A well coordinated plan that includes a mechanism for surveillance, rapid antigen detection testing and viral culture, infection control techniques and chemoprophylaxis is effective for aborting outbreaks of influenza A in the nursing home. Amantadine has been better studied in this situation, and experience with rimantadine is limited. The safety and efficacy of our dose guidelines for nursing home residents need to be studied and directly compared with rimantadine dose guidelines. Except for chemoprophylaxis, these guidelines can be applied to outbreaks of influenza B as well.

Fifty-five documented infections reported from an admission unit of a large skilled nursing facility (SNF) during a five-month period were analyzed. Of these, 45 (82 percent) were urinary-tract infections (UTIs), chiefly asymptomatic bacteriuria. Sixty-three percent of the UTIs were acquired in the SNF, and the remainder were acquired during the preceding stay in a general hospital. Statistically, Proteus species infections were more common among the SNF-acquired UTIs, whereas Pseudomonas aeruginosa infections were the most common among the hospital-acquired UTIs. The following recommendations are made: 1) for previously hospitalized elderly patients in whom urinary-tract sepsis develops soon after admission to an SNF, treatment should start with an antibiotic active against Pseudomonas aeruginosa while the results of cultures are pending; 2) symptomatic lower urinary-tract infections caused by SNF-acquired Proteus species should be treated with nalidixic acid or trimethoprimsulfamethoxazole; 3) the term "nosocomial infection" should be broadened to include infections acquired in long-term care institutions; and 4) infection surveillance should be started in selected long-term care institutions for the elderly as part of an expanded National Nosocomial Infections Survey.

Leukoencephalopathy and autonomic dysfunction have been described in individuals with very low serum B(12) levels (<200 pg/ml), in addition to psychiatric changes, neuropathy, dementia and subacute combined degeneration. Elevated homocysteine and methylmalonic acid levels are considered more sensitive and specific for evaluating truly functional B(12) deficiency. A previously healthy 62-year-old woman developed depression and cognitive deficits with autonomic dysfunction that progressed over the course of 5 years. The patient had progressive, severe leukoencephalopathy on multiple MRI scans over 5 years. Serum B(12) levels ranged from 267 to 447 pg/ml. Homocysteine and methylmalonic acid levels were normal. Testing for antibody to intrinsic factor was positive, consistent with pernicious anaemia. After treatment with intramuscular B(12) injections (1000 μg daily for 1 week, weekly for 6 weeks, then monthly), she made a remarkable clinical recovery but remained amnesic for major events of the last 5 years. Repeat MRI showed partial resolution of white matter changes. Serum B(12), homocysteine and methylmalonic acid levels are unreliable predictors of B(12)-responsive neurologic disorders, and should be thoroughly investigated and presumptively treated in patients with unexplained leukoencephalopathy because even long-standing deficits may be reversible.

Increasing numbers of older patients with acute, subacute, rehabilitative, and chronic problems are being cared for in acute care hospitals. Health care professionals working in the acute care hospital have not had the training necessary to deal with this particular population. This article discusses the conception and implementation of a multidisciplinary educational and consultation team on an acute care medical unit in an academic medical center.

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Many older adults lack knowledge concerning the consequences of a sedentary lifestyle, atypical disease symptoms, the adverse effects of multiple medication use, and the hazards of frequent hospitalizations. Medically trained healthcare providers and community health practitioners can provide older adults with this information through health education classes. However, these healthcare professionals must continually update their knowledge as the science of gerontology and geriatrics is always expanding. The advanced certificate in gerontology administration program at LIU-Brooklyn hosted a 3-h train-the-trainer seminar, which was attended by 62 healthcare professionals to raise awareness concerning the realities of aging and to describe a range of behaviors that support health. For approximately 90 min, the keynote speaker presented issues and solutions that addressed the before-mentioned areas of knowledge deficit, followed by a question and answer period. Participants were asked to use an anonymous survey evaluation form featuring both quantitative and qualitative questions to rate the seminar. Close-ended questions were developed on a five-point scale ranging from 5 = strongly agree to 1 = strongly disagree. These items were analyzed to compute frequency and percent. The participants rated the seminar favorably with 98% stating that they learned the benefits of exercise for older adults; 97% learned how to avoid the hazards of hospitalization. Evaluations of the seminar suggest that it is feasible to develop educational programs targeting healthcare professionals and community health practitioners.