Lona Mody, M.D., M.Sc.

Dr. Mody is an Assistant Professor, University of Michigan Medical School, and Associate Director, Clinical Programs, at the Ann Arbor VA Geriatric Research Education and Clinical Center, Ann Arbor, Michigan.

Within the past 12 months, Dr. Mody reports no commercial conflicts of interest.

Release Date: 07/21/2009
Termination Date: 07/21/2012

Estimated time to complete: 1 hour(s).

Albert Einstein College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Albert Einstein College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Upon completion of this Cyberounds^®, the participant should be able to:

• Describe risk factors and epidemiology of common infections in long-term care facility residents
• List diagnostic criteria for infections in patients with a paucity of symptoms
• Implement strategies to prevent common infections in long-term care facility residents.

Healthcare delivery in the United States has evolved dramatically over the last two decades. Previously, healthcare occurred primarily in acute care facilities. Today, it is delivered in multiple settings including hospitals, sub-acute care, long-term care facilities (LCTFs) or nursing homes, rehabilitation, assisted living, home and outpatient settings.

Efforts to restrain healthcare costs have led to a reduced number of hospitalizations and shorter lengths of stay (with an associated increase in severity of illness and intensive care unit admissions), along with increased outpatient, home care and nursing home stays for older adults.(1) As a consequence, nursing homes and rehabilitation units are seeing sicker patients, who require more intense medical supervision and are more susceptible to infections and antimicrobial resistance (Table 1).

Infections in LTCFs increase the mortality and morbidity of residents and lead to transfers to acute care hospitals. In fact, each year, a staggering 1.5-2.0 million infections occur in long-term care facilities, resulting in frequent hospital transfers and an estimated 1-2 billion dollars in hospital expenditures.(2)

Older adults over the age of 65 account for a disproportionate share of patients with infection-related hospitalizations in the U.S.(3) The hazards of the hospitalization of LTCF residents are numerous and include functional decline, delirium, pressure ulcers and adverse drug events (Figure 1). This Cyberounds^® review highlights the epidemiology, diagnosis and prevention of common infections in the long-term care setting.

Q	A 72-year-old woman residing in a long-term care facility, who has advanced dementia, moderate functional loss and congestive heart failure, now presents with increasing cough, fever up to 100.6°F and increasing confusion. She states that she is seeing strange people entering and leaving her room. Her daughter confirms that this deterioration in mental status is new. On physical exam, her blood pressure is 101/40 mm Hg, pulse 125/min, respirations 26/min and pulse ox 84%. You decide to transfer her to the hospital for evaluation of fever and management. What are the potential side effects of hospitalization in this population?
	a. Delirium b. Dementia c. Adverse drug events d. All of the above e. A and C.
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