Approach to Fever and Infection in the Nursing Home

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Abstract
OBJECTIVE: To summarize current information on the scope, epidemiology, clinical manifestations, diagnostic approach, and general management of infectious diseases in nursing home residents, as well as the specific treatment of common infections occurring in the nursing home setting.DESIGN: Survey and literature review of the diagnostic and therapeutic problems of nursing home residents with infections.CONCLUSIONS: Older persons residing in nursing homes as well as other types of long‐term care facilities are at increased risk for infections. Moreover, infection is the most frequent reason for patients to be transferred from nursing homes to an acute‐care facility. The most common infections that are acquired in nursing homes are urinary tract infection (cystitis pyelonephritis), respiratory infections (pneumonia, bronchitis), and skin/soft tissue infections (infected pressure ulcers, cellulitis). Most serious infections in this setting are caused by bacteria; however, influenza and other respiratory viruses as well as herpes zoster may cause significant morbidity in older nursing home residents. Mycobacterium tuberculosis infects nursing home residents at a higher rate than it infects older community dwellers. Infections in older nursing home residents may manifest clinically, with atypical symptoms and signs, including the absence of fever. Rapid diagnostic evaluation and early therapeutic intervention are essential for minimizing the high mortality and morbidity associated with infections in this older population; most nursing home residents with serious infections should be considered for hospitalization. J Am Geriatr Soc 44:74–82, 1996.

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