Issues Surrounding Antibiotic Use in Older Adults

By the year 2030, an estimated 20 % of the United States population will be aged 65 years and older, and almost 30 million of these individuals are anticipated to have functional limitations necessitating long-term care. Older adults’ increased susceptibility to nosocomial infections, combined with their often atypical presentation, results in a tendency to inappropriately prescribe antibiotics in long-term care facilities (LTCFs). Furthermore, reduced laboratory capacity in LTCFs can cause significant delays in receiving culture results and prolonged duration of empiric antimicrobial therapy. This review explores these factors and other issues contributing to the misuse and overuse of antibiotics as they relate to diagnosis, transmission, and management of infections in older adults. Inappropriate antimicrobial use has considerable consequences, including the development of multidrug resistant organisms, increasing incidence and mortality related to Clostridium difficile infection, and increasing adverse drug reactions, and therefore prompt and coordinated action is required to address this growing public health threat.