Annals of Long Term Care

Septic Arthritis in Patients Aged 80 and Older: A Comparison with Younger Adults
Florence Gavet, MD, Anne Tournadre, MD, Martin Soubrier, MD, Jean Michel Ristori, PhD, and Jean Jacques Dubost, MD

Objectives: To compare the frequency and characteristics of septic arthritis in patients younger than 80 and aged 80 and older.

Design: Retrospective.

Setting: Single hospital center.

Participants: Patients admitted between 1979 and 2002 for septic arthritis.

Measurements: Age, sex, time to diagnosis, predisposing factors, joint, temperature, white blood cell count, microorganism, and short-term outcome.

Results: Of 335 patients, 206 (61.4%) were aged 60 and older, and 42 (12.5%) were 80 and older. The latter had an average age of 84 (range 80–97) and were mainly women (72%). Eighteen of the 42 had at least one risk factor. The mean time to diagnosis was 21 days (range 1 day to 3 months). Twenty patients (47%) had knee involvement, six (14%) shoulder involvement, ten (23.8%) a prosthetic infection, and five (12%) polyarticular infection. Ten (23%) were afebrile. In half of the cases, there was no increase in white blood cell count. The microorganisms isolated were Staphylococcus aureus (n=16, 38%), coagulase negative staphylococci (n=8, 19%), streptococci (n=12, 28%), and gram-negative bacilli (n=6, 14%). The mortality rate increased with age: 0.7% of patients younger than 60, 4.8% of those aged 60 to 79, and 9.5% of those aged 80 and older.

Conclusion: Advanced age is a risk factor for septic arthritis and poor outcome. J Am Geriatr Soc 2005;53(7):1210-1213.

Atypical Antipsychotic Medications and Risk of Falls in Residents of Aged Care Facilities
Le T. T. Hien, BS, Robert G. Cumming, MB, BS, MPH, PhD, Ian D. Cameron, MB, BS, PhD, Jian S. Chen, MD, Stephen R. Lord, PhD, Lyn M. March, MB, BS, PhD, Jennifer Schwarz, RN, David G. Le Couteur, MB, BS, PhD, and Philip N. Sambrook, MD

Objectives: To determine whether use of atypical antipsychotics (olanzapine and risperidone) is associated with lower risk of falls than use of typical antipsychotics.

Design: Prospective cohort study with 1-month follow-up.

Setting: Residential aged care facilities in Sydney, Australia.

Participants: Two thousand five people aged 65 to 104 (mean age 86).

Measurements: Medication use at baseline was collected from medical records. Data on potential confounders were collected at interview and physical examination and from medical records. The outcome was accidental falls (one or more).
nResults: One thousand one hundred seven subjects (55%) used at least one type of psychotropic medication, with 289 (14%) using an antipsychotic. There were 82 olanzapine users, 38 risperidone users, and 181 users of typical antipsychotics. Eleven percent of subjects (n=226) had at least one fall during follow-up. After adjusting for a comprehensive range of falls risk factors, hazard ratios (HRs) for falls were 1.35 (95% confidence interval (CI)=0.87–2.09) for typical antipsychotics, 1.32 (95% CI=0.57–3.06) for risperidone, and 1.74 (95% CI=1.04–2.90) for olanzapine. Antidepressants were also associated with falls (adjusted HR=1.45, 95% CI=1.09–1.93).

Conclusion: Despite fewer extrapyramidal side effects, atypical antipsychotic medications are not associated with fewer falls than the older, more-established antipsychotics. J Am Geriatr Soc 2005;53(8):1290-1295.

Obesity in Nursing Homes: An Escalating Problem
Kate L. Lapane, PhD, and Linda Resnik, PhD, PT, OCS

Objectives: To estimate trends in the prevalence of obesity in nursing homes, to characterize the obese nursing home population, and to evaluate the extent to which estimates of the prevalence of obesity varied by facility and geographic location.