Appropriateness of laboratory testing in nursing home elderly with advanced dementia: an opinion poll among physicians.
OBJECTIVE
Dilemmas regarding selection of appropriate laboratory tests in older frail nursing home patients with advanced dementia are commonly encountered by physicians. Our objective was to study physician opinions about evaluating the appropriateness of laboratory testing in older hospitalized patients in nursing homes based on a real case.


METHODS
A 750-bed university teaching hospital in the Bronx that regularly receives acutely ill older residents from long-term care facilities, with medical care provided by residents, fellows, and teaching faculty.


METHODS
An opinion poll was conducted among 53 physicians. Information was provided on the history, physical examination, and laboratory findings of a 92-year-old woman with advanced Alzheimer's dementia admitted for gastrointestinal bleeding to the acute care Geriatrics unit. A questionnaire sought opinions on selection of laboratory tests (emphasizing Troponin I) and management in this patient. Chi-square analysis was performed to analyze the data


RESULTS
The majority of polled physicians (37/53, P = 0.01) felt that ordering Troponin I in the setting described hindered patient care and stated they would not have ordered the test. The opinion on overall management was divided (P = 0.861).


CONCLUSIONS
Dilemmas regarding choosing appropriate laboratory tests, including their implications for care, are found frequently in the setting of frail, demented elderly from nursing homes hospitalized for acute care. We suggest that the choice of tests in these subjects with advanced dementia be individualized based on due consideration for life expectancy, quality of life, and surrogate opinion.
Dharmarajan
T S
TS
New York Medical College, USA.
Narayanan
S L
SL
Ali
R
R
Ahmed
S
S