The infections discussed thus far—pneumococcal disease, influenza, and nosocomial infections—deserve priority among prevention efforts for the elderly because they are risk factors with known prevalence and with severe impacts; moreover, they have well-understood prevention methods with high assurance factors. Other high-risk infections also deserve some mention, however.12,19 For example, tuberculosis remains a problem for elderly individuals. Detecting cases in the older population is difficult; in addition, isoniazid prophylaxis has greater risks for the elderly than for younger persons. Safer preventive therapy and better early case detection is particularly needed for older individuals. Fever of unknown origin is not unusual for the elderly and often results in lengthy and costly evaluations. More expedient and less expensive methods of diagnosing the causes of such fevers are needed. Infectious diarrhea, endocarditis, meningitis, urosepsis, and pressure sores are other examples of infections in the elderly for which better methods of prevention are needed. Any elderly person with valvular heart conditions known to predispose an individual to endocarditis should receive antibiotic prophylaxis for any procedure known to cause bacteremia. All elderly individuals with a known risk factor for the acquired immune deficiency syndrome (AIDS) (e.g., homosexuality, intravenous drug abuse, prior blood transfusions, or hemophilia) should be screened and counseled about human immunodeficiency virus infection.
All elderly persons, particularly those aged 65 and older, should receive 23-valent pneumococcal polysaccharide vaccines.
Revaccination of elderly persons should be considered for those who have received only 14-valent pneumococcal vaccine.
All persons aged 65 and over should receive influenza vaccination annually. Consideration should be given to using amantadine as prophylaxis for those individuals with an allergy to eggs.
Pneumococcal and influenza vaccines should be given to all nursing home residents. Vaccination should be considered for all elderly persons discharged from hospitals during the fall and winter.
Good infection control practices should be implemented in all institutions but especially in long-term care facilities to combat nosocomial infections. Accrediting agencies should demand proper infection control practices for nursing home licensure.