through increased turnover. In most instances, treatment of infection leads to a satisfactory outcome in the elderly. However, in palliative care situations and in patients with terminal dementia, the decision whether or not to treat an infectious disease is becoming a difficult ethical issue.
Collapse
Affiliation(s)
- Gaëtan Gavazzi
- Department of Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | | |
Collapse
|
16
|
Abstract
BACKGROUND Infections are an important cause of morbidity and mortality in older people; however, they are often difficult to diagnose because the signs and symptoms of infection in older people are frequently atypical. Fever, one of the most important signs of infection, is a case in point. Preliminary evidence suggests that the febrile response in older persons is blunted, leading to the clinical maxim, "the older, the colder." The objective of this study was to assess the effect of age on the febrile response to moderate-to-severe pneumonia in hospitalized patients adjusted for the effect of anatomic site at which the temperature was measured. METHODS This is a retrospective cohort study of 320 hospitalized patients with moderate-to-severe pneumonia. The study was designed to assess the effect of age on the febrile response to moderate-to-severe pneumonia in hospitalized patients, adjusting for the effect of the anatomic location of the temperature measurement. The highest temperature of each day and the anatomic sites at which temperatures were taken (axillary, oral, rectal, or other) on days 1 and 2 of infection and at hospital discharge. Baseline demographic information, including age, were obtained for each patient. RESULTS There were 320 patients (median age, 64 years; range, 18-97 years). Using a linear regression model, significant inverse correlations were found between age and the temperature for patients on the first and second days of hospitalization (P < 0.001). For each decade increase in age, the average temperature on the first 3 days of infection was lower by 0.15 degrees C. Temperature at discharge, a surrogate for baseline temperature, also decreased at an equal rate with age. CONCLUSION In this study, the febrile response to infections was reduced with increasing age and baseline temperatures were generally lower in older patients.
Collapse
Affiliation(s)
- M C Roghmann
- VA Maryland Health Care System, Medical Care Clinical Center, Baltimore, Maryland 21201, USA.
| | | | | |
Collapse
|
17
|
Nicolle LE, Bentley DW, Garibaldi R, Neuhaus EG, Smith PW. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol 2000; 21:537-45. [PMID: 10968724 DOI: 10.1086/501798] [Citation(s) in RCA: 190] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and the virtual absence of relevant clinical trials. This position paper recommends approaches to management of common infections in LTCF patients and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the position paper acknowledges the unique aspects of provision of care in the LTCF.
Collapse
Affiliation(s)
- L E Nicolle
- Department of Medicine, Health Sciences Center, Winnipeg, Manitoba, Canada
| | | | | | | | | |
Collapse
|
18
|
Ernst ME, Ernst EJ. Effectively treating common infections in residents of long-term care facilities. Pharmacotherapy 1999; 19:1026-35. [PMID: 10610008 DOI: 10.1592/phco.19.13.1026.31595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinicians involved in caring for institutionalized elderly frequently must treat common infections endemic to the setting. Numerous factors specific to these patients make accurate diagnosis and management more difficult than in healthy ambulatory adults. Three infections are commonly encountered in residents of long-term care facilities: bacterial pneumonia, urinary tract infections, and skin and soft tissue infections. More antimicrobial agents are available now than ever before; therefore, judicious administration of drugs and familiarity with current treatment recommendations are imperative.
Collapse
Affiliation(s)
- M E Ernst
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Iowa, Iowa City 52242, USA
| | | |
Collapse
|
19
|
The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc 1998; 46:635-51. [PMID: 9588381 DOI: 10.1111/j.1532-5415.1998.tb01084.x] [Citation(s) in RCA: 311] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
|
21
|
Chaimowicz F. [Health of Brazilian elderly just before of the 21st century: current problems, forecasts and alternatives]. Rev Saude Publica 1997; 31:184-200. [PMID: 9497568 DOI: 10.1590/s0034-89101997000200014] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Current characteristics and perspectives of Brazilian demographic and epidemiological transition processes are analyzed. Results from the 1991, 1993, 1995 and 1996 censuses, new population projections and recent studies on socioeconomic and health profiles of elderly people of S. Paulo, Rio de Janeiro and Belo Horizonte are discussed. In 1995, estimated life expectancy at birth in Brazil was already over 67 years. The number of individuals aged 60 years and older--in 1995, 8.3%, of the total population--is expected to duplicate and probably stabilize by the year 2050. Yet lacking coverage and quality, health services are already burdened with degenerative diseases and mental disorders, frequent outpatient appointments, high hospital bed occupation and high costs. Functional impairment and self-reported diseases are related to poverty among the elderly. for whom social and health support are not properly provided. Support from informal caregivers becomes more difficult due to impoverishment, family size reduction and youth migration. Institutionalization remains a poor approach as scarcity of beds and inadequacy of staff preclude its utilization. To minimize the impact of population aging on health services, it is proposed that effective programs covering the control of degenerative diseases and the prevention of their complications should be implemented--for the elderly population too. The importance of physical exercise, screening for neoplastic diseases, immunization, prevention of fractures caused by falls and early diagnosis of depression and dementia is emphasized. Actions must be coordinated by primary health care units, oriented towards local needs. It is essential to maintain the elderly in adequate, productive activities, invest in young people's education and health and in social and medical support programs for the caregivers.
Collapse
Affiliation(s)
- F Chaimowicz
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
| |
Collapse
|
22
|
Nicolle LE, Bentley D, Garibaldi R, Neuhaus E, Smith P. Antimicrobial Use in Long-Term-Care Facilities. Infect Control Hosp Epidemiol 1996. [DOI: 10.2307/30141012] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
23
|
Abstract
This article summarizes the preoperative evaluation and postoperative care recommended for elderly patients undergoing urologic procedures. Most of the common issues faced during the perioperative period are discussed, but many other topics require reference to other sources or consultation with specialists. A thorough preoperative evaluation is needed, and meticulous attention to postoperative care is mandatory. The most important common problem is assessment of cardiovascular risk in patients and a general approach is suggested by the authors. Surgical risk in elderly patients is increased, but most of this excess risk is because of associated comorbid conditions. Effective pre- and postoperative assessment and care can minimize this risk and maximize the chances of a successful outcome.
Collapse
Affiliation(s)
- R Smith
- Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Reseda, California, USA
| | | | | |
Collapse
|
24
|
Nicolle LE, Strausbaugh LJ, Garibaldi RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996; 9:1-17. [PMID: 8665472 PMCID: PMC172878 DOI: 10.1128/cmr.9.1.1] [Citation(s) in RCA: 241] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed.
Collapse
Affiliation(s)
- L E Nicolle
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | | | | |
Collapse
|
25
|
Abstract
OBJECTIVE To summarize current information on the scope, epidemiology, clinical manifestations, diagnostic approach, and general management of infectious diseases in nursing home residents, as well as the specific treatment of common infections occurring in the nursing home setting. DESIGN Survey and literature review of the diagnostic and therapeutic problems of nursing home residents with infections. CONCLUSIONS Older persons residing in nursing homes as well as other types of long-term care facilities are at increased risk for infections. Moreover, infection is the most frequent reason for patients to be transferred from nursing homes to an acute-care facility. The most common infections that are acquired in nursing homes are urinary tract infection (cystitis pyelonephritis), respiratory infections (pneumonia, bronchitis), and skin/soft tissue infections (infected pressure ulcers, cellulitis). Most serious infections in this setting are caused by bacteria; however, influenza and other respiratory viruses as well as herpes zoster may cause significant morbidity in older nursing home residents. Mycobacterium tuberculosis infects nursing home residents at a higher rate than it infects older community dwellers. Infections in older nursing home residents may manifest clinically, with atypical symptoms and signs, including the absence of fever. Rapid diagnostic evaluation and early therapeutic intervention are essential for minimizing the high mortality and morbidity associated with infections in this older population; most nursing home residents with serious infections should be considered for hospitalization.
Collapse
Affiliation(s)
- T T Yoshikawa
- Department of Internal Medicine (MP-11), Charles R. Drew University of Medicine and Science, King-Drew Medical Center, Los Angeles, California 90059, USA
| | | |
Collapse
|
26
|
Abstract
As they age, women become increasingly susceptible to all infectious processes. Compounding increased susceptibility are the aging process and chronic and coexisting diseases that can mask or confound an infectious process. Infections in older women may present atypically, which hinders diagnosis and treatment. The presentation, treatment, and nursing care involved in treating elderly women with urinary tract infections and vulvovaginitis are discussed.
Collapse
Affiliation(s)
- P G Sale
- Department of Urology, McGuire Medical Group, Richmond, VA, USA
| |
Collapse
|
27
|
Abstract
Infections are common in elderly persons. The clinical manifestations of infection may be atypical or absent in the elderly. The microbial cause for many common infections may be more diverse in elderly patients, and obtaining diagnostic clinical specimens often is more difficult. Aging is associated with changes in pharmacokinetics and a higher rate of adverse drug reactions. These factors impact on the approach to treating infections in the elderly.
Collapse
Affiliation(s)
- T T Yoshikawa
- Office of Geriatrics and Extended Care, United States Department of Veterans Affairs, Washington, DC, USA
| | | |
Collapse
|
28
|
Nawas YN, Balk RA. General Approach to Shock. Clin Geriatr Med 1994. [DOI: 10.1016/s0749-0690(18)30366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|