Residents of long-term care facilities are at increased risk of developing infectious diseases. Health care workers in long-term care facilities are a potential source of infection and are also at risk for contracting infections from residents of the facility. Physicians, physician assistants, nurse practitioners, and nurses are called upon to assist long-term care facilities with the development and implementation of policies pertaining to employee health and its impact on infection control. All employees should be screened for Mycobacterium tuberculosis. All employees should be offered vaccinations against hepatitis B and influenza. Each employee’s immunity status regarding varicella-zoster should be accessed by enquiring about past exposure and, if indicated, blood testing. If indicated, varicella-zoster immunization should be offered. Most long-term care employees should not be tested for HIV as part of their employment.(Annals of Long-Term Care: Clinical Care and Aging 2005;13[9]:

Urinary tract infections (UTIs) are the most common bacterial infections encountered among nursing home residents. The diagnosis and treatment of UTIs are often challenging in this patient population, as clinical manifestations are often atypical. With advancing age, the female/male ratio of UTI incidence narrows, approaching 2:1 in the elderly. In older adults with UTI, more types of urinary pathogens are often isolated compared to their younger counterparts. While Escherichia coli (E. coli) is the most frequently isolated pathogen from older adults with UTI, in elderly patients with recurrent UTIs, resistant gram-negative bacteria other than E. coliand gram-positive bacteria (eg, enterococci, coagulase-negative staphylo-cocci, and group B streptococci) are more frequently isolated. Ordering urine cultures should be avoided in the absence of symptoms, or if a decision was made not to treat. There is no consensus on the duration of antibiotic therapy for nursing home residents with UTI

Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease (CAD). Modifiable risk factors such as cessation of cigarette smoking and control of dyslipidemia, hypertension, and diabetes should be treated. Statins decrease the incidence of intermittent claudication and improve exercise duration, as well as reduce cardiovascular events and mortality in persons with PAD and hypercholesterolemia. Antiplatelet drugs and angiotensin-converting enzyme inhibitors should be administered to all persons with PAD. Beta-blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol improve exercise time until intermittent claudication. Indications for lower-extremity angioplasty or bypass surgery include incapacitating claudication, limb salvage in persons with limb-threatening ischemia, and impotence of vascular origin. Amputation should be performed if tissue loss ha

Our increasing elderly population suffers from very common age-related eye diseases and potential loss of vision. Part I of this two-part article examined the effect of age and disease on vision and overall vision function, as well as the symptoms and current effective treatments of cataracts and glaucoma, two of the most common disorders affecting the elderly. Part II will discuss macular degeneration and diabetic retinopathy, both common conditions for which effective sight-saving therapies are now available, dependent upon early and accurate diagnosis. Dry eye disease, also remarkably common but underappreciated and underdiagnosed, has substantial impact on vision and quality of life, and will also be reviewed in this section. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[9]:41-46)