Antimicrobial use is often a part of EOL care and ASP should be prepared to be involved in antimicrobial decision-making in this population. ASP can play a critical role at EOL by supporting clinicians in assessing the potential benefits and harms of antimicrobials for patients at the EOL and also providing a "big picture" view that takes into account the larger societal costs of unnecessary antimicrobial use. Given that patients and families may be more influential in medical decision-making in this population, antimicrobial stewards should also be prepared to guide clinicians in how best to discuss antimicrobial decision-making with patients and families and to adjust recommendations based on clinical contexts that can change quickly. Despite the unfamiliar milieu, the principal goal of antimicrobial stewardship remains the same-right drug, right time, right dose, and right duration.49 With care taken to use a holistic approach of the factors leading to antimicrobial use, ASP can help to achieve these goals and improve the quality of life for patients at the EOL.
CDI disproportionately affects the older adults, particularly those requiring frequent hospital stays or LTCF admission. Recurrences of CDI are common in older adults and may have significant adverse effects on quality of life. Although intrinsic factors associated with aging contribute to the risk for CDI in this population, modifiable factors such as antibiotic therapy also play a major role. Ensuring appropriate diagnostic testing and management is challenging for older adults in the community and in LTCFs. FMT is a promising approach for older patients with multiple recurrences.
Stepping On is an evidence-based, 7-week, small group falls prevention program for older adults at risk for falls, which has been disseminated widely across the United States. This article describes the program's format and conceptual underpinnings, the research demonstrating its effectiveness, and the steps taken to ensure adaptability and fidelity with its delivery by trained facilitators affiliated with organizations providing services to community-dwelling older adults.
