Diarrhea Among Residents of Long-Term Care Facilities

Both sporadic cases of diarrhea and outbreaks of infectious gastroenteritis occur commonly in long-term care facilities. There are no national statistics on the prevalence or incidence of diarrhea among residents of nursing homes, but recent studies from the Centers for Disease Control and Prevention have described the increased morbidity and mortality associated with gastrointestinal illnesses among the elderly. Although deaths related to diarrheal illnesses have long been considered a problem of infants and young children in the developed world, 51% of the 28,538 diarrhea-related deaths in the United States from 1979 through 1987 occurred in adults older than 74 years, and 27% occurred in adults between 55 and 74 years old. In contrast, only 11% of these deaths occurred in children <5 years old (ie, the vast majority of deaths occurred in older Americans rather than in children). For both the very young and the very old, there were winter peaks in the mortality rates consistent with the presumption that infectious illnesses led to death, and one of the major risk factors for dying from diarrhea was being a resident of a nursing home. In a subsequent study in which 87,181 hospitalizations were analyzed, 85% of 514 diarrhea-related deaths occurred in adults over 65 years old. The odds ratio of dying during a hospitalization involving gastroenteritis was 52.6 (CI95, 37.0 to 76.9) for adults ≥70 years old as compared with children <5 years old.