WRITER: AMY LILLARD
CONTACT: DAVE PEDERSEN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
Release: Oct. 14, 1999
Infections in nursing home patients are due to physical
IOWA CITY, Iowa -- Elderly patients in nursing homes
get often-deadly infections at a growing rate each year, due to their own
bodies' changes with age and characteristics of the nursing home environment.
Since the number of elderly patients requiring nursing
home care is increasing as America grows older, health care practitioners
need to know the risk factors for these infections and the best methods of
managing them, according to a University of Iowa Health Care researcher.
In his recently published paper, Michael Ernst, Pharm.D.,
assistant professor (clinical) in the College of Pharmacy, reviewed the most
common infections that afflict elderly patients in nursing homes and summarized
their characteristics and varieties of treatment. The goal was to encourage
health care providers to be vigilant and thorough.
"We put together this article to review the guidelines
for treatment of infections as more and more antibiotics emerge and more and
more elderly need care," Ernst said. "Health care providers need to be reminded
why their patients develop these infections and select the appropriate antibiotic
to use. This should provide a quick reference."
Research into elderly patients and nursing homes is
lacking, Ernst said. However, some information regarding the elderly in nursing
homes is known. Ernst notes that more than 1.5 million infections occur annually
in American nursing homes, with around 10-20 infections per 100 residents
per month. This means about 1-2 infections for each resident each year, and
these figures are most likely underreported.
The most common infections that afflict the patients
are bacterial pneumonia, urinary tract infections and skin and soft tissue
infections. The increased rates of infection are caused in part by bodily
changes as patients grow older, including less elastic skin, less respiratory
and gastrointestinal ability, and the presence of comorbid illnesses. This
means having a chronic illness, like diabetes or asthma, which makes the patient
more susceptible to infection and immune system illnesses.
In addition to bodily conditions that may cause infections,
the nursing home environment has an effect, as well.
In a closed environment with other patients that may
be ill or have infections, the likelihood of becoming ill increases. Also,
many instruments used that stay in the body for a long time, such as catheters
and feeding tubes, make it easy for infecting agents to enter the body. The
large number of prescribed drugs patients receive each day, at an average
of 5-10 drugs per resident per day, may increase side effects and other illnesses.
Finally, the tendency for many elderly patients to have other chronic conditions
including diabetes, asthma, dementia or other cognitive problems, may make
it difficult for patients to know when they are sick or to tell the health
care providers if they are.
The role nursing homes play in infections is hard
to separate from the part aging plays, Ernst said.
"It's hard to separate the issues. The significance
of infections depends on the patients, but location does play a role, especially
the fact that transmission is facilitated in the closed environments. Influenza
outbreaks can occur that are deadly," he said.
After describing the common infections and their causes,
the researchers reviewed the options for treatment through drugs. In many
cases, however, infections and other illnesses have developed resistance to
these drugs. When treatment is ineffective or illnesses are not immediately
detected, the patients may be hospitalized, which is extremely costly and
often carries the same risks associated with nursing homes.
Because of this, health care providers need to be
vigilant in observing their elderly patients. Ernst recommends this article
as review for nursing homes professionals, in particular, in order to provide
the best care possible.
"A bit of review always helps, to remember the important
characteristics and the subtleties of these infections. Individual nursing
homes may want to look at their own facilities and see which infections are
common. Also, they may want to think about their antibiotic use and how infections
are identified, managed and treated.
"The key is to watch carefully for infection and institute
the appropriate therapy. This may delay or prevent hospitalization, saving
cost and maybe the patient's well-being," he said.
Ernst's review attempts to fill a void that exists
in studies on the elderly. One difficulty in conducting studies with institutionalized
patients is the need for each participant's consent, which can be a barrier
for the many patients who have developed cognitive problems. The increasing
number of elderly patients and patients in nursing homes calls for increased
efforts to learn more about them and determine the best treatments available,
Ernst's practice and research interests are in family
medicine and geriatrics. Erika Ernst, Pharm.D., who is co-author of the paper
with her husband, conducts research in infectious diseases.
The paper was published in the September issue of
the journal Pharmacotherapy.
University of Iowa Health Care describes the partnership
between the UI College of Medicine and the UI Hospitals and Clinics and the
patient care, medical education and research programs and services they provide.