The burden of infection is felt most acutely in nursing homes, where sickness and illness have been on the rise over the past few decades. As life expectancy has increased, more and more individuals are entering nursing homes and assisted living facilities with co-occurring medical conditions, making the prospect of a virulent infection even more dire.
Each year, about 2 million infections are diagnosed in US nursing homes. At the same time, the use of antibiotics has risen to treat these infections, leading to the development and proliferation of antibiotic-resistant bacteria, which are extremely difficult to treat. These infections are life-threatening and require expert medical attention. Unfortunately, many nursing homes are unable or unwilling to provide adequate care.
Some nursing home patients live at an increased risk of developing an infection, a fact that nursing homes should understand and manage appropriately. Infections are more common among patients with indwelling devices (like a feeding tube), along with those who were recently admitted to a hospital, have impairments in function and multiple other illnesses.
Infections often follow patients as they move from the hospital to a nursing home, or from one nursing home to another. These residents serve as vectors (carriers) of the disease, potentially introducing new disease-carrying organisms (including antibiotic-resistant) bacteria to their new homes. This is not to demonize those who carry disease into a new setting, but the fact remains that many infections are transmitted in this way.
The most common infections among nursing home residents are various and complex, including:
Pneumonia, however, is likely the greatest killer of nursing home residents. In fact, pneumonia and associated lower respiratory tract infections have been estimated to be the leading cause of death among nursing home residents. Pneumonia is also a leading reason why nursing home residents are transferred to hospitals.
The risk is highest among residents who use feeding tubes. Nursing home residents comprise between 10% and 18% of all people who are hospitalized for pneumonia, and that burden comes with a high cost. The cost of treating pneumonia in a hospital is around $10,000 per admission. Aspiration pneumonia is common in patients with feeding tubes.
Diagnosing pneumonia in the nursing home setting can be difficult, because the illness often presents atypical symptoms in elderly individuals. Compared to younger patients, the elderly are less likely to suffer from chills, chest pain and muscle pain when they have pneumonia.
Poor hygiene, namely poor oral hygiene, has been suggested as a possible cause of pneumonia in the nursing home environment. Researchers believe that bacteria in dental plaque may communicate to the lungs, ultimately causing pneumonia.
The seasonal flu can become fatal in a nursing home setting. Influenza outbreaks are common in nursing homes, among both residents and staff members. It is critical that all nursing home staff members receive their flu shots on a regular basis. Both residents and staff members should be immunized against influenza.
Urinary tract infections may well be the most common form of infection in nursing homes, striking most frequently in patients with indwelling catheters. The presence of a catheter also increases the risk for bacterial sepsis, a blood infection.
Elderly adults do not produce a sufficient amount of gastric acid to fight off bacterial and viral forms of gastroenteritis, which means that infections cause the vast majority of diarrhea cases in the nursing home setting. In most cases, these illnesses are self-limiting and require no treatment, though in severe cases, gastroenteritis can lead to severe illness and even death because it increases the risk of dehydration.
This problem appears to be greatest in nursing homes. Several studies have shown that patients in nursing homes are up to four times more likely to die from a gastroenteritis infection than elderly adults living in the community.
Dehydration is a common problem in nursing homes, especially when caregivers are negligent in their duties. Norovirus is a common cause of dehydration. Nursing homes account for around 35% of the norovirus outbreaks in the United States.
Elderly nursing home residents are already at risk of developing skin and soft tissue infections because the skin changes as it changes. The dermis and epidermis begin to atrophy, even as the body's natural wound healing abilities deteriorate. The skin thins over time, meaning that external insults will be more likely to cause cuts or abrasions. Elderly skin provides an easy medium for bacteria and viruses to colonize, including:
Even more common are chronic wound infections, including infected bed sores, vascular ulcers and diabetic wound infections. Bed sores, or pressure ulcers, are a particular cause for concern, developing in elderly patients who are bedridden. Nursing home residents who cannot move themselves should be repositioned every 2 hours at a minimum.
Needless to say, proper hygiene is essential in the nursing home setting. After all, nursing homes are medical facilities first and foremost. Even minor infections can lead to disastrous results. A simple skin infection can ultimately result in sepsis, a deadly blood infection, or burrow underneath the surface to damage nerves, bones and soft tissues.
Infections in a nursing home should be treated with the utmost care. They should be prevented where ever possible through appropriate infection control procedures. When they strike, infections should be diagnosed quickly and treated appropriately. It's not too much to ask, especially when an elderly loved one's life is on the line.
Tragically, thousands of nursing home residents die every year due to preventable infections. These infections are often the result of a nursing home's negligence, the careless failure to recognize and treat an infection correctly. When negligence causes injury or death, family members may be eligible to file a nursing home lawsuit to pursue justice.
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