Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

Long-term Care

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Researchers examine factors affecting diagnosis of acute illness and mental health conditions among nursing home residents

Nursing home residents are at high risk for developing acute illnesses such as pneumonia, dehydration, and gastroenteritis. Many of them also suffer from chronic illnesses such as depression, Alzheimer's disease, cancer, and emphysema. In many cases, early diagnosis of these conditions can prevent patient hospitalization and death. Two recent studies supported by the Agency for Healthcare Research and Quality focused on diagnosis of physical and medical conditions in nursing home residents. The studies are summarized here.

Boockvar, K.S., and Lachs, M.S. (2003). "Predictive value of nonspecific symptoms for acute illness in nursing home residents." (AHRQ grant T32 HS00066). Journal of the American Geriatrics Society 51, pp. 1111-1115.

In this study, the investigators identified 11 nonspecific symptoms documented by nursing home staff in the medical records of 202 newly admitted residents of one large urban home. They then used nurse reports and medical records in 10-day intervals to determine which of these symptoms predicted acute illness. Overall, nonspecific symptoms and acute illnesses occurred in 21.7 percent and 12.5 percent of 10-day intervals, respectively. Lethargy, weakness, and decreased appetite each correctly predicted the presence of an acute illness one out of two times the symptoms were reported.

Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Dizziness, delusions, depressed mood, and aggression had no statistical association with acute illness. Nursing home staff should pay particular attention to individuals with symptoms found to be predictive of acute illness, suggest the researchers.

Dobalian, A., Tsao, J.C., and Radcliff, T.A. (2003, Fall). "Diagnosed mental and physical health conditions in the United States nursing home population: Differences between urban and rural facilities." (AHRQ grant T32 HS00046). Journal of Rural Health 19(4), pp. 477-483.

These researchers found that residents in rural nursing homes were 25 percent less likely to be diagnosed with depression compared with those in homes in large metropolitan areas. It was not clear whether this difference was due to the greater stigma of depression felt among rural residents, treatment variations once care was sought, or other causes. The study also found that residents in homes in small metropolitan areas were 39 percent less likely to have cancer than those in large metropolitan areas. Diagnosis of six other conditions—anxiety, Alzheimer's and non-Alzheimer's dementia, emphysema/chronic obstructive pulmonary disease, heart disease, and stroke/transient ischemic attack, were similar among rural and urban nursing home residents.

These findings suggest that for many health conditions, environmental factors such as rurality are less relevant for the nursing home population than for the community-dwelling population. Perhaps this is because nursing home residents frequently suffer from a greater number of chronic conditions, explain the researchers. They analyzed data derived from the 1996 Nursing Home Component of AHRQ's Medical Expenditure Panel Survey, a probability sample of 815 nursing homes and 5,899 residents, to determine whether differences in likelihood of diagnosis among these eight conditions existed between urban and rural nursing home residents.

Editor's Note: Another AHRQ-supported study (HS07585) on a related topic suggests that nursing home case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. For details, see Carter, M.W. (2003, August). "Variations in hospitalization rates among nursing home residents: The role of discretionary hospitalizations." Health Services Research 38(4), pp. 1177-1206.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care