Recommendations aim to enhance health and quality of life for frail and vulnerable patients in nursing home care

More than 1.5 million adults live in nursing homes in the United States, and approximately 30 percent of people will die with a nursing home as their last place of residence. As this population continues to increase, so will the need for physicians to assist those patients with proper care and guidance in making end-of-life decisions.

The role of physicians in collaborating with a team of caregivers and family members in nursing home care is the focus of an article by MU researchers that appears in the Journal of the American Medical Association. Recommendations in the article provide a guide for physicians to follow when considering a patient’s admission to a nursing home, assessing health and care while in the nursing home, and advising end-of-life care.

“Part of the physician’s role is determining the risk factors for going into a nursing home,” said Steven Zweig, MD, chair of the family and community medicine department at MU and lead author of the article. “Looking at the developmental tasks and stages that patients and family members go through in assessing long-term care and providing recommendations for care was our focus.”

Zweig and his colleagues describe a three-step communication process to assist physicians in better dialogue with patients and family members as they determine goals for care. Each step contains examples of questions to ask patients and suggested discussion topics, ranging from talking about the patient’s values, social support system and medical decisions to guidelines for adopting a living will.

“The stages of aging will inevitably result in increasing disability,” Zweig said. “It helps in those early stages to get to know your patients and learn what their values and goals are with regard to their care if they’re not able to make decisions for themselves later.”

Other recommendations the article provides include a list of responsibilities for the attending physician in the nursing home, a checklist for periodic nursing home visits, and a checklist for management of the acutely ill nursing home resident.

With declining numbers of medical students entering primary care and geriatric medicine, experts worry that there will be an insufficient number of qualified physicians to care for the growing population of aging patients. Zweig stresses the importance of helping physicians become more adept at providing care for elderly patients by including experiences in caring for elderly patients in a variety of settings.

“We’re doing a lot of things within our curriculum at the University of Missouri to make the care of elderly patients something that medical students and resident physicians would find meaningful,” Zweig said. “Some of these messages are highly relevant to all physicians. The characteristics of integration, care coordination and continuity of care over time are critically important elements that have to be represented in the health care system.”

Zweig is also the Paul Revare, MD, Family Professor of Family Medicine and director of the MU Interdisciplinary Center on Aging, which unites scientists from across the university in improving care for elderly patients. Earlier this year, MU was awarded a grant to enhance geriatric medicine education from the Donald W. Reynolds Foundation. The grant establishes programs to help medical students and resident physicians become productive members of interprofessional teams. They learn the importance of the patient-centered medical home, which involves close collaboration among multiple care providers and is especially important to elderly patients with multiple chronic illnesses.

MU’s Curtis W. and Ann H. Long Department of Family and Community Medicine has ranked among the top 10 family medicine departments in the country for the past 17 years.

Other MU faculty members who contributed to the JAMA article include Lori Popejoy, PhD, with the Sinclair School of Nursing, and Debra Parker-Oliver, PhD, and Susan Meadows, both with the family and community medicine department.