Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship.


Introduction:Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Methods:Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre- and postcourse knowledge assessment. Results:The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06). Discussion:By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.





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Publication Info

Michener, Alyson, Barbara Heath, Christopher J Crnich, Rebekah Moehring, Kenneth Schmader, Lona Mody, Westyn Branch-Elliman, Robin LP Jump, et al. (2018). Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship. MedEdPORTAL : the journal of teaching and learning resources, 14. p. 10754. 10.15766/mep_2374-8265.10754 Retrieved from

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Rebekah Moehring

Associate Professor of Medicine

Kenneth Edwin Schmader

Professor of Medicine

Dr. Schmader’s areas of research include herpes zoster, infections, and vaccines in older adults.  He conducts translational, clinical trials and observational studies of zoster, influenza, and other infections funded by grants from the National Institute on Aging (NIA), National Institute of Allergy and Infectious Diseases (NIAID), Centers for Disease Control (CDC), VA Office of Research and Development, and Industry sources.  He has played a pivotal role in the development of zoster vaccines in older adults.  Dr. Schmader also performs research in medications and older adults, focusing on pharmacoepidemiology, optimal drug use and reduction of adverse drug reactions.

He is the Director of the NIA-funded P30 Duke Pepper Older Americans Independence Center and Co-PI of the NIAID funded Vaccine and Therapeutics Effectiveness Unit (VTEU) at Duke.  He serves on the Working Groups for the Herpes Zoster, Influenza, and General Adult Immunization Guidelines for the US Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) and is the American Geriatrics Society liaison to the ACIP.

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