Although urinary tract infection is considered the most common infection among elderly nursing home residents, a significant proportion of these residents actually have asymptomatic bacteriuria, which is very common among the nursing home elderly. Nursing home residents with culture-proven bacteria in their urine, but without specific symptoms arising from the urinary tract, have asymptomatic bacteriuria and do not benefit from treatment with antibiotics. Distinguishing asymptomatic bacteriuria from true urinary tract infection is important since the presence of asymptomatic bacteriuria does not increase morbidity and mortality, but frequently results in unnecessary antibiotic prescriptions, which contribute to increasing drug resistance and may cause adverse drug reactions and drug-drug interactions. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[7]:17-22)

Type 2 diabetes is rising in epidemic proportions due to increases in lifestyle risk factors and the aging of the population. Cognitive disorders, depression, and alcohol abuse are notable psychiatric conditions that clinicians treat in patients with diabetes. Cognitive deficits and dementia prevalence are higher in persons with diabetes. While prevalence of depression is high, it is recognized and treated in fewer than 25% of persons with diabetes. Heavy alcohol intake increases the risk of developing diabetes and worsens existing diabetes. Psycho-tropic medications are prescribed for many conditions in diabetes. Clinicians treat painful diabetic peripheral neuropathy with antidepressants and mood stabilizers, which may deliver low efficacy or have notable risks in this population. Antidepressants and atypical antipsychotics are prescribed for depression and dementia, respectively, and may have side effects that can worsen diabetes. Thus, in older persons with type 2 diabetes, treatm

Ischemic, venous, and neuropathic lower-extremity wounds in long-term care are challenging and unique medical problems with specific methods of care. Certain ulcers will not heal, and a frank discussion of amputation is often warranted. Some residents will elect to forgo invasive treatment or amputation, and are often treated in a palliative mode without the goal of wound healing. The functional status of the resident and staffing limitations at the facility should factor strongly into all wound treatment plans for residents. This review will discuss appropriate wound-specific care and adequate pain control for chronic ulcers in LTC residents. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[7]:26-31)