Introduction
Long-term care facilities (LTCF) residents have been estimated to have the highest
incidence of diarrheal illness among adults living in the developed world. This study
describes undiagnosed diarrhea, intestinal inflammation, and Clostridium difficile colonization in a LTC population and explores whether these are associated with functional
decline, as defined by weight loss or a change in cognitive or ADL status.
Methods
An observational study of a convenience sampling of residents in a 180-bed LTCF was
obtained; evaluation of stool and medical records was done. Stool specimens were evaluated
for consistency, gross blood, inflammation (via quantitative fecal lactoferrin, IBD-SCAN),
and C difficile (via PCR for gdh). SPSS and STATA were used and significance was set at P < .05.
Results
There were 46 stools collected; 13 of the subjects were male, 28 were older than 65
years, and 35 were prescribed 5 to 15 medications. Twenty-six of the 46 stools collected
had elevated quantitative fecal lactoferrin levels. Although only 5 subjects were
reported to have diarrhea (4 with elevated lactoferrin), 28 stool specimens were observed
to be liquid or semi-solid (19 with elevated lactoferrin), and these liquid/ semisolid
stools were significantly correlated with lactoferrin positivity (P = .017). In analysis of functional status, there was no statistically significant
association between change in ADL (n = 17) or cognitive status (n = 5) and elevated
lactoferrin. However, all 3 subjects who had significant weight loss had elevated
lactoferrin, although the mean fecal lactoferrin was not statistically different from
those without weight loss. Of the 2 samples with C difficile, both were liquid and, when compared with all other liquid stools (n = 22), the mean
lactoferrin was statistically higher (134.1 versus 28.8 μg/mL, P = .008). These 2 subjects had neither weight loss nor change in cognitive status,
but 1 had a change in ADL status.
Discussion and conclusions
Diarrhea in LTCF residents is underdiagnosed. Diarrhea and the presence of C difficile in the stool are associated with intestinal inflammation, as detected by fecal lactoferrin.
With our small numbers, we were not able to identify a specific link; however, we
were able to identify a correlation between weight loss and intestinal inflammation,
but, with just 2 samples, not C difficile colonization. This relationship highlights the importance of larger studies to further
examine the rate of diarrhea in LTCF; the effect of diarrhea and intestinal inflammation
on weight loss; and the interaction of C difficile colonization with weight loss, malnutrition, and functional decline.
Keywords
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Article info
Publication history
Published online: March 15, 2010
Footnotes
These data were presented as an abstract at the American Medical Directors Association Convention in Charlotte, NC, in March, 2009 and published as follows: Archbald-Pannone L, Sevilleja J, Evans J, Guerrant R. Asymptomatic C. difficile colonization and weight loss among LTCF residents. J Am Med Dir Assoc 2009;10(3):B5–B5.
Richard Guerrant, MD, licensed fecal lactoferrin testing to Techlab, Inc., Blacksburg, VA. He is cofounder of A1Glutamine, LLC and on the Probiotics Scientific Advisory Board for Danone-Yakult. All other authors have stated there are no disclosures to be made that are pertinent to this article.
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Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
