Academic journal article Bulletin of the World Health Organization

Prevalence of Infections and Their Risk Factors in Geriatric Institutions: A One-Day Multicenter Survey

Academic journal article Bulletin of the World Health Organization

Prevalence of Infections and Their Risk Factors in Geriatric Institutions: A One-Day Multicenter Survey

Article excerpt

This one-day prevalence survey of 1919 patients (74% females and 44% aged -85 years) in nine geriatric hospitals, six of them located in France and three in Switzerland, indicated a high prevalence of infections in elderly institutionalized patients (infection rate: 18.7% in males and 15.4% in females). The risk factors for infection were identified and the relative risks assessed.

Prevention of infections in geriatric wards should be one of the goals of every care-giver. A low rate of infection in elderly inpatients is thus likely to be associated with care of good quality.

Introduction

The world population of over-60-year-olds, which was 370 million in 1980 and 415.6 million in 1985, is expected to increase to 1100 million in the year 2025.' This fact, together with our changing values on life and the inevitable socioeconomic challenges in the future, will produce major difficulties in the health field (1, 2). Of the many problems related to human aging, two are investigated in the present collaborative study: institutionalization of the elderly and increased infections in this age group.

In western Europe (3) and the USA (4), 5-6% of the elderly live in nursing homes with geriatic facilities, in old-age homes, or in long-stay hospitals. Usually, this age group is the most disabled and economically less favoured, and care-givers aim to im rove the quality of life in this population (5), in spite of reduced functional capacities and multiple symptoms and signs of disease (6, 7).

The present study focuses on the increased susceptibility to infection among the elderly who are in institutions. Although infectious diseases are not usually recognized to be associated with old age (8), they are a major cause of death in this age group (9). Since infectious diseases are not easily diagnosed because of their atypical manifestations in the elderly (10), they are often neither efficiently prevented nor correctly treated 11).

Nine geriatric hospitals collaborated in the investigation of the prevalence of infectious diseases in their patients, identifying the risk factors of infection and establishing a prospective programme for more appropriate care. The results of this one-day prevalence survey carried out by the participating institutions on 17 December 1987 are presented and discussed below.

Methods

The survey was conducted on the same day in nine geriatric teaching hospitals located in France and Switzerland, the majority of them being associated with a University. Investigators in each of the participating centres filled in a simple questionnaire on their inpatients (both infected and not infected) concerning age, sex, presence or absence of infection and, for infected individuals, the site of infection. In addition, six of the nine hospitals recorded for all patients the presence of any factors that favoured infection. Diagnosis of infection conformed to the guidelines established by the U.S. Centers for Disease Control (12).

In each hospital the questionnaires were filled in by residents or doctors in charge of the patients and were revised by the responsible investigator and mailed to the coordinating centre for statistical analysis (University Geriatric Institutions, Geneva, Switzerland).

Prevalence of infection was determined as the ratio of the number of infected cases detected on the survey day to the total hospitalized population investigated on that day. Specific infection rates were also determined by sex, age group, and site of infection. Infection rates by site were calculated separately for patients affected and not affected by the corresponding risk factors. As hospitalized patients may not constitute a population sample representative of the association between potential risk factors and infection, the estimated odds ratios and their variances were used to approximate the values of relative risks and their 95% confidence intervals (13). …

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