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Long-term Care

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New checklist enables nursing assistants to effectively monitor the health of nursing home residents

Nursing home residents often suffer from acute illnesses and their complications, which can reduce their quality of life and sometimes lead to death. They would fare better if these illnesses were detected and treated early. Early detection is difficult, however, because nursing home residents may not be able to report physical complaints due to cognitive and communication impairments. Also, many preexisting physical, mental, and behavioral findings, which are unique to each resident, can impede recognition of a change in their condition.

A new illness warning checklist allows nursing assistants, who work closely with residents each day, to assess changes in the residents' functional and behavioral status that may signal the onset of acute illness. The checklist demonstrated fair sensitivity and high specificity for acute illness among nursing home residents in a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00066). Close monitoring of patients who have changes in behavioral or functional status that signal potential acute illness might avert problems and deaths from acute illness by allowing earlier treatment, notes Kenneth Boockvar, M.D., M.S., of Mount Sinai School of Medicine.

Dr. Boockvar and his colleagues developed the validated, standardized checklist for communication with medical staff. They determined which functional and behavioral status items to include in the 12-item instrument by use of focus group interviews with nursing home staff.

Twenty-three nursing assistants completed the checklist during observation of 74 nursing home residents over 4 weeks. Acute illness was identified by nurse report and chart review. Residents with an instrument-recorded change were more likely to develop an acute illness within 7 days than those with no change. A final 5-item instrument had a sensitivity of 53 percent and a specificity of 93 percent for acute illness. Nursing assistants' documentation of signs of illness preceded chart documentation by an average of 5 days.

See "Nursing assistants detect behavior changes in nursing home residents that precede acute illness: Development and validation of an illness warning instrument," by Dr. Boockvar, H. Daniel Brodie, M.D., and Mark Lachs, M.D., M.P.H., in the September 2000 Journal of the American Geriatric Society 48, pp. 1086-1091.

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