Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 50, Issue 5 M252-M256, Copyright © 1995 by The Gerontological Society of America
Acute gastroenteritis in three community-based nursing homes
RV Sims, RJ Hauser, AO Adewale, G Maislin, S Skeie, RJ Lavizzo-Mourey and H Rubin
Geriatrics Division, Philadelphia VA Medical Center, Pennsylvania, USA.
BACKGROUND: Acute gastroenteritis is a cause of considerable morbidity and
mortality in the elderly population. A prospective assessment of acute
diarrhea in three community-based long-stay homes is described. METHODS: A
cohort study of acute gastroenteritis was performed in three
community-based nursing homes, involving 572 residents over an 8-month
period. Diarrhea cases were enrolled on the basis of the acute onset of
loose stools of > or = 24 hours, as well as one of the following: a
rectal temperature of > or = 100 degrees F, dehydration, positive occult
blood, > or = 48 hours duration, or as a part of any outbreak. Stool
cultures for Clostridium difficile were performed on all NH 1 patients.
RESULTS: Fifty-three gastroenteritis cases were ascertained, consistent
with incidence rates of 14.6, 36.4, and 6.7 cases/100 patient years in NH
1, NH 2, and NH 3, respectively. Requiring a Foley catheter (OR = 2.57; 95%
CI, 0.93, 7.09) increased diarrhea risk. Six Clostridium difficile
enteritis cases and an episode attributable to Aeromonas/Pleisomonas
species were diagnosed. One C. difficile diarrhea case was imported from
hospital to NH 1. Ten of 12 fecal excretors resided in close geographic
clusters in NH 1, where a majority of the latter were mobile and
incontinent of stool. CONCLUSIONS: Acute gastroenteritis was a common
disease in the study nursing homes, for which specific risk factors were
identified. A predominant role for Clostridium difficile in the taxonomy of
nursing home diarrhea was suggested.
