Medical care for nursing home residents: differences by dementia status. Epidemiology of Dementia in Nursing Homes Research Group.
OBJECTIVE
To understand the use of medical services by nursing home residents.


METHODS
Descriptive, longitudinal study comparing medical service use of residents by dementia status and describing the use of medical services following detection of fever or infection.


METHODS
Fifty-nine randomly selected nursing homes in Maryland from 1992 to 1995.


METHODS
2,153 residents admitted to one of 59 randomly selected nursing homes.


METHODS
A panel of psychiatrists and neurologists ascertained dementia based on review of medical records, interview data with significant others and nursing staff, and results of a cognitive exam. Medical service use was abstracted from medical records.


BACKGROUND
Understanding the use of medical services by nursing home residents as distinct from services provided by the nursing home is important, particularly as new medical care models are tested. This study compares the medical service use of residents by dementia status and describes the use of medical services following detection of fever or infection.


RESULTS
Residents with dementia compared with those without dementia had lower annual rates of physician visits (10.2 vs 12.7, P < .001) and hospitalizations (0.9 vs 1.2, P < .001), virtually the same rate of emergency department visits, and similar lengths of stay in the hospital. Subsequent to infection, a lower proportion of residents with dementia had either a physician visit, an emergency department visit, or a hospital admission compared with residents without dementia (27.2% vs 32.2%, P < .001). In 87% of infections, an antibiotic was used, implying meaningful contact with a physician. Residents with dementia compared with those without dementia had fewer physician visits subsequent to fevers (20.6% vs 29.9%, P < .001) and infections (21.8% vs 27.5%, P < .001).


CONCLUSIONS
The association of less medical service use by individuals with dementia compared with those without dementia may reflect differences in health status or implicit end-of-life decision-making and a proclivity toward less-aggressive treatment for these individuals.
Burton
L C
LC
Health Services Research and Development Center, School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
German
P S
PS
Gruber-Baldini
A L
AL
Hebel
J R
JR
Zimmerman
S
S
Magaziner
J
J
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000628:therapy*; D019538:Health Care Surveys; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012720:Severity of Illness Index