However, the clinical diagnosis of an infection in a frail, elderly LTCF resident may be quite difficult, given the atypical clinical manifestations of infection in the very old, limited availability of a clinician onsite in the LTCF to examine the resident, and lack of quick access to diagnostic laboratory and radiological tests. Infection (or presence of a fever) is often the reason an LTCF resident is sent to an emergency department or transferred to an acute care facility. One of the most common risks (and complications) of long-term care is infection. The population at risk resides in a closed institutional setting the ratio of healthcare staff to residents may be suboptimal and quick and easy access to diagnostic, therapeutic, and preventive interventions is limited. As more and more care is provided in LTCFs, inherent risks and problems arise when the population is very old, frail, and disabled. Thus, nursing homes serve as the prototype long-term care facility (LTCF) that manages chronically disabled elderly individuals. Although there are different types and venues for longterm care, nursing homes (nursing facilities) remain the dominant sites for providing care for chronically and functionally disabled and cognitively impaired older persons. When such age-related factors in an older person create a need for care, services, and support that cannot be met by family and other caregivers, the need arises for long-term care outside the home environment. Such a demand is inevitable, given the changes, diseases, disabilities, and socioeconomic factors associated with growing old. With the increasing growth of the aging population-especially those aged 85 years and older-over the next 40 years, there will be a parallel demand for longterm care. To our wives, Catherine Yoshikawa and Lynn Ouslander, for their love and support. Current printing (last digit): 10 9 8 7 6 5 4 3 2 1 PRINTED IN THE UNITED STATES OF AMERICA Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. For more information, write to Special Sales/Professional Marketing at the headquarters address above. 270 Madison Avenue, New York, NY 10016 tel: 21 fax: 21 Eastern Hemisphere Distribution Marcel Dekker AG Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-6 fax: 41-6 World Wide Web The publisher offers discounts on this book when ordered in bulk quantities. ISBN: 0-8247-0784-2 This book is printed on acid-free paper. Drew Medical Center Los Angeles, CaliforniaĮmory University School of Medicine Atlanta, GeorgiaĬopyright © 2002 by Marcel Dekker, Inc. Drew University of Medicine and Science and Martin Luther King, Jr.–Charles R. INFEC TION MANAGEMENT F O R G E R I AT R I C S I N L O N G -T E R M C A R E FA C I L I T I E SĬharles R.

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