Module 16

Module Leader:

James E. Shaw

Geriatric Objectives:

1. Know the percentage of deaths in the elderly that is attributable to microbial infection?
   
   
2. Know how each issue below relates to predisposition of the elderly to microbial infection:
   
   
   1. waning immunity (Table 114-1)

   2. nutrition (protein-energy under nutrition; vitamin deficiency and supplementation)

   3. co-morbidities (Table 114-2)

   4. social factors (institutionalization, domiciliary setting, MRSA, VRE, persistent antibiotic pressure)
      
      
3. Know why body temperature ("fever") and cognitive impairment make microbial disease in the elderly difficult to diagnose.
   
   

4. Know why antibiotic dose reductions are frequently required in the elderly.  Know the primary routes of clearance of the following antibiotics: Beta-Lactams, Macrolides, Tetracyclines, Fluoroquinolones, Trimethoprim-sulfamethoxazole, Vancomycin, and Rifamycins (Table 114-3).

5. Infective endocarditis (IE) is no longer a disease of the young and middle aged, but an important syndrome in the elderly:
   
   
   1. Contrast native-valve endocarditis in the young with native-valve and prosthetic-valve endocarditis (PVE) in         the elderly, considering the kinds of organisms "seeding" these diseases and their source before colonization.
   2. Know why endocarditis is difficult to diagnose in the elderly with regard to fever and leukocytosis.
   3. Contrast the percentages of young and elderly that present with these morbidity indicators. 
      
      
6. Contrast the symptoms of bacteremia (chills, sweating, lymphopenia, and fever) in the young and elderly.  Know the origins (general body locations) of the organisms causing bacteremia in the elderly.  Contrast the mortality rates (in percentages) of nosocomial gram-negative bacteremia in the young and elderly.
   
   
7. Know the definition of "fever of unknown origin" (FUO).  In what percent of the cases is the origin of the fever known? (Table 114-5).
   
   
8. What percent of new AIDS cases occur in patients over the age of 50?  Should more attention be focused on education programs to prevent AIDS in the elderly?  Explain your answer.
   
   
9. Know why varicella zoster virus (VZV) disease is important in the elderly population.  Know where VZV "hides" in man during latency and what is meant by "post herpetic neuralgia".  Why is primary infection with VZV in adults more severe than VZV primary infection in children (consider interstitial pneumonia in your answer).  Know how VZV disease in immunosuppressed adults can be prevented (use Learning Resources reference 2 when addressing the issues in objective 9).
   
   
10. Know 3 infectious etiologies that are commonly associated with Facial Nerve Palsy in older adults.
    
    
11. Know the common vaccines that are recommended for the elderly in general, and those that are recommended specifically during periods of travel.

Chapter 114: "Infection in the Elderly", pgs. 1443-1454 in  Principles of Geriatric Medicine and Gerontology (Fourth Edition), (1999) by Hazzard, Blass, Ettinger, Halter, and Ouslander. (1999).

Chapter 51: "Human Herpesviruses", pgs. 427-430 in Medical Microbiology, 3rd Ed. Murray, Rosenthal, Kobayashi, and Pfaller. (1998).

This text is also available in your ISP library.

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