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2022 FEB 12 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in drug resistance. According to news reporting from [...]

TB has made a 'comeback,' and residents and staff need added protection Tuberculosis - the name conjures up images of frail individuals coughing into blood-speckled handkerchiefs in remote sanatoriums. Along [...]

Persistent scabies outbreaks in extended care facilities result from multiple factors: atypical presentations in the elderly, leading to delayed or inaccurate diagnosis; incomplete or ineffective treatment of the patient and exposed population; and failure to coordinate notification, education, treatment, and disinfection. A case report of scabies in an elderly resident of an extended care facility illustrates various types of scabies manifestations, the advisability of obtaining diagnostic scrape preparations, and the efficacy and safety of permethrin. Guidelines for an aggressive and comprehensive effort for eradication are offered. Key words. Scabies, nursing homes; aged; mite infestations. J Fam Pract 1993; 37:82-86), Scabies is a disease that has plagued man throughout recorded history. It is caused by the parasitic mite Sarcoptes scabiei var hominis burrowing and laying eggs in the stratum corneum [...]

PURPOSE: To describe the epidemiology and characteristics of gross hematuria in elderly residents of nursing homes and to identify the associations of gross hematuria with urinary infection and the potential contribution of urinary infection to morbidity. PATIENTS AND METHODS- This was a prospective, descriptive study of episodes of gross hematuria identified by the nursing staffs at two long-term-care facilities over 2 years. Episodes were characterized with respect to patient variables, presence of bacteriuria, duration of hematuria, therapeutic interventions, and genitourinary investigations. Clinical and serologic criteria were used to identify invasive infection. RESULTS: The incidence of gross hematuria was 31/100,000 resident days. Bacteriuria was present in 58 (74%) of 78 episodes with evaluable cultures. Fifty-two (61%) episodes lasted more than 24 hours, 25 (29%) were temporally associated with fever, and antimicrobials were given for 53 (61%) episodes. Gross hematuria occurred more frequently in men than in women and was more frequently associated with fever in men. Twenty-four (28%) episodes occurred in subjects with indwelling catheters, 30 (34%) in subjects with known genitourinary abnormalities, 26 (30%) in subjects with no genitourinary investigations, and 4 (4.6%) in subjects with genitourinary investigations but no abnormalities identified. No adverse clinical outcomes were identified in patients in whom antimicrobial therapy was not initiated. The maximal estimated incidence of invasive urinary infection associated with hematuria was 5.8/100,000 resident days, and of bacterial hemorrhagic cystitis, 6.3/100,000 resident days. CONCLUSIONS: These data suggest that underlying genitourinary abnormalities are present in most elderly institutionalized subjects with gross hematuria when genitourinary investigations are performed. Although bacteriuria is usually present, urinary infection, by itself, is an infrequent cause of gross hematuria. Afebrile hematuria without irritative symptoms probably does not require antimicrobial therapy. A standard approach to this clinical problem in the institutionalized elderly should be developed to optimize patient management and appropriate use of antimicrobial therapy.

PURPOSES: To describe an outbreak of pneumococcal disease in a Washington state nursing home and to report a survey or pneumococcal vaccine utilization in Washington nursing homes. PATIENTS AND METHODS: Outbreak Data were collected from nursing home residents' records. Nasopharyngeal cultures were obtained from residents and staff. Survey. Fifty-four randomly selected Washington nursing homes were surveyed about pneumecoccal vaccine utilization and policies. RESULT: Outbreak, Three confirmed and 4 possible cases of pneumococcal disease occurred over 9 days among 94 residents; 5 patients (71%) died. Cases were identified among 6 of 42 residents on 1 wing, compared with 1 of 52 on the other 2 wings (relative risk 7.4, 95% confidence interval 1.0, 398d5). Streptococcus pneumoniae seretype 9V was cultured from the blood of 3 confirmed case-patients and the nasopharynx of 2 of 73 resident& Only 7 % of residents had received pneumococcal vaccine, including one case-patient who had received 14-valent vaccine without serotype 9V. Survey. Only 22% of residents were reported to have received pneumococcal vaccine; vaccination status was unknown for 66 %. Physician discretion determined pneumococcal vaccination in 49 (91% ) nursing homes; 9 (17%) had a written policy. Two major barriers to pneumococcal vaecination were cited: low priority among physicians (43%) and difficulty in determining residents' vaccine history (37%). CONCLUSIONS: A pneumecoccal disease outbreak among undervaccinated nursing home residents probably resulted from person-to-persen transmission. Pneumecoccal vaccine appears to be underutilized in Washington state nursing homes.

Bordetella pertussis is a gram-negative bacteria that causes lung infections and whooping cough in children and adults. It can produce symptoms of varying severity ranging from a mild lung infection to a prolonged cough with shortness of breath and vomiting. During the summer and fall of 1985, a large outbreak of pertussis occurred in two rural communities in central Wisconsin. The outbreak spread to a local nursing home, which had 107 residents and 116 employees. Blood samples from 105 of the residents and 104 of the employees were tested for antibodies to pertussis. Thirty-eight of the residents and eight of the employees tested positive for pertussis. In addition, four of the residents had positive bacterial cultures for pertussis. These four residents had persistent coughing that lasted from 43 to 54 days. The nursing home residents between the ages of 70 and 79 appeared to have the greatest risk for illness. None of the affected residents had shortness of breath or vomiting and all recovered without complications. Following testing, residents and employees received prophylactic (preventive) treated with erythromycin for 7 to 14 days. At the present time it is not known how pertussis was introduced into the nursing home. The authors advise that people who suffer from prolonged coughing, particularly those living in a community were pertussis is known to be present, may have a pertussis infection. Early diagnosis is important because oral erythromycin can reduce the severity of the illness and can prevent infection in people who come in contact with the bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Scabies is a highly communicable skin disease, carried by a mite, that is hard to treat, particularly in groups of people living in close quarters. Treatment programs in three nursing homes are described; the drug permethrin was used against scabies infestations of long duration. All nursing home residents, staff, and their contacts (families, friends, and visitors), a total of 995 people, underwent treatment with permethrin 5 percent cream applied over the body from ears to soles of the feet. The cream was also applied under the nails with a toothbrush. It was removed several hours later with soap and water. Of the 995 people treated, 202 were diagnosed as having scabies (111 of those with scabies were nursing home patients). Improvement of those treated was evaluated after two weeks; if they had not improved, they underwent a second permethrin treatment. Final evaluation occurred on day 28. Of 195 persons who completed the experimental protocol, 98 percent were cured (just under half were cured after only one treatment). The four patients who were not cured after four weeks had extensive scabies, with more than 1,000 lesions on their bodies. After several months' follow-up, the infestation had not recurred at two of the homes, and the few cases at the other home were successfully treated with permethrin. Twenty-eight subjects reported side effects, the most common of which was itching. The difficulty of diagnosing scabies in nursing home populations is discussed. Its main symptom is itching at night, a complaint that is often dismissed by staff as a normal accompaniment of aging or senile dementia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Osteopenia, a condition of subnormal bone density, is a risk factor for bone fractures. The bone density of older men is known to decrease progressively with age, which helps to explain the gradual increase in fractures after age 50 years. Fractures appear to be especially common among nursing home residents; a comparison of fracture rates found that men in nursing homes had five to 11 times the rate of hip, spine and wrist fractures of men the same age living independently. The bone densities of 65 nursing home residents and 25 men living in the community were compared with a population of age-matched normal men. Subjects ranged in age from 57 to 85 years. The community residents had bone densities that were 97 to 105 percent the average density among the normal men, whereas nursing home patients had bone densities that were only 71 to 92 percent of the normal group. Half the men from the nursing home but none of the community subjects had bone densities less than 70 percent of age-matched normal men. Bone densities of the nursing home subjects who weighed more were higher; factors that were not linked to bone density in this study were height, age, medical diagnosis, medications, and functional level. However, other studies have identified 20 risk factors for osteopenia including old age, lack of physical activity, being underweight, and various medications and health problems. The nature of this study made it difficult to link history of fractures to osteopenia in these subjects, and a clear link was not found. But the subjects in this nursing home had a high degree of osteopenia, and taken together with the tendency for falls and accidents in nursing homes, this population appeared to be at high risk for fractures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Two of the most common, and even ominous, condition s in elderly residents must be treated carefully. Up to one-half of nursing home patients experience constipation during their stay -- [...]

Pressure sores, also called decubitus ulcers and bedsores, are due to ischemic damage and necrosis of the skin (and, if progressive, muscle tissue) covering bony prominences when intensive pressure is [...]

It is time for a national strategy The Public Health Laboratory Service recently published the first audit of infection control practice in nursing homes in the United Kingdom.[1] It proposes [...]

High-risk infections in the elderly Presentations of pneumonia and urinary tract infections are atypical in the institutionalized elderly, treatment considerations differ, and underlying diseases usually confuse the picture. Elderly residents [...]

Prevalence of Diseases Among The Elderly in Nursing Homes South Florida is an area known for its aging population. Many of the elderly people reside in nursing homes because of [...]

Managing nursing home residents is becoming ever more clinically demanding. Due to the triple impact of OBRA, the rapid growth of the over-85 population and hospitals' 'quicker and sicker' discharges, [...]

Norwalk-like viruses were identified as the main cause of gastroenteritis in Maryland nursing homes after outbreaks affected 156 patients during one season. Specifically, a genogroup II "Bristol-like" virus designated MD-145 [...]