Hypervirulent mutations of Clostridium difficile have resulted in epidemic outbreaks with devastating consequences in the United States, Canada, and Europe in recent years. Older persons are particularly susceptible to C. difficile-associated disease (CDAD). This highly contagious organism can spread rapidly through long-term care (LTC) facilities due to a number of factors, including the ability to survive on environmental surfaces for several hours in the vegetative state, and for months after forming spores. The organism’s ability to survive alcohol-based handrubs and cleaning solutions commonly used in healthcare settings makes it extremely difficult to eradicate. Long-term care facilities are vulnerable to the importation of epidemic strains from places where outbreaks are in progress, as residents are typically admitted from several referral sources. Clonal infections due to cross-contamination from symptomatic residents and asymptomatic carriers can occur very quic

There has been a significant change in nearly every aspect of C. difficile-associated diarrhea (CDAD), with the emergence of a new, more pathogenic strain termed BI/NAP1, or ribotype 027. There has been an increase in the number of cases and severity of disease, an increase in the number of recurrences, and a decreased response to therapy. Although traditionally considered a hospital infection, CDAD is increasingly reported in long-term care facilities and in healthy persons living in the community. This has forced investigators to seek other potential treatments and to develop a multifaceted approach to managing CDAD, including education of hospital personnel regarding spread and prevention of CDAD, surveillance programs for detection of CDAD, institution of preventive techniques to combat CDAD, and a reduction in the use of high-risk antibiotics. (Annals of Long-Term Care: Clinical Care and Aging 2008;16[7]:25-31)

The obesity epidemic is spreading through all age groups in the United States, including the elderly. Studies have shown that obesity is associated with cognitive and functional decline, increased service utilization and cost, and nursing home (NH) admission. Unfortunately, little attention has been paid to the impact that the obesity epidemic among older Americans will have on the delivery of quality long-term care (LTC) services. This article reviews the literature on the association between obesity and disability, as well as obesity and NH admissions, and discusses the known and potential impacts of obesity on the delivery of LTC services. These potential impacts include increased demand for NH care, longer stays due to earlier entry, staffing issues, and increased cost of providing services. Increased monitoring and research are needed in this area in order to adequately prepare the LTC system for potential challenges associated with providing care for obese older Americans. (A