Mohammed Al Houqani, MBBS, Department of Medicine, University of Toronto, Toronto, ON.
Theodore K. Marras, MD, FRCPC, Attending Staff, Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital; Assistant Professor of Medicine, University of Toronto, Toronto, ON.

Long-term care-acquired pneumonia is a clinical syndrome of pneumonia that develops in a resident of a long-term care facility who has not been recently hospitalized. It is one of the leading causes of mortality and morbidity among the residents of long-term care facilities. Streptococcus pneumonia, Haemophils influenza, and Moraxella catarrhalis are the most frequently identified bacterial causative. Poor oral hygiene increases the risk of long-term care-acquired pneumonia. In this review, we discuss the risk factors, pathogenesis, etiology, management, and the preventive measures for long-term care-acquired pneumonia.
Key words: Long-term care, nursing home, health care facilities, pneumonia, fluoroquinolones.

William A. Banks, GRECC, Veterans Affairs Medical Center and Saint Louis University School of Medicine, Division of Geriatrics, Department of Internal Medicine, St. Louis, MO.
Marian R. Banks, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO.

The term "nursing home" is often a misnomer. The typical nursing home is more institution than home and run more like a hospital than a household. Indeed, the American Heritage dictionary defines "nursing home" as "a hospital for convalescent or aged people" (emphasis ours). Yet many of us will spend a good portion of the last part of our lives in these institutions. How can these last years be made as enjoyable and meaningful as possible? We recently published a study examining the effects of animal-assisted therapy (AAT) on loneliness among nursing home residents. The statistical aspect of that study has been published elsewhere and it showed, among other things, that AAT can reduce loneliness.¹ However, during the course of that study we learned several lessons that couldn't be reduced to statistics. Here, we review some of the things we learned about making long-term care facilities more comfortable and enjoyable for residents.

There are many movements afoot to improve life in long-term care facilities. Pet therapy, music therapy, activities and holiday events are all assumed to be progressive programs. Since these programs are considered to be good, they are assumed to be good for all.

Wilbert S. Aronow, MD, CMD
Department of Medicine,
Divisions of Cardiology and Geriatrics,
Westchester Medical Center/New York Medical College,
Valhalla, NY.

Cardiovascular disease (CVD) is the most common cause of death of older persons in a nursing home (NH). In a prospective study, we investigated the major clinical cause of death of all persons aged 60 years and older residing in a large NH with full-time staff physicians over a 15-year period.¹

CVD was the cause of death in 63% of the 2,372 persons who died. Another 25 persons (1%) died of bacterial endocarditis. Of the 2,372 persons who died, 25% died of sudden cardiac death, 18% died of a documented fatal myocardial infarction, 11% died of refractory congestive heart failure, 6% died of thromboembolic stroke, 1% died of cerebral hemorrhage, 2% died of pulmonary embolism, 1% died of mesenteric vascular infarction diagnosed at surgery, and <1% died of peripheral vascular disease including dissecting aneurysm of the aorta and ruptured abdominal aneurysm.¹

In a prospective study, we investigated the prevalence and incidence of CVD in 1,160 men, mean age 80 years, and in 2,464 women, mean age 81 years, residing in a NH.² Of the 3,624 persons, 60% were white, 26% African-American, 14% Hispanic, and <1% Asian. Follow-up was 46 months (range 1 to 196 months).