The Nursing Home, the Hospital, and the Elderly

Three pieces of evidence, examined together, suggest that it is our elderly who are most at risk for being harmed by the rising plague of infections resistant to treatment, i.e., antibiotic therapy—especially if they’re in a nursing home or a hospital.

Beginning with the nursing home, we recently reported that:

“Current data suggests that here are nearly 3 million infections in nursing homes every year, resulting in 150,000 hospital admissions and 300,000 deaths.  As the US nursing home population is expected to increase from 3 to 5 million by 2030, we can expect to see a larger burden of these types of infection.”

Those are the words of James A. McKinnell, MD, an Infectious Disease specialist from Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute. Using a more comprehensive method (the “Zorro swab“)to determine the prevalence of superbugs in nursing homes, his group found significantly more drug-resistant pathogens than previous studies have. For example, almost half of all nursing home residents are colonized with at least one superbug; nursing homes themselves are awash with superbugs as almost 90% of the rooms are contaminated with at least one of them; and methicillin-resistant staph aureus (MRSA) is the most prevalent bad bug, as it was found in almost two-thirds of the rooms.

Thus, says Dr. Mckinnell, “When a facility tells me their rates are 6%, I usually add 30% to account for all the missed and untested multidrug-resistant organisms.”

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Second, when you think of nursing homes you also have to think of hospitals, because the elderly are constantly transferred between the two. And therefore, “a silent transmission [of pathogens] goes on” from the nursing home to the hospital.

But what about the hospital itself? Can you pick up bugs there and transmit them back to the nursing home?

A landmark study found that 1 in 12 adult patients in Canadian hospitals are either colonized or infected with a bug that’s resistant to drug therapy. Again, the major culprit was MRSA.

But there’s an inside story to the study that for some reason never gets mentioned: the average age of the people colonized or infected was 72 (See Table 3).

These people, of course, are the very ones most likely to require nursing home care after their release from hospital.

Finally, we are seeing “a tremendous shift” in elderly patients with infectious disease who require ICU care: In 1996 it was the 11th-ranked diagnosis for elderly in the ICU; today it’s the top-ranked diagnosis, replacing cardiovascular disease. That surprised the researchers because the elderly have such a high prevalence of coronary artery disease and congestive heart failure.

One conclusion Dr. Mckinnell drew from his study is that “Nursing homes are the perfect storm of [elderly] patients carrying pathogens and at the same time at [an increased] risk of getting sick if they are exposed to them.”

However, if we were to consider the other two studies alongside Dr. Mckinnell’s, we might rephrase his conclusion to this: “Nursing homes and hospitals together, are the perfect storm of [elderly] patients carrying pathogens and at the same time at [an increased] risk of getting sick if they are exposed to them.”

 

 

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