Review
Urinary Tract Infections in Long-Term Care
Urinary tract infections (UTIs) are the most common cause of bacteremia in long-term care (LTC) patients and may present with subtle nonspecific symptoms. UTIs should be suspected in older adults in LTC who manifest a sudden problem with incontinence, decreased physical or cognitive function, or loss of appetite. When a UTI is suspected, empiric antibiotics should be started based on the local infection pattern. Typically, trimethoprim/sulfamethoxazole is the major first-line empiric agent.
Implementing Long-Term Care Infection Control Guidelines Into Practice: A Case-Based Approach
Infections result in significant morbidity and mortality among residents of long-term care facilities (LTCFs). The prevalence of antimicrobial-resistant organisms is increasing along with the medical complexity of residents in this setting. However, given the heterogeneity of LTCFs and diversity of residents, the management and prevention of infections and antimicrobial resistance is often not straightforward. In addition, infection prevention methods must be balanced with other clinical goals and the optimization of residents’ functional status, comfort, and quality of life.
Institutional Strategy for the Prevention and Management of Influenza and Pneumococcal Disease in the LTC Setting
Influenza and pneumococcal disease are major causes of morbidity and mortality within the long-term care (LTC) continuum. Influenza kills an average of 36,000 Americans annually, with more than 90% of those deaths occurring in the elderly. While vaccination rates of LTC facility residents for influenza and pneumococcal disease have increased over the past decade, rates now appear to have reached a plateau.
Challenges in Antihypertensive Therapy in Older Persons
High blood pressure increases the risk of cardiovascular (CV) morbidity and mortality in a continuous fashion, even in very old adults. It is also associated with dementia and physical disability. Now it seems evident that treating stage 2 hypertension can reduce CV morbidity and mortality (especially stroke), and dementia to a modest degree in older adults.
Examining Oral Health in Nursing Home Residents and Overcoming Mouth Care–Resistive Behaviors
Nursing home residents are a group with significant health disparities in the area of oral health. Poor oral health can place nursing home residents at risk for developing pneumonia, exhibiting poor glycemic control if already diabetic, and increasing cardiovascular disease. The majority of nursing home residents arrive with some or all of their dentition but without the resources to continue preventive dental care—Medicare does not reimburse for routine dental care and Medicaid either does not reimburse for this service or reimburses so poorly, few providers will accept it.
Complications Associated with Percutaneous Endoscopic Gastrostomy Tubes
Percutaneous endoscopic gastrostomy (PEG) tube has now become a method of choice for long-term nutritional support, especially for the geriatric population. Technical advances during the past two decades have made this method a less expensive alternative to parenteral nutrition and more acceptable to patients. As literature demonstrating the benefits of enteral over parenteral nutrition mounts, we expect a continuous rise in the use of PEG tubes. Although considered safe, PEG tube placement can be associated with a diverse range of complications.
Implications for Exercise to Prevent or Reduce Falls in the Elderly Population
With the expanding population of older adults, falls, which are closely associated with considerable mortality, morbidity, and medical expense, have aroused much attention regarding concerns about reducing and preventing fall events in elderly individuals. This literature review discusses intrinsic and extrinsic contributing factors of fall events and presents some specific types of exercise programs beneficial for older adults. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[11]:30-34)
Screening for Prostate Cancer in Long-Term Care
Prostate cancer is a common disease and is the second leading cause of cancer-related death in men. However, many older men with prostate cancer will die from comorbid illness rather than cancer. Survival from prostate cancer with available treatment options, including surgery, radiation, androgen suppression, and watchful waiting, is mediated by age, tumor grade, and comorbid illness. Due to the long natural history of prostate cancer and the presence of competing comorbidities, the majority of elderly men with newly diagnosed prostate cancer will not benefit from curative therapy.
URINARY INCONTINENCE IN THE ELDERLY FEMALE
Urinary incontinence is a common condition in the rapidly aging U.S. population. The incidence and prevalence of incontinence is increasing in the elderly, in no small part due to the greater recognition of its signs and symptoms and the subsequent negative impact on quality of life. Elderly women are different from their younger counterparts, due not only to several physiologic changes in the urinary tract, but also to concomitant morbidity and polypharmacy.
MANAGEMENT OF OSTEOPOROSIS IN ELDERLY WOMEN
Osteoporosis is characterized by low bone mineral density (BMD) and poor bone quality, resulting in reduced bone strength and increased risk of fracture. Osteoporotic fractures are associated with increased morbidity and mortality, particularly in the elderly, as well as high healthcare costs. The risk of fragility fractures increases with aging, independently of BMD. Many therapeutic agents are available for the treatment of osteoporosis, yet there are limited data on their efficacy and safety in the elderly.
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