Natasha Bagdasarian, MD, Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Preeti N. Malani, MD, Department of Internal Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System; Geriatric Research Education and Clinical Center, Ann Arbor, MI, USA.

The treatment and prevention of Clostridium difficile infection (CDI) in the long-term care (LTC) setting presents unique challenges. In this review, we offer an overview of CDI treatment along with a brief discussion of infection control strategies in the LTC setting. The approach to recurrent CDI is also addressed.
Key words: Clostridium difficile, aging, metronidazole, vancomycin, long-term care.

Jill M. Watanabe, MD, MPH, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Christina M. Surawicz, MD, FACG, Department of Medicine and Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA.

The principal causes of diarrhea are infectious and inflammatory in origin, but the diagnosis and management of diarrhea in older patients may be complicated by age-related vulnerabilities and comorbidities. Several studies have indicated that the bacterial composition of feces may change with increasing age¹ and that immune response at the mucosal surface may also diminish.² Outbreaks of infectious diarrhea, including Escherichia coli 0157:H7 and viral origins, have occurred in the long-term care setting.^3,4 It is also known that a wide spectrum of medications can cause diarrhea through various mechanisms. Older patients are at greater risk of developing mesenteric or colonic ischemia due to underlying atherosclerotic disease and risk of embolic events from atrial fibrillation, valvular heart disease, or cardiomyopathies.^7,8 This article highlights the age-related considerations for the diagnosis and management of diarrhea in the older adult.

Key words: mesenteric ischemia, ischemic colitis, Escherichia coli 0157:H7, Clostridium difficile, microscopic colitis, radiation colitis