Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long‐Term Care Facilities: 2008 Update by the Infectious Diseases Society of America

High, Kevin P.; Bradley, Suzanne F.; Gravenstein, Stefan; Mehr, David R.; Quagliarello, Vincent; Richards, Chesley L.; Yoshikawa, Thomas T.

doi:10.1111/j.1532-5415.2009.02175.x

Cited by 147 publications

(124 citation statements)

References 155 publications

(347 reference statements)

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“…24,25 Although this UTI definition is different from the strict definition, it reflects clinical care in LTCFs and adds knowledge to practice guidelines to assist physicians in making decisions.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities

Caljouw¹,

Hout²,

Putter³

et al. 2013

European Geriatric Medicine

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OBJECTIVES:To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. DESIGN: Double-blind randomized placebo-controlled multicenter trial. SETTING: Long-term care facilities (LTCFs). PARTICIPANTS: LTCF residents (N = 928; 703 women, median age 84). MEASUREMENTS: Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. RESULTS: In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57-0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68-1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). CONCLUSION: In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. J Am Geriatr Soc 62:103-110, 2014.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities

Caljouw¹,

Hout²,

Putter³

et al. 2013

European Geriatric Medicine

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“…However, as compared to older children and adults, infants and young children experience higher and more prolonged fevers, more rapid temperature increases, and greater temperature fluctuations [15]. In the geriatric group (>65 years), who are likely to have lower body temperatures, IDSA defines fever as single oral temperature >100 • F (>37.8 • C); or (2) repeated oral temperatures >99 • F (>37.2 • C) or rectal temperatures >99.5 • F (>37.5 • C); or (3) an increase in temperature of >2 • F (>1.1 • C) over the baseline temperature [16].…”

Section: Defining Normal and Febrile Body Temperaturesmentioning

confidence: 99%

Fever, fever patterns and diseases called ‘fever’ – A review

Ogoina

2011

Journal of Infection and Public Health

240

163

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Summary Fever is a prominent feature of disease since antiquity. The febrile response is orchestrated by the central nervous system through endocrine, neurological, immunological and behavioural mechanisms. Other than a regulated rise in body temperature, fever is often accompanied by various sickness behaviours, changes in metabolic and physiological characteristics of body systems and alterations in immune responses. Fever and the febrile response, therefore, remain significant contributors to the pathogenesis, clinical presentation and outcome of many illnesses and diseases.This review highlights the pathophysiology of the febrile response and describes the fever types and patterns, including their clinical significance. The various medical illnesses called ''fever'' are also listed and the origins of their appellations discussed.

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“…It is well known that nonspecific symptoms and lack of specific ones are common in NHR [9][10][11], contributing to a delayed diagnosis and treatment [10]. These atypical signs are observed as absence of fever, weakness, falling, weight loss, physical dysfunction and cognitive decline [3,7,[12][13][14]. In addition, early signs of infection are very similar to, and also as diffuse as, signs of acute illness [12,15,16].…”

Section: Discussionmentioning

confidence: 83%

“…Signs and symptoms of infection in the frail elderly is often atypical with a lack of specific ones [3], causing a delay in diagnosis and treatment [2]. The most frequent serious infection is pneumonia [3], with mortality rates similar to cerebral vascular insult and heart failure [4]. Risk factors are male gender, physical impairment, Chronic Obstructive Pulmonary Disease (COPD )and advanced dementia [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

Sund‐Levander

Grodzinsky

2015

Clin Med Rev Case Rep

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rectally. One morning nursing assistants (NA) observed that Mr. Nilsson was behaving differently, e.g. he did not feel well, expressed as "expression in the eyes", less appetite, lethargy and general signs of illness. They also observed respiratory symptoms. The NA continued to report about his changed condition for the next few days to the registered nurse (RN), who noted that he might have a cold but took no further action as he did not have a fever. His ear temperature was 37.6°C in the morning and 36.8°C in the afternoon the first day, and 37.2°C in the morning and 37.3°C in the evening the second day. Day six Mr. Nilsson's temperature is 38.1°C and hence the RN informs the general practitioner (GP), who takes no further action. There is no more RN documentation about his condition until day 16, when the RN order paracetamol due to increased body temperature (38.9°C). The next morning the nurse contacts the GP who prescribes antibiotics due to suspected pneumonia. The condition worsens and Mr. Nilsson dies on day 24. See flowchart over the 24 days in figure 1. DiscussionThis case illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. It is well known that nonspecific symptoms and lack of specific ones are common in NHR [9-11], contributing to a delayed diagnosis and treatment [10]. These atypical signs are observed as absence of fever, weakness, falling, weight loss, physical dysfunction and cognitive decline [3,7,[12][13][14]. In addition, early signs of infection are very similar to, and also as diffuse as, signs of acute illness [12,15,16]. Changes, such as lethargy, weakness, decreased appetite, agitation, disorientation, dizziness, falls and delusions are reported to have high predictive values for acute illness in frail elderly [16]. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. An individual that normally is confused, anxious and restless may become apathetic and infirm, or vice versa, when infection is suspected. On the other hand, an individual who normally is unrestrained could become more confused, aggressive, anxious and restless. As specific symptoms are often lacking [9][10][11] the presence of fever, in terms of > 38°C, is often evaluated as a significant symptom of illness and an important reason for taking further action. However, fever in frail NHR has been reported to be lower than traditionally stated [17][18][19]. In addition, the effects on body temperature from medication with paracetamol daily have to be considered. AbstractSigns and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms ...

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Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long‐Term Care Facilities: 2008 Update by the Infectious Diseases Society of America

Abstract: Residents of long-term care facilities (LTCFs EXECUTIVE SUMMARYBy the year 2030, 20% of the United States population is estimated to be aged у65 years, and almost 30 million

Cited by 147 publications

References 155 publications

Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities

Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities

Fever, fever patterns and diseases called ‘fever’ – A review

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

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