Risk Factors For Infection In Longterm Care Residents

Infections occur commonly in residents of nursing facilities (nursing homes) as a consequence of different factors. The majority of persons residing in nursing facilities are 65 yr of age or older. Comorbid illnesses, such as obstructive uropathy, that increase with age can predispose the patient to UTI. Chronic obstructive pulmonary disease and congestive heart failure contribute to development of respiratory tract infections. Vascular insufficiency and neuropathy, frequent complications of diabetes mellitus, are associated with increased risk of skin infection.

Alterations in a patient's functional status, such as impaired feeding, bathing, toileting, and mobility, can also lead to infection. Use of enteral devices to assist in feeding can promote aspiration and lead to pneumonia, whereas urethral catheters to prevent incontinence can contribute to the development of UTI. Decreased mobility and incontinence are significant risk factors for the development of pressure ulcers and potential secondary infection. The increased need for nursing assistance in the performance of activities of daily living can facilitate transmission of pathogens between nursing facility residents.

Medications used to treat comorbid illnesses can inadvertently impair important host defenses. Medications that are sedating can impair the cough reflex and increase the risk for pneumonia or reduce mobility and increase the risk for skin infection. Medications may also reduce oropharyngeal secretions and facilitate colonization of the

From: Infectious Disease in the Aging Edited by: Thomas T. Yoshikawa and Dean C. Norman © Humana Press Inc., Totowa, NJ

oropharynx with pathogens. Drugs can also contribute to decreased urinary outflow, stasis, and the development of bacteriuria (1,2,4).

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