Medical care in the nursing home

Article Abstract:

Although the problems in the care and treatment of individuals who reside in nursing homes in the US are not limited to medical problems alone, the characteristics of this population make geriatric medicine an important element in overall treatment. Many cases documented in recent years have pointed out instances of incorrect diagnoses, unnecessary treatments, the neglect of existing conditions, and the overuse of psychotropic drugs, often without the involvement of an appropriate medical professional. Older individuals comprise the largest growing population in this country and the problems of nursing home residents must be addressed before they become unmanageable. For the long-term, improvements and advances in the science of geriatrics, as it becomes more incorporated into general medicine, will ultimately improve conditions in nursing homes. Technological advances coming from research and the use of computers will further enhance medical care for the elderly and infirmed. In the meantime, strategies should include: the formation of a standardized approach to health maintenance and screening, more effective measures aimed at preventive medicine, and greater emphasis upon ethics in nursing homes. Better documentation of drugs that are prescribed and closer monitoring of the dispensing of medications should be put into effect. Relative to this, the conditions of the elderly residing in nursing homes can be improved through more involvement by mental health professionals in the evaluation of nursing home patients, especially prior to prescribing and administering psychotropic drugs. Greater emphasis upon a coordinated effort by a variety of professionals is needed for these measures to be effective.

Case studies, Evaluation, Geriatric nursing, Nursing home care

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Effect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients

Article Abstract:

Dementia of the Alzheimer type (DAT) refers to a degenerative disease of the brain in which patients lose intellectual function over time and typically require admission to a nursing home as the disease progresses. During their institutional care, many DAT patients experience recurrent infections with fevers. These individuals, who often cannot communicate, may have no signs of infection other than fever. A study was performed to examine the incidence of fever and the effectiveness of various treatments in institutionalized DAT patients; treatment effectiveness was evaluated based on survival rate. Over the study period of 34 months, 75 of the 104 patients developed fevers. The total number of febrile episodes was 172. Fevers were more common among the patients with more advanced DAT. Two treatment groups were formed, those who underwent a diagnostic workup and antibiotic treatment for all fevers, and those who received only treatment to alleviate pain (palliative care). The patients with more advanced DAT did not benefit from the more aggressive treatment, as shown by the equivalent survival rates in the antibiotic and palliative care groups. Among patients with less severe DAT, there was a better survival rate in the group given antibiotics. The authors conclude that patients with advanced Alzheimer's disease do not have a better chance of surviving infections when their fevers are treated with antibiotics compared with receiving palliative treatment only. These findings are relevant to the debates concerning quality of life and "right-to-die", as well as to the cost of medical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Infection, Complications and side effects, Drug therapy, Alzheimer's disease, Fever

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Comorbidity of chronic conditions and disability among older persons - United States, 1984

Article Abstract:

Comorbidity, the coexistence of chronic conditions, is commonly found in older populations. A thorough evaluation had not been performed concerning the impact of comorbidity on increasing age. Using data from the Supplement on Aging to the 1984 National Health Interview Survey, an examination of prevalence and patterns of comorbidity in older populations was conducted. Respondents, who were 55 years old or older, answered questionnaires regarding chronic conditions and physical limitations. Other health-related and social issues were also explored. The nine most frequent chronic conditions were identified in individuals over 60-years old. In degree of prevalence they were as follows: arthritis, high blood pressure, cataracts, heart disease, varicose veins, diabetes, cancer, osteoporosis/hip fracture, and stroke. An increase of multiple disorders was associated with advancing age. Most individuals who were 80 years or older had two or more of these nine conditions; 70 percent of the women and 53 percent of the men. Comorbidity was directly associated with the prevalence of any of the nine individual conditions. The number of people who required assistance with normal daily activities also increased with the prevalence of comorbidity. An editorial note from the Centers for Disease Control observed a number of limitations of the data from this survey. Despite these limitations, the incidence of comorbidity in older individuals is substantial and efforts aimed at prevention should be the focus of public health strategies.

Chronic diseases, Surveys

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